A prisoner's right to healthcare

"Criminals go to prison as punishment, not for punishment" - Sir Alexander Henry Patterson

Theme: Ethics and Controversy

Zuairia Shahrin

“They raped the women of our community, they cold-heartedly murdered the innocents, they are best in prison. Why should they deserve healthcare that is funded by our hard-earned tax dollars?” - Something probably a lot of us would say if we were asked about whether or not prisoners deserve healthcare. 

Undoubtedly, prisoners have made some of the worst possible life choices; this is why they have ended up in prisons. But British penologist Sir Alexander Henry Paterson used to say “Men come to prison as a punishment, not for punishment.”[1] Being in prison does not confiscate their basic human rights. Because of imprisonment, convicts have already lost what we recognise as the most loved human right - Freedom. Consequently, many human rights that would otherwise have belonged to them are seized too. However, this never included the right to healthcare. Then why are law-abiding citizens like us reluctant to help them? Have we been coerced to believe that “They should suffer for the crimes they have committed?” Nonetheless, the law recognises prisoners as a distinctly defenceless populace whose safety depends on the jailer’s generosity. 

Legally, prisoners cannot be made subjects to “cruel and unusual punishments.” In 1973, a state prisoner within the Texas Department of Corrections, J.W. Gamble was given an assignment.[2] As he was unloading cotton bales from a truck, one of them fell on him. He complained about back and chest pains, but little did he know that he would be the recipient of solitary confinement rather than medical care. What was the need for this unnecessary punishment when being in prison is punishment per se? Every time a prison staff figure deliberately fails to address an inmate’s health needs, he violates the Eighth Amendment, a law that protects prisoners and that generates a de facto right to healthcare for all persons in custody, regardless of conviction. Although as commoners we are not in positions of authority, our reluctance to allow medical care for inmates can also be deemed as a criminal offence. By denying healthcare for them, we are inflicting pain, and the mere intent of that can be sufficient to establish assault charges. More importantly though, if we are to be offenders of the law by engendering physical pain and discomfort to others, what makes us any different from the 10.35 million prisoners in the world? Nevertheless, I feel that it is now time to familiarise ourselves with the cruel instances that expecting women in prisons undergo. 

The leader of a recent study about the treatment of incarcerated women, Lorie Goshin, claims, “We dehumanize this group of women to such an extent that we don’t see how wrong this is - just how unnecessary and cruel it is.” [4] People like you and me cannot even start to imagine the gruelling torment that a mother experiences during labour. But just seeing the child’s face outweighs all of the physical sufferings, according to mothers. Do you know what’s worse than labour pain? Stillbirth, in my opinion. Upon research, I came across Polly’s story, who was four months’ pregnant during the time of her miscarriage on the 22nd of November last year. “I knew without looking that the bleeding was worse, I could feel it but didn’t pull the light on to see,” cried Polly. Even though every pregnant woman is entitled to it regardless of her background, pregnant inmates are not given extra fruits or vegetables for the life that is growing within them.[12] A woman who was 16 weeks pregnant when she was sent to prison stated how she had developed SPD (Symphysis Pubis Dysfunction) which rooted a searing pelvic pain. Despite it being within prison regulations, she did not receive an extra pillow when she asked for it. But that’s not it. If a pregnant inmate receives any medical treatment whatsoever, they are examined by amateur healthcare workers. Not only does this put the mother at risk, but also the unborn child. 

Low prison policy standards have been the source of inadequate nutrition during pregnancy and lack of maternity care. Just like Polly’s, this has led to 20% of prison pregnancies miscarrying, as claimed by a recent study conducted by the John Hopkins School of Medicine.[4] How can we look forward to healthy deliveries if inmates are shackled 61% of the time? The adoption of restraint mediums during labour, birth and instantly after birth bars a mother of free motion that may result in life-threatening embolic complications, emergency Caesarian sections, and deformities in the birth canal or the baby itself. These restraints obstruct the bond between the mother and the child, making breastfeeding increasingly challenging. This may cause depression and anguish in these women, as reported by the American Psychological Association.[6] Despite nonprofit organisations trying to educate the jail staff about the importance of prenatal and maternity care, pregnant inmates are not looked after properly.[4] Instead, they are recipients of debilitating treatment such as shackling because of the prison regulations. I think it’s time we make amendments to these policies. 

The International Covenant established that everyone has the right to enjoy the highest attainable standard of physical and mental health.”[7] Why then does the mass population forget that this applies to prisoners just as it does to us? Prisoners are in prisons because of the wrong decisions they made. But name me one person who hasn’t made at least one mistake in his/her life. Understandably, prisons were constructed to ensure public safety rather than inhibiting transmission of diseases and efficiently delivering healthcare. But our failure to realise that the majority of the convicts will return to society after serving their sentence puts us at risk. Whilst in prison, convicts are susceptible to many infectious diseases which may also be latent. Recently, a rise was seen in the HIV prevalence in Malaysia’s Kajang Prison. Out of all, 48.3% were HIV-infected, which resulted in the weakening of their immune systems. This made them predisposed to Tuberculosis. 95.1% of this group were men, with their median age being 36 years. While the national HIV prevalence is 0.4%, the HIV prevalence in prisons is 15 times higher due to the overcrowding. Just notice how we have lost a large number of men to infectious diseases. With the progression of the Malaysian economy, we are losing many employees to the tertiary sector of industries. If these men had received even the adequate amount of healthcare, a healthy majority of them could have returned to society and could have worked in primary and secondary sectors; they are still at working ages. 

Not only do countries like Malaysia lose a large number of men to diseases because of overcrowding in prisons, but they also lose men to high suicide rates resulting from sexual misconduct. According to the Bureau of Justice Statistics, 80,000 men and women get sexually abused in American correctional facilities.[10] Whilst rape on female inmates maintains the majority, a surprising 37.5% cases constituted of male LGTB inmates being the victims. Even more depressing is the fact that male convicts, regardless of age or severity of their crimes, are 9.81% more likely to undergo serious punishments like thrashing, losing visitation privileges, water deprivation, reduced shower privileges and extension of sentences.[11]

The point of being in prison was meant to be rehabilitation, not torture. 

More often than not, external influences and beliefs impair us of the ability to develop a growth mindset. For all we know, J.W. Gamble could have died due to having angina, pericarditis, heartburn, or even depression. Only because Gamble was a prisoner in his time, the negligence from prison staff and doctors did not stratify as medical malpractice or “cruel and unusual” treatment. What if instead of Gamble, the prisoner had been one of your family members? Would your attitude be the same? And let’s not forget our female inmates. Instead of looking at them as bearers of life, some of us see them as societal misfits. Why don’t we grasp that these women are mothers first, and then inmates? An engineer’s son does not have to be an engineer; he can be an actor if he wants to. Similarly, a convict’s child does not have to be another convict. 

Some of these criminals have committed unpardonable offences, and there is no way we can deny nor justify their actions. However, if these individuals have been put in prison for obstructing the rights of others, does denying them a basic quality of healthcare make us any better? It is the general intention or perception that inmates do receive the necessary medical treatment, but there is evidence to suggest otherwise. If the offender was found  in critical condition when arrested at a crime scene, emergency doctors would have no choice to treat them in a hospital environment, because medical professionals take an oath to do no harm. Therefore, if an individual is guilty of a crime whether before or after being incarcerated, how should that affect the treatment they deserve as human beings? 

Zuairia Shahrin

GLOSSARY:

1. Solitary confinement: A form of imprisonment where one inmate lives in a single cell with little to no meaningful contact with other inmates. This action may be taken to protect an inmate from other inmates, or to protect other inmates from one particular inmate. 

2. Per se: In itself

3. De facto: In effect

4. Prosecution: Conducting legal procedures against a person or an organisation

5. Pelvic: Lower part of the human body consisting of the region between the abdomen and thighs 

6. Incarcerated: Imprisoned

7. Shackled: Tied up

8. Embolic: A material that causes a blockage inside a blood vessel 

9. Latent: Existing but not yet manifesting the usual symptoms 

10. Prevalence: The proportion of a particular population found to be affected by a medical condition at a specific time

REFERENCES:

1. Smith, M. (19 October 2019). Alexander Paterson, Youth Work and Prison Reform. Infed. Retrieved April 1 2020. [Online] Available from: https://infed.org/mobi/alexander-paterson-youth-work-and-prison-reform/

2. Anonymous. “Estelle v. Gamble.” Oyez. Retrieved April 7 2020. [Online] Available from: https://www.oyez.org/cases/1976/75-929

3. “Estelle v. Gamble :: 429 U.S. 97 (1976). JUSTIA US Supreme Court. Retrieved April 7 2020. [Online] Available from: https://supreme.justia.com/cases/federal/us/429/97/

4. Yearwood, L. (24 January 2020). Pregnant and shackled: why inmates are still giving birth cuffed and bound. The Guardian. Retrieved April 1 2020. [Online] Available from: https://www.theguardian.com/us-news/2020/jan/24/shackled-pregnant-women-prisoners-birth

5. Kajstura, A. (29 October 2019). Women’s Mass Incarceration: The Whole Pie 2019. Prison Policy Initiative. Retrieved April 1 2020. [Online] Available from: https://www.prisonpolicy.org/reports/pie2019women.html

6. Corby, A. (August 2017). End The Use of Restraints on Incarcerated Women and Adolescents during Pregnancy, Labour, Childbirth and Recovery. American Psychological Association. Retrieved March 30 2020. [Online] Available from: https://www.apa.org/advocacy/criminal-justice/shackling-incarcerated-women.pdf

7. Anonymous. International Covenant on Economic, Social and Cultural Rights. United Nations Human Rights Office of the High Commissioner. Retrieved March 30 2020. [Online] Available from:  https://www.ohchr.org/en/professionalinterest/pages/cescr.aspx

8. Bick, J. (15 October 2007). Infection Control in Jails and Prisons. Infectious Diseases Society of America. Retrieved April 1 2020. [Online] Available from: https://academic.oup.com/cid/article/45/8/1047/344842

9. Al-Darraji, H. (10 January 2014). Latent Tuberculosis Infection in a Malaysia Prison: Implications For A Comprehensive Integrated Control Program In Prisons. BMC Public Health. Retrieved March 30 2020. [Online] Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-22

10. Bronson, J. (25 April 2019). Prisoners In 2017. Bureau Of Justice Statistics. Retrieved April 1 2020. [Online] Available from: https://www.bjs.gov/index.cfm?ty=pbdetail&iid=6546

11. Grabianowski, E. How Prisons Work: Crime and Punishment Inside Prisons. How Stuff Works. Retrieved April 7 2020. [Online] Available from: https://people.howstuffworks.com/prison3.htm

12. Anonymous. (16 November 2018) I had my baby in prison, so I know how jails are risking mothers’ lives. The Guardian. Retrieved April 7 2020. [Online] Available from: https://www.theguardian.com/commentisfree/2018/nov/16/baby-prison-jails-mothers-pregnant-women