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Growing Old in Prison

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Given our national goal for decades of jailing as many people of color as possible for long periods of time, it’s hardly surprising that growing old in prison has become a major problem. Occasionally, the story ends with someone being let free after decades in prison. We saw that this week with the release of Albert Woodfox, the last of the Angola 3 to remain in prison, after 45 years in prison for a murder he almost certainly did not commit. That most of those years were spent in Louisiana’s notorious Angola prison under terrible conditions of solitary confinement (which by any moral standard is an obvious violation of the 8th Amendment, but of course that’s one of the amendments that don’t matter for so-called originalists). This is not a happy ending in any way, shape, or form, but at least he can live outside of his torture chamber.

More often though, long-term prisoners die there. What happens in these cases? What does hospice care look like in prison? To say the least, it’s a complicated issue and question that does not always serve prisoners well at all.

But such programs, according to the study, have two primary challenges: pain and trust. Pain management in a facility where drug use is rampant—and, indeed, a major cause of incarceration—is problematic. Doctors and nurses can find it hard to believe a patient who tells them he’s in pain. “A culture of suspicion emerged concerning the illicit drug trafficking of narcotics intended for pain relief,” the Palliative Medicine report states. The “macho” prison culture also prevented many in pain from admitting what they felt. But a larger issue, one difficult to measure, exists: “Prison healthcare staff may believe that prisoners deserve their suffering.” In other words, pain is punishment. Staff members tend to default on the side of pain over more medication when prescribing narcotics to hospice patients. In church parlance and even in broader society, the belief that pain makes us better people is commonplace. In prison, suffering is part of the centuries-old plan.

It’s also hard for prisoners to believe that staff members have their best interests in mind. Can you trust doctors who work for a system that controls every aspect of your life? A system that was established to punish, subjugate, discipline, restrain, subdue? Decisions to limit care (or not pursue every option) can make prisoners even more distrustful of their caregivers. Couple that with the requirement that, in 55 percent of prisons, patients must sign DNR orders before they can enter hospice, and a climate of deprivation, ill will, and doubt about the facility’s objectives can grow. Patient safety is tempered with a paternal “we know what’s good for you” attitude; prisoners who feel their lives are less valued think the system doesn’t care about them or is invested in getting rid of them. Yet sending prisoners to external hospices, as is done in the United Kingdom, or releasing those who are too ill to violate laws, is also a problem. The saddest sentence of the Palliative Medicine report is: “For some, the prison and its inhabitants are all that is familiar due to institutionalization.”

Just part of our society’s larger failings in the criminal injustice system.

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