Unethical Health Practices in US Prisons

The criminal justice system is littered with inequality: from predatory probation and parole, racial disparities in sentencing, and blanket impunity for police violence, many working in this space find it so morally repulsive that it’s sometimes referred to as the criminal “injustice” system (Harvard, 2021). This broken system is not free of ethical problems in a medical context, with utter neglect often assigned to the health of those held within prisons and jails. Incarcerated people are viewed as completely expendable: subhuman objects with an expiration date that has been predetermined through cruel and inhumane practices. As a consequence of this, their fundamental right to access equal and fair healthcare is undermined. Lawmakers have done little to no work to address these deep-rooted issues, and the onus is on us within the medical field to raise the alarm and stop the blatant mistreatment of our brothers and sisters within US correctional facilities.

According to a report from The Correctional Association of New York, incarcerated women face a tremendous lack of access to basic reproductive healthcare (Center for Reproductive Rights, 2014). 54% of women reported not getting sufficient sanitary products each month, with instances of women using notebook paper and torn shower curtains to wipe themselves when they had their periods (Marusic, 2019). Even more alarming, a whopping 85% of pregnant women reported being shackled during their pregnancies (The Guardian, 2020). Women (particularly pregnant women) occupy an already marginalized status, and the brutal disregard for their humanity which is present within the criminal justice system is a deep moral stain on our society. Those in the medical community should call attention to the debilitating health effects that such practices can have, and ensure that lawmakers pass laws protecting the humanity and health of incarcerated women.

The disregard for health doesn’t stop there, with incarcerated people being denied access to the very rehabilitation that they need in order to return as functioning members of society. According to a study done at the Public Policy Initiative, while approximately 65 percent of prison inmates in the US meet the diagnostic criteria for addiction, only 11 percent of those individuals receive any form of treatment while in prison (National Center on Addiction and Substance Abuse, 2010). The result of this lack of rehabilitation has been devastating, especially in that it has exacerbated recidivism rates and done absolutely nothing to address the addiction that leads to some drug-related crime in the first place.

Approximately 95 percent of incarcerated addicts will return to substance abuse after their release from prison (Martin, 1999). On top of this disturbing statistic, 60 to 80 percent of them will commit new drug-related crimes, yielding an enormously high recidivism rate and increasing the burden on an already strained criminal justice system (Marlowe, 2003). When considering the disproportionate enforcement of drug laws on minority and socioeconomically deprived groups, the criminalization of drug use is even more unjustified. Prison does little to address drug-related crime, and without rehabilitation, does absolutely nothing to address underlying issues such as addiction and dependence.

The solution to this problem is obvious: prison is not the place to send our suffering addicts. Drug use should be universally decriminalized, and addicts should be offered treatment services rather than overly-punitive, ineffective, expensive, and inhumane prison sentences. After empirical success in Portugal, drug decriminalization was implemented in Norway, the Netherlands, and Oregon (among other countries and localities) (Slade). The medical community in Canada has called for such decriminalization, and we should follow suit in the US (CBC, 2020).

The medical community should urge lawmakers to dramatically restructure how society views criminal justice. Pregnant women should not be shackled. There should be a concerted and deliberate shift of onus on rehabilitation rather than deterrence. Women should not be forced to create makeshift menstrual products with notebook paper. Most of all, the criminal justice system must be dramatically restructured to finally start treating our incarcerated people as just that: people, not subhuman and expendable objects.

References

1. Harvard University. (2021, August 20). Criminal injustice. Harvard University. Retrieved October 31, 2021, from https://www.harvard.edu/in-focus/unequal/criminal-injustice/.

2. Center for Reproductive Rights. (2014). Reproductive Injustice: Racial and Gender Discrimination in US Healthcare. Center for Reproductive Rights. Retrieved October 31, 2021, from https://tbinternet.ohchr.org/Treaties/CERD/Shared%20Documents/USA/INT_CERD_NGO_USA_17560_E.pdf.

3. Marusic, K. (2019, June 11). The sickening truth about what it's like to get your period in prison. Women's Health. Retrieved October 31, 2021, from https://www.womenshealthmag.com/life/a19997775/women-jail-periods/.

4. Guardian News and Media. (2020, January 24). Pregnant and shackled: Why inmates are still giving birth cuffed and bound. The Guardian. Retrieved October 31, 2021, from https://www.theguardian.com/us-news/2020/jan/24/shackled-pregnant-women-prisoners-birth.

5. The National Center on Addiction and Substance Abuse at Columbia University. (2010). Behind Bars II: Substance Abuse and America’s Prison Population. The Hill. Retrieved October 31, 2021, from https://thehill.com/sites/default/files/behind%20bars%20ii%20report%20final%202-24-10_0.pdf.

6. Steven S. Martin, C. A. B. (1999). Three-year outcomes of Therapeutic Community Treatment for drug-involved offenders in Delaware: From prison to work release to aftercare - Steven S. Martin, Clifford A. Butzin, Christine A. Saum, James A. Inciardi, 1999. SAGE Journals. Retrieved October 31, 2021, from https://journals.sagepub.com/doi/abs/10.1177/0032885599079003002.

7. Marlowe, D. B. (2003, August). Integrating substance abuse treatment and criminal justice supervision. Science & practice perspectives. Retrieved October 31, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851043/.

8. Slade, H. (n.d.). Case study - transform drug policy foundation. Transform Drug Policy Foundation. Retrieved October 31, 2021, from https://transformdrugs.org/assets/files/PDFs/Drug-decriminalisation-in-Portugal-setting-the-record-straight.pdf.

9. CBC/Radio Canada. (2020, July 25). Amid 'horrific' spike in opioid deaths, doctors call for decriminalization, regulation of Drugs | CBC Radio. CBCnews. Retrieved October 31, 2021, from https://www.cbc.ca/radio/day6/portland-protests-how-covid-affects-weather-forecasts-canada-s-opioid-crisis-love-on-the-spectrum-and-more-1.5660707/amid-horrific-spike-in-opioid-deaths-doctors-call-for-decriminalization-regulation-of-drugs-1.5660720.

Long-Covid: Should We Be Worried?

It’s 2021, and, for many of us, it is starting to feel like we are getting past the toughest part of the Covid-19 pandemic. People are getting vaccinated, and while mask mandates are still encouraged and enforced in many areas, they are starting to become less prevalent in vaccinated populations. This is what we’ve all been wishing for since the pandemic first began. Unfortunately, this is not the case for many patients and victims of Covid-19. Long Covid: what is it, what causes it and who does it affect?

Long Covid typically refers to symptoms that persist past 12 weeks after infection. These symptoms range from mild to severe and can have a detrimental effect on the patient’s health, as some patients are left unable to accomplish simple tasks such as showering or sleeping properly. Other markers of Long Covid can include tiredness, shortness of breath, heart palpitations, chest pain, changes to taste or smell, problems with memory and concentration, or joint pain. Additionally, several studies have reported up to 200 varying symptoms [1].

Even more concerning, doctors are not completely sure of what causes these symptoms. Several possibilities and theories are swirling around the medical community. For example, one prevalent hypothesis holds that it is caused by the patient’s immune system working overdrive to try to fight off the virus, leading the immune system to attack normal tissue that helps us perform daily functions. This is a terrifying thought; our immune systems are supposed to defend our body and tissues, not be the reason we are getting sick. Another theory posits that part of the virus stays in our bodies for months after, causing these lasting effects known as Long Covid for some. It is still too early to specify the exact cause, and several doctors believe that it could be a combination of several possibilities. Preliminary data is showing that this could be the case [2].

Regardless, Long Covid is something to be fearful and aware of, as it could affect any Covid-19 patient. The effects of Long Covid seem to be prevalent within all age groups, however, it is not yet statistically known how Long Covid affects children versus adults. For example, it has been observed that children display fatigue, depression, shortness of breath and other long-haul symptoms [3], but this is something that warrants further study. In addition to physical symptoms, the severe mental toll of Covid-19 cannot be ignored.Whether it be due to isolation or actually contracting the virus, and what that means for one’s health, it is important to pay attention and take care of your mental health throughout this pandemic process.

Long Covid is a scary reality for all of us, and it is key to remember that no one is alone in this battle. We are all struggling. We are all trying to make the best out of a horrible situation. Long Covid may still be a mystery, but we are all faced with its possible implications.

References

[1] Schraer, R. (2021, September 17). Long covid: What is it and what are the symptoms? BBC News. Retrieved October 22, 2021, from https://www.bbc.com/news/health-57833394.

[2] Marshall, M. (2021, June 9). The four most urgent questions about long covid. Nature News. Retrieved October 22, 2021, from https://www.nature.com/articles/d41586-021-01511-z.

[3] Covid 'long haulers': Long-term effects of COVID-19. Johns Hopkins Medicine. (n.d.). Retrieved October 22, 2021, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-long-haulers-long-term-effects-of-covid19.

Disability, COVID 19, and the Medical System

People with disabilities represent the largest minority in the United States, yet coverage on the pandemic rarely considers an analysis of how disabled people were affected by COVID - 19. Broadly, this lack of coverage is just one way by which ableism, discrimination against disabled individuals, manifests. Broadly, the COVID - 19 pandemic demonstrates the way by which ableism manifests itself as a system of power both in general society within healthcare systems. It's critical the field of medicine interrogates itself and shifts the paradigm by which it views care.

COVID - 19 served to illuminate the broader structures of ableism. To see evidence, one only needs to take a look at their computer screens. Accommodations that disabled people have been fighting for years to be the norm, such as hybrid/virtual meeting options and the ability to work from home to circumvent the barriers of transportation, access, and physical and mental stamina, were immediately put into place when nondisabled folks needed them to continue working during the pandemic. And, while this was celebrated as an example of our flexibility, resiliency, and determination as a broader society in “these troubled times,” for folks with disabilities in years prior, fighting for accommodations was seen as an act of narcissism and ungratefulness. As Lennard Davis, internationally known author in disability studies and Distinguished Professor of English at the University of Illinois at Chicago, wrote in his article Bending over Backwards: Disability, Narcissism, and the Law, that individuals who seek accommodations are given the perception they are “ attempt[ing] to claim themselves as an exception to the rules of society, which allows them to overstep the bounds assigned to normal people.” Rather than accommodations being seen as something that helps bring individuals with disabilities achieve equity with their nondisabled colleagues, it's been framed as a “benefit” that allows disabled people to unfairly get ahead. And now, as the world begins to open up and people return to personhood, many of these accommodations will disappear as well - despite them being successful - leaving people with disabilities back to their original position: fighting for equitable accommodations despite being seen as ungrateful.

And, it's worth highlighting, it's not just through the hypocrisy of accommodations that COVID exposed ableism - it's found everywhere. Disability activist Imani Barbarin, explores how anti-vaccination movements use ableism in their discourse, not wanting their children to get the vaccine, lest they end up with autism. The public shame of not getting a vaccine often ignores people with disabilities who medically can’t get the vaccine or lack the means of access to go to a clinic, and can unfairly force individuals to reveal their medical illnesses and disability. COVID - 19 overwhelmingly killed individuals in institutions, nursing homes, and hopices - areas where people with disabilities are found.

Along with the general population during this pandemic, the medical field too has struggled with its approach to disability. The case of Michael Hickson demonstrates many of these problems so effectively: rather than be given comparable quality of care to a nondisabled patient, Hickson died after he was refused treatment for COVID - 19 as he was a disabled parapalegic, lacking sufficient “quality of life” and therefore was “taking” resources belong to someone else. During this pandemic especially, with healthcare workers being told to divert resources to patients who have the best possible outcome for care - a metric that excludes disabled people, who are often considered to have a worse quality of life by the simple virtue of having a disability, even though that is just not true. But it would be wrong to argue this was a one time situation brought on by the Pandemic. In her essay, Healthcare as Eugenics, Ani B. Satz, professor of law at Emory University, draws comparisons between the logics of past historical movements of eugenics, which sought to eliminate disability through state run programs of sterilization of disabled folks and the creation of disabled movements, and the current field of medicine. Both the field of medicine today and past eugenics movements were centered on eliminating disability, seeking to “cure” the population and push for typical forms of functioning, such as surgery, rather than look for atypical modes of function, power chairs, that may lead to the best outcomes for patients. Satz writes “Healthcare seeks to prevent, ameliorate, or eliminate disability with the goal of normalizing individuals.'' This creates the perception of associating disability with loss and stigma, sending a message that “the lives of individuals with disabilities are not as valuable as the lives of individuals who function typically.”

COVID- 19 has certainly exposed the ways which ableism manifests within society and healthcare, but it's deeper roots within modern healthcare signal a need for the medical field to shift its paradigm from one of a medical, cure focused approach of removing disability to a more social, patient centered model of care. This model doesn’t say that curing patients is flawed or wrong, but rather we refocus our care around what's best for the patient outcomes that fits what the patient desires. This approach begins at the medical school level, where adopting disability conscious medical training, which Dr. Quirici, Dr. Doebrich, and Dr. Lunsford describe as “draw[ing] on insights from intersectional disability justice activism” to “improve upon competency programs by utilizing disability studies and the principles of disability justice to guide us in the critique of norms, traditions, and institutions to more fully promote the respect, beneficence, and justice that patients deserve.”

References

1. Barbarin, Imani. "Death by a Thousand Words: COVID-19 and the Pandemic of Ableist Media," Refinery 29, https://www.refinery29.com/en-us/2021/08/10645352/covid-19-and-the-pandemic-of-ableist-media. Accessed 20 Oct 2021.

2. Davis, Lennard. “Bending over Backwards: Disability, Narcissism, and the Law.” March 2000. Berkeley Journal of Employment & Labor Laws. vol 21, Issue 1, 2000, Accessed 10 October 2021.

3. Doebrich, Adrienne, Quirici, Marion, and Lunsford, Christopher. ‘COVID-19 and the Need for Disability Conscious Medical Education, Training, and Practice’. 1 Jan. 2020 : 393 – 404.

4. Pulgrant, Andrew. “How The Disability Community Is Still Conflicted About COVID-19,” Forbes, https://www.forbes.com/sites/andrewpulrang/2021/08/31/how-the-disability-community-is-still-conflicted-about-covid-19/?sh=73bbe7d3517d. Accessed 20 Oct 2021.

5. Satz, Ani B. “Healthcare as Eugenics.” Duke University Goodson Law Library. Accessed 20 October 2020.