Clinical and legal issues of inmates' food refusal: the importance of decision-making capacity assessment

Inmates' food refusal is a large-scale phenomenon raising clinical, ethical, and professional responsibility issues. Obtaining a clinical balance of the right to refuse food with the right to protect the inmate's health can be a challenging process. Several reasons may support inmates' choice of refusing food, including political or protest reasons, as well as psychiatric disorders. The World Medical Association defines a hunger striker as a mentally competent person who has indicated his/her decision to go on a hunger strike by refusing to take any food and/or liquid for a significant amount of time. Force-feeding of mentally capable people is not allowed by a legal standpoint, nor medical treatment can be carried out without patients' explicit consent. According to these premises, both the clinical assessment of possible concurrent psychiatric disorders as well as the assessment of inmates' mental capacity to make decisions about refusing food might help in understanding this behavioural issue. We will also discuss the ethical and legal implications related to the right of refusing food according to the current Italian legislation.