Testing Cruzan: prisoners and the constitutional question of self-starvation.

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Testing Cruzan: prisoners and the constitutional question of self-starvation.

INTRODUCTION I. HUNGER STRIKES IN THE UNITED STATES AND ABROAD: THE INTERNATIONAL PREVALENCE OF PRISONER FASTING II. METHODS OF FORCE-FEEDING: PROCEDURE AND PRACTICE III. FOUNDATIONS OF PRIVACY: THE SUPREME COURT AND THE CONSTITUTIONALITY OF THE RIGHT TO STARVE A. The Right To Be Free from Force-Feeding: Cruzan and Glucksberg B. The Implications of Prisoner Status on the "Right To Starve": Turner v. Safley IV. STATE INTERESTS IN FORCE-FEEDING PRISON INMATES A. The Preservation of Life and the Prevention of Suicide B. Effective Prison Administration C. The Ethical Integrity of the Medical Profession D. Fear of Manipulation of the Prison System V. THREE STAND ALONE, SORT OF: COURTS RECOGNIZING A PRISONER'S RIGHT TO REFUSE UNWANTED MEDICAL TREATMENT A. Zant, Thor, and Singletary B. Limitations on the Right Recognized CONCLUSION INTRODUCTION

In 1982, a New York court ordered the force-feeding of a prisoner who was attempting starvation to draw attention to the hungry children of the world. (1) Two years later, the Supreme Court of New Hampshire held that, despite inflicting great pain and discomfort, prison officials could continue to feed an inmate with a nasogastric tube. (2) In 1995, the Supreme Court of North Dakota determined that a sixty-four-year-old diabetic prisoner protesting the conditions of his confinement could be forced to undergo treatment after a hunger strike. (3) Soon after, the Second Circuit allowed the unwanted feeding of a civil contemnor in custody for refusing to testify before a grand jury. (4) In all, nearly fifteen state and federal courts have found that prison officials may force-feed a hunger-striking prisoner through highly invasive means.

Hunger strikes have become increasingly common in prisons across the United States and throughout the world. The practice represents one of few ways that inmates can protest the conditions of their incarceration or express political viewpoints. Fasting can also be the only plausible way for a prisoner to intentionally bring about his or her own death. Even so, from Massachusetts to Illinois to North Dakota, nearly every court that has addressed the issue has declined to recognize a prisoner's right to refuse invasive medical treatment--notwithstanding the grave health and safety risks involved. No federal court has ever recognized a prisoner's right to hunger strike, and the Federal Bureau of Prisons has even created detailed guidelines delineating the process for force-feeding inmates.

This state of affairs persists despite the Supreme Court's holdings in Cruzan v. Director, Missouri Department of Health (5) and Washington v. Glucksberg (6) that individuals necessarily possess a fundamental right to refuse lifesaving medical treatment. This Note argues that force-feeding a competent inmate necessarily violates that inmate's fundamental privacy rights, as established by Cruzan and reiterated in Glucksberg. Part I illustrates the prevalence of prison hunger strikes in the United States and abroad. While this Note addresses primarily United States law, an international context helps to demonstrate the frequency with which hunger strikes occur. Part II briefly explains the typical process of force-feeding and the related pain and health risks. This explanation is critical to understanding the extent of the physical intrusion involved, and therefore the extent of an inmate's liberty interest in avoiding involuntary treatment. Part III outlines Supreme Court jurisprudence establishing a right to refuse unwanted palliative care. Cruzan and Glucksberg create a substantive due process framework that emphasizes individual autonomy over involuntary treatment. No court that has sanctioned force-feeding has ever fully explained why hunger striking should fall outside this clear precedent. Nor has any court demonstrated that the practice serves "legitimate penological interests" and passes muster under Turner v. Safley. (7) Part IV analyzes governments' countervailing interests in force-feeding prison inmates. Case law requires that adequate interests be averred to justify the intrusions posed by force-feeding. The governmental interests generally asserted--including the preservation of life and effective prison administration--prove to be ill-articulated and unsatisfactory. Part V considers the few cases in which courts have recognized a prisoner's right to refuse treatment and explains why even those holdings may be limited.

I. HUNGER STRIKES IN THE UNITED STATES AND ABROAD: THE INTERNATIONAL PREVALENCE OF PRISONER FASTING

Hunger strikes by prisoners are by no means a purely modern form of protest. The practice has persisted for hundreds of years. For example, hunger strikes were waged by the Fenians in the nineteenth century. (8) Since then, these strikes have occurred in prisons across the ...

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