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Hajj and 2009 pandemic influenza A H1N1
Editorial
Force-feeding of prisoners—a shameful practice
iStockphoto
The printed journal includes an image merely for illustration
See Perspectives page 1737
For more on the clinical care of hunger strikers see Editorial Lancet 2008; 372: 777
A judge in Connecticut, USA, is considering whether to continue to allow a prisoner on hunger strike to be force-fed. Superior Court Judge James Graham is expected to rule on the case of William Coleman, who is in the Corrigan-Radgowski Correctional Center, in the coming weeks. Coleman and his lawyers argue that he has a constitutional right to determine what happens to his body, and the right to refuse medical treatment including resuscitation or assisted feeding. He has been force-fed via a nasogastric tube inserted by a physician on occasions since January, 2008, when Judge Graham issued a temporary injunction that allowed the state to feed Coleman by force. This case is one of several in which prisoners in US states are challenging force-feeding as unconstitutional on varying grounds. Physicians throughout the world continue to be involved in force-feeding despite its prohibition by the World Medical Association (WMA) in Declarations (to which the American Medical Association is a signatory),
and despite the provisions of the Geneva Conventions. The WMA states that the autonomy of prisoners who decide, voluntarily, to refuse food must be respected, provided that their mental capacity to make the decision is unimpaired. Physicians such as military doctors, who might have dual loyalties, should make patients their priority, according to the WMA. The long standing role of physicians in force-feeding prisoners or detainees is explored by George Annas in a Perspectives piece in this week’s issue (see p 1737). In his review of two new books, Annas argues that the US Department of Defense (and/or President Obama) should “reassert traditional US military doctrine that no physician in the US military need compromise medical ethics to serve their country”. An alternative, says Annas, would be for state licensing boards to take a position on force-feeding. Access to an independent doctor who can offer impartial and expert care to hunger strikers is essential. Force-feeding should never be part of that care. ■ The Lancet
Hajj and 2009 pandemic influenza A H1N1
Reuters
The printed journal includes an image merely for illustration
Published Online November 14, 2009 DOI:10.1016/S01406736(09)61971-1 See Public Health page 1786
1724
More than 2·5 million Muslims from over 160 countries will be going on Hajj—a pilgrimage to Mecca, Saudi Arabia—this year during Nov 25–30. Such a mass gathering, with up to seven people per m², increases the risk of spreading infectious diseases, particularly the 2009 pandemic influenza A H1N1. In The Lancet today, Ziad Memish and colleagues report several recommendations, based on the current status of this pandemic, for provision of the best health services to pilgrims and to keep disease transmission to a minimum among pilgrims and their contacts at home. These recommendations—which are to be put into practice before and during this year’s Hajj—were made after a consultation in Jeddah during June 26–30, 2009, between global agencies at the invitation of the Saudi Arabian Ministry of Health. They are grouped according to screening and isolation; surveillance, epidemiology, and informatics; laboratory testing; infection control; and treatment of the 2009 pandemic influenza A H1N1 infection. The most important recommendation is that people at risk of infection—such as those older than 64 years,
children younger than 5 years, pregnant women, and immunosuppressed individuals—should not go on Hajj this year. However, because Hajj is one of the five pillars of Islam and should be done at least once in a Muslim’s lifetime, individuals will probably not want to postpone after they have spent much time saving money and planning for this purpose. Some of the other recommendations, such as isolation of pilgrims with influenza-like illness, might not only deter individuals from reporting their illness but will undoubtedly also cause them distress and difficulty reuniting with their companions. Improvement of hand hygiene for infection control might be more acceptable than some of the other recommendations because pilgrims should wash before they pray. These recommendations are a starting point, but they will need to be assessed. Some recommendations might need to be adjusted or discarded as the pandemic develops. However, pandemic influenza A H1N1 alone is understandably unlikely to dissuade many Muslims from going on Hajj. ■ The Lancet www.thelancet.com Vol 374 November 21, 2009
Force-feeding of prisoners—a shameful practice
iStockphoto
The printed journal includes an image merely for illustration
See Perspectives page 1737
For more on the clinical care of hunger strikers see Editorial Lancet 2008; 372: 777
A judge in Connecticut, USA, is considering whether to continue to allow a prisoner on hunger strike to be force-fed. Superior Court Judge James Graham is expected to rule on the case of William Coleman, who is in the Corrigan-Radgowski Correctional Center, in the coming weeks. Coleman and his lawyers argue that he has a constitutional right to determine what happens to his body, and the right to refuse medical treatment including resuscitation or assisted feeding. He has been force-fed via a nasogastric tube inserted by a physician on occasions since January, 2008, when Judge Graham issued a temporary injunction that allowed the state to feed Coleman by force. This case is one of several in which prisoners in US states are challenging force-feeding as unconstitutional on varying grounds. Physicians throughout the world continue to be involved in force-feeding despite its prohibition by the World Medical Association (WMA) in Declarations (to which the American Medical Association is a signatory),
and despite the provisions of the Geneva Conventions. The WMA states that the autonomy of prisoners who decide, voluntarily, to refuse food must be respected, provided that their mental capacity to make the decision is unimpaired. Physicians such as military doctors, who might have dual loyalties, should make patients their priority, according to the WMA. The long standing role of physicians in force-feeding prisoners or detainees is explored by George Annas in a Perspectives piece in this week’s issue (see p 1737). In his review of two new books, Annas argues that the US Department of Defense (and/or President Obama) should “reassert traditional US military doctrine that no physician in the US military need compromise medical ethics to serve their country”. An alternative, says Annas, would be for state licensing boards to take a position on force-feeding. Access to an independent doctor who can offer impartial and expert care to hunger strikers is essential. Force-feeding should never be part of that care. ■ The Lancet
Hajj and 2009 pandemic influenza A H1N1
Reuters
The printed journal includes an image merely for illustration
Published Online November 14, 2009 DOI:10.1016/S01406736(09)61971-1 See Public Health page 1786
1724
More than 2·5 million Muslims from over 160 countries will be going on Hajj—a pilgrimage to Mecca, Saudi Arabia—this year during Nov 25–30. Such a mass gathering, with up to seven people per m², increases the risk of spreading infectious diseases, particularly the 2009 pandemic influenza A H1N1. In The Lancet today, Ziad Memish and colleagues report several recommendations, based on the current status of this pandemic, for provision of the best health services to pilgrims and to keep disease transmission to a minimum among pilgrims and their contacts at home. These recommendations—which are to be put into practice before and during this year’s Hajj—were made after a consultation in Jeddah during June 26–30, 2009, between global agencies at the invitation of the Saudi Arabian Ministry of Health. They are grouped according to screening and isolation; surveillance, epidemiology, and informatics; laboratory testing; infection control; and treatment of the 2009 pandemic influenza A H1N1 infection. The most important recommendation is that people at risk of infection—such as those older than 64 years,
children younger than 5 years, pregnant women, and immunosuppressed individuals—should not go on Hajj this year. However, because Hajj is one of the five pillars of Islam and should be done at least once in a Muslim’s lifetime, individuals will probably not want to postpone after they have spent much time saving money and planning for this purpose. Some of the other recommendations, such as isolation of pilgrims with influenza-like illness, might not only deter individuals from reporting their illness but will undoubtedly also cause them distress and difficulty reuniting with their companions. Improvement of hand hygiene for infection control might be more acceptable than some of the other recommendations because pilgrims should wash before they pray. These recommendations are a starting point, but they will need to be assessed. Some recommendations might need to be adjusted or discarded as the pandemic develops. However, pandemic influenza A H1N1 alone is understandably unlikely to dissuade many Muslims from going on Hajj. ■ The Lancet www.thelancet.com Vol 374 November 21, 2009