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