“Dying with a Smile, Just Knowing that Somebody’s Listened to Me”: End-Of-Life Care and Medical Assistance in Dying in Canadian Prisons

Abstract

Medical assistance in dying (MAiD) has been legal in Canada since 2016 and some incarcerated patients who are at the end of their lives are eligible for the procedure. Interviews with nine incarcerated men at a federal penitentiary in Canada provide insight into some of the ways that people who are navigating aging and end-of-life in prison think about MAiD. Interview themes are organized around: experience with death and dying; possibilities and barriers related to applications for release from prison at end-of-life; experiences of peer-caregiving in a prison palliative care program; support for MAiD and the expansion of eligibility criteria; what a good death looks like. Themes are contextualized alongside federal guidelines related to end-of-life care (EOLC) and MAiD for prisoners, highlighting that sound policy requires both generalizable principles and attention to nuance. MAiD rests on patient voluntariness, and thus autonomy over EOLC decisions is paramount for prisoners.

Assisted dying requests from people in detention: Psychiatric, ethical, and legal considerations–A literature review

“…Older prisoners supported the idea of compassionate release for reasons of age and illness, but they also reported contradictory experiences in reality (47). Prisoners treated in specialized facilities for end-of-life care described the care they received as positive, but they also perceived health care needs as being subordinate to security needs (34).…”

“…However, compassionate release programs-as promoted in several countries-have largely failed to reduce the number of seriously ill prisoners, mainly because the application and review processes are so slow that some prisoners die before completing them (33). Moreover, security concerns may impede the referral of prisoners to hospital and palliative care, not to mention that few requests for referral to palliative care are approved (34).…”

“…Canada reported a total of 7,595 cases of medical assistance in dying in 2020 (72). Only a very small fraction of these cases are related to PID: As of August 2020, prisoners in Canada had made 11 AD requests, three of which were granted (34). In Belgium, a study from 2015 reported that 17 requests had been made by long-term prisoners who were motivated by the constant and unbearable psychological suffering of detention; all requests were eventually declined (28).…”

“…This demand will most likely increase in the future (1,22) as countries are confronted with aging (prison) populations (33), who will experience the same aging-associated medical conditions as the general population. Furthermore, a relevant proportion of the individuals in preventive detention lacks realistic prospects of release because of the risk of recidivism, which could be an additional catalyst of demand for AD as people become weary of further detention (22,34). Wellcalibrated standards for AD in detention settings clearly are of high importance, considering that life is at stake.…”

When Prisoners’ “Right to Die” Goes Online: A Case-Study of Legal and Penal Sensibilities

“…Beyond the content of Guideline 800-9 and the other directives and authorities cited in that guideline (see e.g., Downie, Iftene, and Steeves, 2019), as well as a recent study of how inmates in a Canadian penitentiary navigate end-of-life care and view MAiD (Shaw and Driftmier 2021), little is publicly known about MAiD in prisons (also see Shaw and Elger, 2016;Stensland and Sanders, 2016). The Office of the Correctional Investigator released an annual report in 2019-2020 that identified "three known cases of MAiD in federal corrections, two carried out in the community" (OSC 2020), but the report does not say much more than the Correctional Investigator's recommendations to expand access to compassionate 1 Carter v Canada, 2015 SCC 5, para 2.…”