Treating a hunger striker: Ethical dilemmas

As a medical specialist who looked after Minister Wimal Weerawansa during his hunger strike I think it is my duty to explain some facts to the erudite readers of this newspaper. The doctor patient encounter or the consultation is a private and a confidential encounter. Due to the circumstances not amenable to me the examination and the treatment of Mr Weerawansa was carried out under the glare of the TV lights and I was asked by and did discuss his condition albeit briefly with journalists. He started his hunger strike on Thursday the 8th of July and stopped it after the intervention of the President on 10th Saturday afternoon. From the initiation he refused any solid or liquids including water and was taking medicines given by us after much persuasion. Although there was medical literature about people refusing food reports about refusing food and water both were difficult to find. The laboratory investigations done in several private and government laboratories showed initial electrolyte abnormalities, dehydration and subsequent muscle breakdown.

His refusal of liquids confronted me with an ethical dilemma and myself and Dr Jayathilake (Dr Achala Jayathilake MBBS, MD, PhD a public health specialist –who is also his private secretary-) insisted and prevailed upon his colleagues in the Jathika Nidahas Peramuna that he should have intravenous fluids (saline through blood vessels) during Saturday midday. By that time his blood pressure and pulse was high and he was drowsy so he could not have capacity to make an independent decision. This was due to lack of water in his body. I consulted a prominent nephrologist too. If he had continued to drink water and refused solid or liquid food he would have survived without complications for a longer period. Without water the survival period is much shorter and may be as short as 48 hours. I was worried about dehydration causing kidney impairment and its potential long term effects.

Friday afternoon Minister Weerawansa’s daughter asked me about her father’s condition and her tearful face compelled me to say that he will be all right, although I knew that he needs to drink water within the next 24 hours. Saturday morning the President called me and asked about his condition and by afternoon he intervened to relieve our anxiety. Although by that time he was on intravenous saline we did not have facilities to continuously monitor or to check his electrolytes and other reports. There are cases of brain damage and other complications when people who have undergone hunger strike were fed or given inappropriate food and liquids. Due to this reason, as soon as the hunger strike was over he was whisked away for intensive monitoring in a hospital.

Although as a physician I cannot comment with authority about the impact of his hunger strike; it raised awareness about the committee appointed by the UN secretary general, achieved a consensus in the government about how to respond to it and showed us that Mr Moon sometimes twist the truth!

Dr Sisira Siribaddana MBBS, MD FCCP

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