Hunger strikes in prisons: a narrative systematic review of ethical considerations from a physician's perspective.

Objectives. We sought to identify and review published studies that discuss the ethical considerations, from a physician’s perspective, of managing a hunger strike in a prison setting. Methods. A database search was conducted to identify relevant publications. We included case studies, case series, guidelines and review articles published over a 20-year period. Non-English language publications were translated. Results. The review found 23 papers from 12 jurisdictions published in five languages suitable for inclusion. Conclusions. Key themes from included publications are identified and summarised in the context of accepted guidelines from the World Medical Association. Whilst there seems to be an overall consensus favouring autonomy over beneficence, tensions along this fine balance are magnified in jurisdictionswhere legislation leads to a dual loyalty conflict for the physician.