‘Starving to Death in Medical Care: Ethics, Food, Emotions and Dying in Britain and America, c.1980-2015’

Recent controversies about prisoner force-feeding have renewed debates on the ethical appropriateness of feeding individuals against their will. Critics condemn force-feeding as it seems to clash with prevailing bioethical principles of patient autonomy which grant patients the right to refuse medical treatment (or food) if they wish. This article uses contemporary history to highlight the complex development of policies on supported feeding in recent decades. It maintains that since the late-1970s, doctors and medical personnel have grappled with the problems posed by feeding numerous types of patients (not just hunger strikers) without express permission including the comatose, infants, anorexics and the elderly demented. Between the 1970s and 1990s, inconsistent approaches developed, which regularly negated the principles of patient autonomy. Many doctors and family members struggled emotionally with the prospect of letting an individual starve. Decisions made about whether or not to feed were informed by factors such as age, gender and perceptions of vulnerability. If patient autonomy is to guide decisions made to use, withdraw or withhold nutritional support, it would benefit from being consistently applied. Emotional detachment is essential to achieve this, although emotions, at the same time, present barriers to the implementation of ethical standards in clinical practice.