Abstract

Excerpted From: Sydney Manning, Healthcare in Carceral Settings: Providing Alternatives for the Medically Vulnerable Incarcerated Person, 22 Seattle Journal for Social Justice 747 (Spring, 2024) (287 Footnotes) (Full Document)

It is no secret that carceral environments are uncomfortable by nature--people who are incarcerated are confined in space, regimented in schedule, limited in possessions as well as contact with the outside world, and bound to a place that can be dirty, violent, and dangerous. In the United States, a correctional facility is a place of punishment, not of recovery, and the environment has a reputation for being harsh compared to the standards of many wealthy and industrialized nations, such as Northern European nations which practice a minimalist approach to punishment. For most, such a facility is an unpleasant environment. But for some, this environment is much worse--it is torturous; it is deadly.

People with disabilities are overrepresented in the American penal system, yet there has been shockingly little success in meeting appropriate standards of care for them. Programs and activities are not always made accessible to those with a sensory impairment, which denies these individuals the ability to learn new skills and form social connections. People with physical impairments may be unable to navigate narrow corridors or leave their cell at all, thus inadvertently subjecting them to solitary confinement without justification. Moreover, they are sometimes deliberately housed in solitary confinement “for their own safety” when the general environment cannot be made safe for them. Unfortunately, incarcerated people with disabilities are subjected to violence and abuse from both the guards and the fellow incarcerated at an extreme rate.

Complex medication management is challenging in a carceral setting, especially with effective self-management being at odds with security concerns. As a result, people may be unable to access necessary medical supplies when incarcerated, leading to serious health consequences without intervention. These problems are continuously exacerbated by the increasing population of incarcerated people with disabilities. Not only do the overall incarceration rates continue to climb, but the average age of incarcerated people is also increasing, consequentially creating a growing class of elderly incarcerated people with age-related conditions and disabilities. These factors together indicate that concerns for the management of health conditions and disabilities in the carceral setting will only increase over time.

Without appropriate accommodations and medical care, imprisonment unavoidably imposes torturous conditions--isolation, pain, and illness--in violation of the Constitution. The penal system's failures to create appropriate environments and provide adequate medication and health management have led to catastrophic results, as will be discussed throughout, for incarcerated people who are medically vulnerable. As a result, they are subjected to indignities belying recognition of their humanity, and conditions far beyond what society would ever intentionally mete out as punishment. In recognition of offenders with needs that cannot be appropriately managed in such settings, it is time to look at how, and whether, these vulnerable populations should be imprisoned.

This article seeks to understand the nature of the carceral system's failure to care for its people with physical disabilities and other health vulnerabilities before suggesting a more progressive and compassionate approach. It will focus on incarcerated individuals made physically vulnerable by their conditions, recognizing that the complexities of mental and developmental disabilities within the carceral system are out of the scope of this analysis.

First, this article will detail how people with disabilities have been treated in carceral facilities historically, along with the reforms that sought to remedy these practices. It will describe current standards of care, and how they fall short of the protections that all people--including incarcerated people--deserve. It will also detail myriad ways that the current system fails to live up to even those minimal standards. Next, this article will summarize the shortcomings of previous solutions that have been proposed or attempted. Finally, it will propose a new solution to how society must approach these issues with the most vulnerable offenders and describe several potential options for future pursuit.

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To care for the vulnerable means caring even when someone has been convicted of a crime. To subject the vulnerable to incarceration and the horrific consequences that result is at odds with principles of law and justice as well as moral and ethical inclinations. It is time to recognize that a person does not lose their right to dignity or become less worthy of protection when they are convicted. It speaks volumes about society that it has not yet adopted a new path forward, and the existence of the several alternatives this article proposes demonstrates that the incarceration of vulnerable people is not the only path forward. The author hopes that by sharing these contrasting solutions these suggestions of expanding judicial discretion, implementing new sentencing alternatives, and considering the health and safety of the convicted individual when determining their sentence may bring forth changes in the carceral system and inspire lawmakers to think critically about how, and whether, to incarcerate vulnerable offenders.