The Ethics And Practicalities Of Dealing With Prisoners Who Are Growing Old And Dying In Custody
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It may surprise you to learn that there are prisoners in the UK who are now into their 70s, 80s and 90s. There is even one aged over 100. The “tough on crime” policies of recent decades have resulted in harsher sentences and reduced opportunities for early release, which means that offenders now spend longer in prison than they would have done previously for the same crimes. Across the world, the number of incarcerated people is steadily increasing and now stands at around 11m, even though in most societies levels of crime are actually falling.

As sentences grow longer there are more people growing old in prison. In England and Wales, the number of prisoners aged over 60 is rising faster than any other age group, and government projections are that this trend will continue into the foreseeable future.

The Prison Reform Trust has identified four distinct groups of older prisoners. These are repeat prisoners, those who are in out of prison for less serious offences and who find themselves in prison when older; those who have grown old in prison who were handed a long sentence before the age of 50; first-time offenders given a short prison sentence; and first-time older prisoners given a long sentence.

A specific issue with this population (particularly the first-time older prisoners) is the nature of their offences: 45% of male prisoners aged 50 and over are convicted sex offenders, and this number rises to 87% of the over 80s. Sex offenders are amongst the most vilified of prisoners, particularly those who have offended against children. In prison they are often contrasted with “ODCs” – “ordinary decent criminals” – who while they might be burglars or drug dealers are viewed as having at least some sort of moral decency. So it’s not surprising that older prisoners in general and sex offenders in particular elicit little public sympathy, even when they are approaching the end of their lives in custody.

However, HM Prison and Probation Service faces an increasing challenge to provide appropriate and safe custody for older prisoners. My research has shown high levels of frailty and vulnerability in the older prisoner population, including multiple complex health and social care needs, and challenges associated with having to take multiple medicines regularly. Many prisons are simply not suitable for old, frail people, and the equipment and resources needed to care for them are often not available. Prison staff with responsibility for older prisoners need adequate training and support, particularly when dealing with deaths in custody.

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Justice and security

Ageing and dying in prison poses important questions about ethics and justice. Like it or not, sex offenders have human rights. The United Nations General Assembly has endorsed a set of standard minimum rules for the treatment of prisoners, known as The Nelson Mandela Rules, which includes rules governing healthcare. Rule 24 states: “Prisoners should enjoy the same standards of health care that are available in the community, and should have access to necessary health-care services free of charge without discrimination on the grounds of their legal status.”

The End of Life Care Strategy for England and Wales also states clearly that all people approaching the end of life should be able to access high quality care, regardless of who or where they might be. So the prison service has a duty to provide adequate and equivalent care to those dying in prison.

What sort of solutions are available? It’s clear that either the numbers of older prisoners need to be reduced, or far greater resources need to be provided to keep them in custody. Reducing the number of older prisoners would entail using alternatives to custodial sentences, shorter sentences, or releasing more of them on compassionate grounds near the end of their lives. But there are undoubtedly some prisoners who would re-offend if released, so this would require a careful case-by-case assessments. Inevitably, sometimes the decision would be wrong.

On the other hand, if society decides to continue to imprison increasing numbers of older people, then adequate facilities – secure care homes, for example – need to be built, urgently.

In 2013 the House of Commons Justice Committee stated that the needs of older prisoners were “distinct from the rest of the prison population”. It recommended that the growing older prisoner population required a national strategy “to remove inequity of provision and maintain minimum standards”. Six years on, there is little sign of such a strategy, and prisons and prison staff must still try and cope with the challenge in an unplanned and under-resourced basis.The Conversation

About The Author

Mary Turner, Reader in Health Services Research, University of Huddersfield

This article is republished from The Conversation under a Creative Commons license. Read the original article.