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RSS Charles R McNabb was five months into a hunger strike his 5-foot-9 fra me withered to less than 100 pounds when he was wheeled into the Airwa y Heights prison infirmary last year. The prison medical staff wanted to insert a feeding tube. McNabb, convict ed of arson, wanted to continue starving. He was remorseful, he had told jailers, for badly burning his stepdaughter. Was it a case of a patient's right to deny medical care, or of the state' s obligation to avert a prison suicide? The Washington State Court of Appeals yesterday ruled that the Department of Corrections (DOC) was justified in force-feeding McNabb, setting a p recedent for other state inmates who attempt hunger strikes. The five-page ruling dismissed McNabb's claim that the feeding tube viola ted his state Constitutional right to privacy, including the right to de cline medical treatment. "The right to decline force-feeding is not abso lute because the state has an interest in protecting the sanctity of the lives of its citizens," wrote appellate judge Ken Kato for a unanimous three-judge appellate panel in Spokane. There is a difference between the case of McNabb who was otherwise heal thy and those in which a terminally ill patient declines treatment, ac cording to the ruling. "Rather, his situation is one where it can be inferred that the road to d eath is set in motion for purposes of committing suicide," Kato wrote. He had been charged with arson and assault for setting fire to his estran ged wife's Spokane house. His 16-year-old stepdaughter was seriously bur ned in the fire. He slowly wasted away in the county jail while awaiting his July 2004 trial, dropping at least half of his 190 pounds. A Spokane County judge granted a local hospital the authority to insert a feeding tube if his condition became life-threatening, but doctors disa greed over his health, and McNabb's strike continued. He pleaded guilty in July and was sentenced to 14 years. "I am declining to eat for personal reasons," he wrote in a sworn declara tion in August 2004, as he filed a lawsuit. I am deeply committed to that decision and for that reason I have consistently declined to eat, except under threat of force-feedin g, for almost six months." Not long after the feeding tube was inserted, McNabb began eating volunta rily to avoid being force-fed. He now is serving his sentence at the Mon roe Correctional Complex. Marc Stern, chief physician for the prison system, applauded the deci sion. "One of the things we struggle with is: Where does the patient autonomy e nd and where does the state autonomy begin?" "We do have cancer patients who can't eat and choose to not eat. But being p erfectly healthy and saying, 'I'm not going eat,' that's where your auto nomy ends and our autonomy begins." Stern said he suspects that McNabb was at least drinking juice during his strike; Terri Sloyer, McNabb's attorney, said the ruling, taken to an extreme, co uld allow the forced drugging of inmates should the DOC claim it is in t he best interests of the prison. "You don't lose your right to consent or not consent to medical treatment as a prisoner," Sloyer said. "And force-feeding is one of the most inva sive medical procedures there is." At least five other state-court rulings nationwide allow force-feeding of prisoners. The most notable case was that of John Lennon's assassin, Ma rk Chapman, who claimed his 23-day hunger strike was intended to draw at tention to starving children.
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