Hunger strikes

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Abstract
Hunger strikes in different parts of the world are regularly in the news. Doctors with an interest in human rights may be asked to give independent medical advice to an asylum seeker intending to start a hunger strike. Several recent articles have addressed the ethics of treating hunger strikers,1 2 but there is less information available on the physiological issues. It is essential to understand both these issues to be able to advise the individual appropriately. There have been several studies of fasting for a few days, but in the past 15 years only three studies have described voluntary total fasting for prolonged periods. The first was of a monk who tried to fast for 40 days for religious reasons but was forced to stop on day 36 because of unacceptable symptoms.3 The second was of four adults who were planning to fast indefinitely. One became very unwell on day 38, and the others ceased fasting on day 40.4 The third was a retrospective study of 33 South African political prisoners on hunger strike for up to 28 days.5 Hunger strikes have been around since Roman times, and the suffragettes brought the tactic to public awareness in Britain earlier this …

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