Medical Treatment and Mentally Incompetent Inmates

Article excerpt

Health care is one of many challenges facing prison administrators today. Longer mandatory senttences fewer early releases and an overall "graying" of the American population have led to a steady increase in the number of inmates older than 50. Older inmates, like older Americans in general, usually require more health care treatment than younger inmates. It is clear that prison administrators must address the medical needs of such inmates. But what are the considerations when inmates are unwilling to consent to treatment or are unable to actively participate in their health care because of age or infirmity? Consider two examples.

"Ronald" is a 63-year-old diabetic inmate. His treatment is difficult because he suffers from vascular dementia and is completely dependent on medical staff for assistance with nearly all his daily living activities, including bathing and eating. Ronald requires constant monitoring and prompting to ensure he takes his medication.

"Patricia" is a 31-year-old inmate with end-stage AIDS. Patricia has developed numerous brain lesions that severely affect her ability to communicate and comprehend information. She barely remembers most of the people with whom she has daily contact in the infirmary. Her psychiatrist has determined that she is functioning at about the mental level of a 2-year-old. Although Patricia generally agrees to take the medication necessary to control her condition, she occasionally refuses. Each refusal places Patricia closer to immediate and severe health risks.

Patricia's and Ronald's cases are typical of the situations correctional health care providers face in Pennsylvania and nationwide. Pennsylvania's correctional institutions exercise care, custody and control over approximately 37,000 inmates, more than 1,500 of whom are older than 55. More than 20 percent of the inmate population has mental health concerns or are confined to a long-term care or special needs unit. Each of those inmates likely will require some level of medical care during their incarcerations. Many of them will be unable or unwilling to consent to treatment when it is needed. Providing adequate care to those inmates in a manner that also conserves limited administrative resources is an important and often difficult issue for correctional managers.

The Pennsylvania Department of Corrections (DOC) treatment protocol includes identifying the legal options that best address the lack of inmate consent in both a timely and legally complete manner. Often, timeliness is the most important consideration. If an inmate's medical condition is immediately life-threatening, some of the available legal options are too slow to be of practical use. The remainder of this article discusses the legal options available in Pennsylvania. Most, if not all, of these options are available in some form throughout the country.

Bodily Integrity and the Right To Refuse Medical Treatment

Before discussing the options available when inmates are unable or unwilling to consent to medical treatment, it is perhaps best to explain the concept of consent itself. The doctrine of informed consent arises from one of the U.S. Supreme Court's earliest decisions relating to the right to privacy. In that decision, Union Pacific Railway Co. v. Botsford, 141 U.S. 250, 251, 11 5. Ct. 1000, 1001, 35 L. Ed. 734 (1891), the Supreme Court declared, "No right is held more sacred, or is more carefully guarded by the common law, than the right of every individual to the possession and control of his own person ..." At its most basic level, informed consent is nothing more than the legal recognition that people generally have the right to decide what will and will not be done to their bodies. That includes the right to decide whether to take medication or permit surgery.

Courts in Pennsylvania and nationwide recognize that patients generally have the right to refuse medical treatment. Like many rights, however, it is not absolute. …