Psychiatry and the dying prisoner

"Dying with a Smile, Just Knowing that Somebody's Listened to Me": End-Of-Life Care and Medical Assistance in Dying in Canadian Prisons

Medical assistance in dying (MAiD) has been legal in Canada since 2016 and some incarcerated patients who are at the end of their lives are eligible for the procedure. Interviews with nine incarcerated men at a federal penitentiary in Canada provide insight into some of the ways that people who are navigating aging and end-of-life in prison think about MAiD. Interview themes are organized around: experience with death and dying; possibilities and barriers related to applications for release from prison at end-of-life; experiences of peer-caregiving in a prison palliative care program; support for MAiD and the expansion of eligibility criteria; what a good death looks like. Themes are contextualized alongside federal guidelines related to end-of-life care (EOLC) and MAiD for prisoners, highlighting that sound policy requires both generalizable principles and attention to nuance. MAiD rests on patient voluntariness, and thus autonomy over EOLC decisions is paramount for prisoners.

Assisted dying requests from people in detention: Psychiatric, ethical, and legal considerations-A literature review

The principle of equivalence of care states that prisoners must have access to the same standard of health care as the general population. If, as recent court decisions suggest, assisted dying is not limited to people with a terminal physical illness or irremediable suffering, it might also be requested by people with severe mental illness in detention. Some of the countries with legal regulations on assisted dying also have recommendations on how to handle requests from prisoners. However, detention itself can lead to psychological distress and suicidality, so we must consider whether and how people in such settings can make autonomous decisions. Ethical conflicts arise with regard to an individual's free will, right to life, and physical and personal integrity and to the right of a state to inflict punishment. Furthermore, people in prison often receive insufficient mental health care. In this review, we compare different practices for dealing with requests for assisted dying from people in prison and forensic psychiatric facilities and discuss the current ethical and psychiatric issues concerning assisted dying in such settings.

Prescription of pain medication in prisons: A comparative analysis of younger and older male prisoners

PURPOSE

In prison populations, treating pain is particularly challenging, especially for the growing number of older prisoners. The objective was to find out about prevalence, frequency, and types of pain medications prescribed to older prisoners (≥50 years) in comparison with younger prisoners (<50 years).

METHODS

Data were collected in Switzerland as part of a study on ageing prisoners' health. Fifteen prisons (out of 26 of the total eligible population) agreed to take part, and data from medical records of 190 older and 190 younger male prisoners were analysed. Descriptive statistics on pain medication prescriptions (excluding drugs used in opioid dependence) were carried out and differences between the 2 age groups tested for statistical significance.

RESULTS

More than half of younger and older prisoners were prescribed pain medication during the past 180 days, while 10% of younger and 15% of older prisoners were prescribed pain medication on a daily basis. Nonsteroidal anti-inflammatory drugs and "other analgesics and antipyretics" were most frequently prescribed. Significantly (P < .05), more younger than older prisoners were prescribed NSAIDs and drugs to treat muscle skeletal pain. Tramadol was the opioid most often prescribed.

CONCLUSIONS

This is the first empirical study investigating prescriptions of pain medication in Swiss prisoners on a national level. It shows that nonopioid pain medication is an important part of health care provision inside prison, while there are only few prescriptions of strong opioids. Research is needed to investigate whether the standard set by the principle of equivalence is met regarding treatment of pain in prison.