§ The Secretary of State for the Home Department (Mr. Roy Jenkins)
I will, with permission, Mr. Speaker, make a statement about artificial feeding of prisoners.
On 23rd May, I said that I would review the position regarding compulsory feeding and the traditional view that a prison medical officer would be neglecting his duty if he were not prepared to feed artificially a prisoner on hunger strike, if necessary against his will, in order to preserve his health and life. Distasteful and objectionable though artificial feeding is, it has been judged preferable to allowing the prisoner to die or his health seriously to deteriorate.
I should like to pay tribute to the professional skill and compassion with which members of the prison medical service have discharged their responsibilities in circumstances which I know they have found difficult and distasteful.
The doctor's obligation is to the ethics of his profession and to his duty at common law; he is not required as a matter of prison practice to feed a prisoner artificially against the prisoner's will. Since there has been misunderstanding on this point, I think it is in 452 the interests of prisoners, the medical profession and the public, that the procedures to be followed in future should leave no room for doubt.
I am advised that the common law duty placed upon persons in charge of a prisoner is to take such steps as are reasonable in the circumstances of each case to preserve the health and the life of the prisoner. In making their decision in respect of any particular case, they must have regard not merely to the dangers likely to flow from the prisoner's refusal of food but also to those likely to flow from the process of forced feeding itself, if it is resorted to, and particularly if it is resisted.
Accordingly, the future practice should. in my view, be that if a prisoner persists in refusing to accept any form of nourishment, the medical officer should first satisfy himself that the prisoner's capacity for rational judgment is unimpaired by illness, mental or physical. If the medical officer is so satisfied, he should seek confirmation of his opinion from an outside consultant. If the consultant confirms the opinion of the prison medical officer, the prisoner should be told that he will continue to receive medical supervision and advise and that food will be made available to him. He should be informed that he will be removed to the prison hospital if and when this is considered appropriate. But it should be made clear to him that there is no rule of prison practice which requires the prison medical officer to resort to artificial feeding, whether by tube or intravenously. Finally, he should be plainly and categorically warned that the consequent and inevitable deterioration in his health may be allowed to continue without medical intervention, unless he specifically requests it.
I have discussed this subject with my right hon. Friends the Secretaries of State for Scotland and Northern Ireland, who have decided that the procedures I have outlined will apply also in Scotland and Northern Ireland.
§ Sir K. Joseph
Obviously we shall wish to study the right hon. Gentleman's statement, but at first sight this change of policy seems acceptable, provided, as I am sure the right hon. Gentleman intends, that at each stage the position is made abundantly clear to the prisoner concerned.
453 There are two questions which I wish to put to the right hon. Gentleman. It is not altogether clear from his statement whether any amendment to the prison rules will be involved. I do not think that an amendment will be necessary, but perhaps he will confirm that.
Secondly, assuming that it is made abundantly clear that there is no obligation on the doctor arising from his employment as a prison medical officer to force-feed a prisoner, does the right hon. Gentleman believe that the doctor's own professional position will be tolerable? Has he consulted the General Medical Council about that?
§ Mr. Jenkins
Dealing with the right hon. Gentleman's first point, I do not think that any change in the prison rules will be necessary. The two relevant ones are 17(1) and 18(3). The first, 17(1), provides that the medical officer shall have the care of the health, mental and physical, of prisoners. The second, 18(3), lays upon him the duty of informing the governor if he suspects a prisoner of having suicidal intentions. I do not think that it is necessary to make any amendment to the prison rules, though if I thought it to be necessary I should lay such an amendment.
Dealing with the right hon. Gentleman's second point, I have consulted Sir John Richardson, the Chairman of the General Medical Council. The House may sense that in making this statement, which is as clear as it can be, I have been beset by a number of medical and legal difficulties. There is the position of common law. There is the fact that I cannot—and no Secretary of State has been able to do so in the past—instruct a medical officer as to exactly how he interprets his clinical duty. But my desire throughout has been to make the position clear. Perhaps the best way to sum it up is that I hope that in future a medical officer confronted with a prisoner who is on hunger strike will treat him in the prison as nearly as possible in the way in which a doctor would treat a free man or woman outside prison.
§ Dr. Phipps
After the initial examination by a doctor and confirmation by a consultant, is it intended that there will be subsequent examinations so that at some time during a hunger strike it can 454 be decided that the person on hunger strike is no longer mentally able to determine whether it is for his own good to continue? Will there be continuous examinations?
§ Mr. Jenkins
I say in my statement that medical supervision and advice as well as food will continue to be available to the prisoner. What my hon. Friend has in mind may conceivably arise at a later stage. But I hope that he will not press that point too much. I hope that it will be clear to a prisoner who is rational at the beginning of this course and takes a rational decision what are likely to be the consequences.
§ Mr. Beith
Will the right hon. Gentleman accept my welcome for his statement, since I have pressed such a course of action upon him and his predecessor? It removes from prison officers a distasteful task, and it removes from terrorist organisations a potential propaganda weapon which they would not hesitate to use. It will be widely accepted by the general public.
Will the right hon. Gentleman clarify one point? In the event of a medical officer deciding that a prisoner's mental health is impaired by illness, mental or physical, has he any need to consult an outside consultant before proceeding to institute artificial feeding in that situation?
§ Mr. Jenkins
He has no need to do so in terms of the statement that I have made. If he so decided, I think that he would behave as would a doctor outside a prison. There may be circumstances in which people, for psychological reasons, are unable or do not wish or refuse to eat food. There are certain diseases of that kind. The prison doctor would treat such cases as would a practitioner outside prison dealing with a free person.
§ Mrs. Renée Short
We warmly welcome the statement made by my right hon. Friend. We are delighted that this barbaric practice is now to disappear from our prison system. May I ask whether my right hon. Friend has noticed the resolution carried at the BMA conference recently which indicates that doctors are very much against forced feeding and that, therefore, he will have the support of the medical profession in this matter?
455 Will my right hon. Friend also make it possible for prison governors to see that food is left with a prisoner who has decided to refuse food, but in privacy, so that it is left to the prisoner to take food as and when he is able to do so and he is not stood over by prison officers who are trying to compel him to eat by putting psychological pressure on him?
§ Mr. Jenkins
I am aware of the proceedings of the BMA conference. In particular, I have carefully studied the statement by the Central Ethical Committee of the BMA which was issued on 26th June. I think that what I have said is in accordance with the views of the BMA about the degree of clinical freedom which is right and necessary.
I made it clear in my statement that food would continue to be made available to a prisoner. I assure my hon. Friend that those in the prison service who have been concerned with the difficulties—they can be, and have been, very great—of people on hunger strike are only too anxious to enable them to come off it in the best possible circumstances.
§ Mr. Norman Fowler
I welcome the statement by the Secretary of State. Does he agree that there is also the question of preventing hunger strikes and that the best way is by making it absolutely clear that no deals will be done with the hunger strikers? Will he take this opportunity of making that point clear now?
§ Mr. Jenkins
I think that by making the statement I have made known as clearly as I can what I believe will be the future course. I have nothing to add on other matters to what I said to the House when I had a particularly difficult situation to deal with, and I certainly make no apology for the way in which I dealt with it.