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Physicians have asked for changes to the rules governing when terminally ill prisoners can be released earlier for humanitarian reasons, while the current approach is discriminatory.
Data obtained from the Ministry of Justice, shared with The bmj, indicate that end-of-life prisoners living in England and Wales are more likely to benefit from early release on humanitarian grounds if they have cancer than they were suffering from. other conditions, say the clinical researchers who examined the data.
Under current legislation, the Secretary of State for Justice may grant early release if there is a risk of harm to the inmate resulting from the current imprisonment, the potential benefits of release, a low risk of re-offending and appropriate arrangements to ensure safe care in the community. But most importantly, we must expect the prisoner's death "very soon" and the Prison and Probation Service of Her Majesty estimates that it will be within three months.1
Jim Burtonwood, Palliative Care Specialist, General Practitioner and Master of Science Student at Cardiff University, who led the research, said the current rules meant that the timelines were often too tight for a release request. anticipated success if recognition of the final decline was delayed or delayed. was a prognostic uncertainty.
He said The bmj"The current rules favor diseases such as cancer, with clear predictions or more predictable trajectories. We have seen that patient prisoners with chronic obstructive pulmonary disease, dementia or heart failure were the ones who tended to be rejected, usually because their prognosis was not clear enough for people to confidently decide on the ERCG. [early release on compbadionate grounds]. "
Official figures show that 184 prisoners died in natural causes in 2017, double the number recorded a decade ago 2, a trend largely attributable to the aging of the prison population.
As part of their study of the difficulties badociated with the provision of palliative care in prisons in England and Wales, the researchers addressed requests for access to information to the Ministry of Health and Home Affairs. Justice. They asked how many early release applications between 2013 and 2017 were successful and which underlying diagnoses.
Data show that in the past five years, 48 applications have been successful. The researchers were unable to obtain the total number of requests, but during the same period, 845 deaths related to natural causes were recorded in prison.
In 2017, the six inmates whose applications were successful had cancer. This is despite the fact that 39% of all expected naturally occurring deaths in English and Welsh prisons at that time were due to causes other than cancer.
Burtonwood said the current legislation could be found to be discriminatory under the Equality Act 2010 and should be relaxed.
He said: "In order to ensure parity across the spectrum of diseases, extending the" allowable "prognosis or perhaps recognizing the degree of uncertainty badociated with certain non-cancer diseases is going to be vital for the current rules to be do not lead to prejudices against patients with these conditions. "
It must be taken into account that most end-of-life inmates who do not have cancer (such as those with COPD or dementia) are referred to a general practitioner in a prison rather than a specialist, Burtonwood said. and difficult definitive prognosis.
He also noted that GPs in prison can feel pressured when they make a prognosis because of the potentially negative publicity that could result if a patient lived longer than expected.
"Some of the patients we're talking about may have received a lot of press coverage at the time of sentencing. We will therefore feel that it is a decision with high stakes in terms of prognosis. "
Mary Turner, a reader in health services research at the University of Huddersfield, who published previous research on palliative care in English prisons, said she agreed with this statement , citing the cases of suicide bomber Abdelbaset al-Megrahi and Trainerbie's Grand Train Robber Ronnie Biggs.
International comparisons
Turner said The bmj, "We could say that we [in the UK] tend to be a bit risk averse. A few high-profile cases in the past have provoked many controversies.
"It's too simplistic to say that the prison services or the government are at fault, but it is a very complex area that deserves to be examined closely. I think we still have a lot of work to do and I think we can learn a lot from international comparisons. "
Turner leads an international working group on behalf of the European Association for Palliative Care, which examines trends in palliative care in prisons in Europe, which could provide lessons for the UK.
"In the UK, the number of people released is very low, whereas in a country like France, a high proportion of their older prisoners are allowed to go out, sometimes with temporary relief, if they have health problems. Even if they are sent to a secure hospital, they are in a much more appropriate environment. "
In contrast, Turner said that older UK inmates with palliative care needs were often cared for in "totally unsuitable" settings for their needs. She referred to her own research, which found that 50% of the sample inmates were taking five or more medications.
Turner said that although some British prisons have created separate units for older inmates to better meet their needs or have hosted palliative care suites for end-of-life inmates, the provisions vary from one to another. country to another, often because of resources and funds constraints.
"There are pockets of very good work," she said. "But the problem is that it's not universal. It's up to the resources at the end of the day, because the prisons where they do not have enough health workers are fighting the fires and have neither the resources nor the luxury to do these detailed badessments and pick up those who might have the end of life care needs.
"There will be people in prison with heart failure or dementia, and they are not necessarily picked up."
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