Viewpoint: Will I stay or can I go? Assisted suicide in prison

Abstract

Assisted suicide (AS) is a controversial practice with which physicians and nurses are confronted more and more often. In Switzerland, it is available for Swiss residents and in certain cases for foreigners. Prisoners meet the same prerequisites for AS as the general population and should therefore be eligible for it. Ethical issues, such as informed choice and the autonomy of prisoners, and organizational questions need to be addressed. They must not lead to a denial of this practice. Even though prisons constitute a special area of work for medical staff, it is important to address the possibility of AS in prison openly. This can raise awareness of the difficulties health-care professionals face working in closed institutions.

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

“…Beyond emphasizing the importance of release protocols (whether expedited or not), the unique challenges of MAiD in the prison context extend beyond access to release. Choice and agency at end-of-life should be available within the prison itself as well, equivalent to what is offered in the community, and particularly for those who wish to die among their prison family ( Handtke & Bretschneider, 2015 ; Urwyler & Noll, 2020 ). The CSC MAiD guidelines appear to present significant barriers to remain in a CSC institution if that were the patients’ preference.…”

“…Deliberations about MAiD MD-SUMC ought to include discussions and policy decisions around the implications of the expansion of eligibility criteria for people in the custody of CSC. In addition to safeguards and capacity assessment measures that will be created for the general public, extra measures should consider both prison weariness ( Handtke & Bretschneider, 2015 ; Handtke & Wangmo, 2014 ) and psychological suffering. If MAiD eligibility expands to include access to assisted dying for reasons of mental illness, consideration will have to be given to whether there ought to be a differentiation between MAiD requests due to an ongoing and incurable mental disorder, and MAiD requests due to psychological suffering that could be relieved if a person’s circumstances were different.…”

“…Beyond reviewing the limited scholarly literature that exists on assisted dying for prisoners in Canada (Downie et al, 2019) and globally (Devolder, 2016;Handtke & Bretschneider, 2015;Harrington, 2004;Messinger, 2019;Reichstein, 2020;Schildkraut, 2013;Shaw & Elger, 2016;Urwyler & Noll, 2020), we acquired and reviewed Canadian documentation related to EOLC and MAiD that was available publicly online (CSC 2017b Guideline 800-9: Medical Assistance in Dying; OCI reports for the years 2017, 2019, 2020OCI and CHRC 2019 report Aging and Dying in Prison: An Investigation Into the Experiences of Older Individuals in Federal Custody), available through Access to Information and Privacy (ATIP) requests (CSC data on applications and approvals; CSC 2009 Hospice Palliative Care Guidelines for Correctional Services Canada), and made available through direct release to us (Parole Board of Canada [PBC] data on applications and approvals for release). In this paper, while we include a brief overview of some of these documents because they compose the policy context of MAiD and Canadian prisons, we focus our findings and the majority of our analysis and discussion on the primary research data that we elicited from the prisoner interviews.…”

Relational dignity and assisted dying for persons deprived of liberty

“…In Switzerland, for example, once a PDL has been granted compassionate release, they have the same access to assisted dying organisations as everyone else. However, being able to receive this assistance in prison is much less likely (Shaw and Elger, 2016), though not prohibited (Handtke and Bretschneider, 2015). While in Belgium and Switzerland cases have been reported of PDL asking for an assisted death [6], there are no known cases in The Netherlands, Luxembourg or Spain.…”