THE ETHICS COLUMN
Do Prisoners Have a Right to Die?
By Jacob M. Appel, MD, JD
Belgium has prohibited capital punishment since 1996; the country has not actually executed anyone since 1950. The Belgian parliament legalized voluntary euthanasia in 2002—not just for the terminally ill, but for others experiencing profound physical and psychological suffering. The latter have controversially included a pair of deaf twins going blind and a transsexual unsatisfied with a botched operation. Recently, these two progressive trends—a concern for the rights of prisoners and for the autonomy of medical patients—have come into potential conflict as the European nation
A Belgian senator and advocate for prisoners’ rights, Louis Ide, revealed in September that Frank V.D.B, a convicted murderer and rapist, had been euthanized upon request after his petition was approved by three physicians. Another convict who has already served 27 years for homicide has also filed a request for assisted suicide. Unlike requests for aid-in-dying by free citizens, which have become increasingly routine in Belgium, The Netherlands and Switzerland, such a plea by an inmate serving a long sentence raises challenging ethical questions.
On the one hand, the fundamental principles of human rights demand that incarcerated individuals have access to healthcare. If voluntary euthanasia is conceived of as part of a package of medical services that prevent suffering, surely prisoners should not be denied equal access. On the other hand, prisoners are a vulnerable population whose liberty is sometimes curtailed for their own welfare. For example, we do not allow prisoners to participate in many medical experiments or pharmaceutical trials, even if they voluntarily consent, for fear of coercion. Some critics of euthanizing prisoners fear that inmates will fall victim to similar duress. As a just society, we certainly want to avoid the possibility that the state will induce prisoners to choose suicide through providing sub-standard prison conditions to render life intolerable.
Permitting aid-in-dying to prevent intractable psychological suffering raises distinctive ethical challenges. When such suffering arises from chronic pain or sensory deprivation, an analogy can be drawn to terminal illness. But what if the intractable psychological suffering is the tedium and loss-of-control inherent in prison life? In short, what if the punishment and the suffering are one in the same? Should voluntary euthanasia be a backdoor to voluntary capital punishment? And if not, what rationale exists for separating one form of suffering from another?
The answer to these questions may boil down to our rationale for imprisonment. If the goal of incarceration is punitive, one can make a strong case against euthanasia, as it robs society of an opportunity to inflict vengeance. However, if the purpose of imprisonment is to protect society from danger, then affording convicts the right to end their own lives seems reasonable. Of course, if the goal of prison is rehabilitation—and maybe I am naïve to believe that anybody still thinks this—then we need to reconfigure prisons so that inmates retain hope. In a prison designed to rehabilitate, we could be confident that those inmates choosing aid-in-dying would be doing so of their own meaningful volition.#
Jacob Appel, a physician and attorney, is a psychiatrist at Mt. Sinai Hospital in NYC.
