2. Faculty Disclosure
⢠âI do not have any relevant financial
relationships with any commercial interests.â
3. Objectives
⢠Describe the historical roots and modern
definition of a âHunger Strike.â
⢠Identify reasons inmates may refuse to eat
and the appropriate assessment, diagnosis
and treatment for each.
⢠Outline a step-by-step approach applicable to
all types of fasting inmates that incorporates
medical monitoring, housing, mental health
and legal considerations.
4. âHunger Strikeâ
⢠The term âHunger Strikeâ is often used
inappropriately for any inmate who refuses to
eat
5. Bobby Sands
⢠Member of the Irish Republican Army
⢠Wanted to be considered a Prisoner of War
rather than a common criminal
⢠Announced fast on March 1, 1981
⢠Died 66 days later
⢠Generated international publicity for his cause
6. Criteria for a true Hunger Strike
⢠The person intends to commit suicide
⢠The suicide is done for a political or religious
reason
⢠A goal is to generate maximum publicity
7. Suicide by Starvation?
⢠Buddhist monk setting himself on fire to
protest totalitarian rule in Myanmar.
⢠Al Qaida âsuicide bombersâ
⢠Easier to push a button detonating a bomb
than to not eat for 66 days.
8. Most Inmates Who are Fasting are not
âHunger Strikers.â
⢠Religious fasts
⢠Extreme dieting
⢠Manipulative inmates who are secretly eating.
⢠Tantrum throwers
⢠Mentally ill inmates
⢠Protesters (but not suicidal)
⢠True Hunger striker.
9. The Approach to Each of These is
Different
⢠Housing. Special housing. Monitoring.
Audience
⢠Mental Health. Suicidal? Psychotic?
⢠Medical monitoring? Weights, Vital signs, labs
⢠Legal. Commitment? Involuntary feeding?
10. Step by Step Approach
⢠Initial interview
⢠Initial Physical Exam
⢠Setting up a care plan
⢠What about inmates who actually fast for a
long time?
11. Initial interview--Questions
⢠Are you expecting to die?
⢠Are you protesting something?
⢠Total fast or will you eat something?
⢠How long will you fast?
15. Care plan--Housing
⢠Suicide precautions
⢠Who can Remain in the Dorms?
⢠Separate from support group
â Psychological support
â Surreptitious feeding
16. Care PlanâMental Health Evaluation
⢠Suicidal
⢠Psychotic
⢠True Hunger Strikers
⢠Protestors
17. Medical Monitoring
⢠Repeat medical evaluations
â Weights
â Food logs
â Vitals
⢠Do not be an Enabler
â âI donât want a tray. I wonât eat it anyway.â
â Donât feed attention seeking more than necessary.
18. Care Plan--Legal
⢠Psychotic inmates
â Commitment
⢠Hunger strikers
â Timing is important
â Aggressive interventions must be court ordered