29th July 2011
The Malaysian Medical Association (MMA) is very concerned to hear that Dr Jeyakumar Devaraj, a Life Member of the MMA who has been detained under the Emergency Ordinance since July 2nd 2011, has gone on a hunger strike, as announced by his wife R. Mohanarani yesterday, “to seek justice, and he will continue his strike until all six of them are released or brought to trial..”
We urge the authorities to release Dr Jeyakumar and the 5 others from PSM as the police said they had been detained “for being key movers of the July 9 Bersih 2.0 rally”, which is now over. If they are not released immediately, they should be charged and tried in open court.
While we are concerned about the possible detrimental effects of this hunger strike on Jeyakumar’s health – more so as he has been brought to the hospital for heart problems twice since his initial arrest almost a month ago – we must also respect Jeyakumar’s right to this non-violent form of protest.
In this regard, the MMA calls upon the authorities to respect international human rights law and not to resort to force-feeding as a means of ending Dr Jeyakumar’s protest. The World Medical Association (WMA) – the body that establishes ethical guidance for doctors around the world – states that force-feeding by any means is considered as unethical and cruel, inhuman and degrading treatment.
We also wish to remind all doctors that we are ethically bound to respect the right of a competent person to refuse food intake as a form of protest.
The WMA Declaration of Tokyo (1985) states that
“Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially. The decision as to the capacity of the prisoner to form such a judgment should be confirmed by at least one other independent physician. The consequences of the refusal of nourishment shall be explained by the physician to the prisoner.”
The WMA has reiterated the same in the Declaration of Malta on Hunger Strikers, adopted by the 43rd World Medical Assembly in 1991 and revised by the 57th WMA General Assembly in 2006, the full text of which is available at http://www.wma.net/en/30publications/10policies/h31/index.html.
The principles outlined in the Declaration of Malta include the duty of physicians
- To act ethically and to prevent coercion or maltreatment of detainees;
- To respect the detainee’s autonomy (“Forced feeding contrary to an informed and voluntary refusal is unjustifiable”);
- To uphold the principles of “benefience” (doing good – respecting the individual’s wishes and promoting his welfare), complemented by “non-maleficence” (doing no harm – minimizing damage to health and not forcing treatment or coercing him to stop fasting); and
- To ensure that their primary obligation is to the individual patient – “remaining objective in their assessments and not allowing third parties to influence their medical judgement, including not allowing themselves to be pressured to breach ethical principles, such as intervening medically for non-clinical reasons.”
The WMA Declaration of Malta also recommends that a physician be involved in the management of the person undertaking the hunger strike as early as possible, making an assessment of the person’s competency, informing him of the consequences of his action, and performing a thorough medical examination at the start of the fast, noting the person’s values and wishes regarding medical treatment in the event of a prolonged fast. A physician should also be allowed to communicate with the hunger striker in privacy and “ascertain on a daily basis whether individuals wish to continue a hunger strike and what they want to be done when they are no longer able to communicate meaningfully.”
In accordance with the principles of the Declaration of Malta, the MMA urges the authorities to appoint one of our MMA members as the physician involved in the management of Dr Jeyakumar during his fast, so that we can be assured of his health and welfare and can communicate this with his family and friends on a regular basis, and can intervene medically if and when appropriate, while respecting Dr Jeyakumar’s autonomy and right to carry out this form of non-violent protest.