A Doctor’s Challenge – the Hippocratic Oath in
Solitary Confinement
It has been said by many
that the medical field is an honorable profession that has high standards as
well as high expectations. There are many ethical values within the trade and
those most common are: the patient has the right to refuse or choose their
treatment – a practitioner should act in the best interest of the patient –
“first do no harm” - concerns the
distribution of scarce health resources, and the decision who get what treatment
(fairness and equality) – the patient and the person treating the patient have
the right to be treated with dignity – the concept of informed consent has
increased -
Doctors who work in public
owned prisons face an ethical difficulty every day. Their biggest challenge is
working in a dismal environment that seeks loyalty to employers rather than the
patients. The prison rules are strict and cruel for those who break the code.
Confronted with daily
challenges, doctors and nurses are increasingly stressed to look the other way
and mistreat or delay treatment of prisoners housed in solitary confinement.
This quandary is most complex and perplexing and not easy to correct without
impacting ethic related situations related to the treatment of these prisoners
that are isolated from general population and subject to obvious psychological
and physical harm while housed there.
It is not easy to define
torture yet when the mentally ill are housed here in these isolation cells,
every minute they spent there is torture. The substandard living conditions and
obvious barriers between patient and provider create deep chasms that are hard
to fill despite individual efforts to bring the problems to the surface
occasionally without serious harm or consequences. Professional attention is
precious as time doesn’t allow much interactions and thorough examination for
those housed in solitary confinement.
Solitary confinement has
been deemed to be a combination of stress, anxiety, depression and
hopelessness. Some claim no harm is done even during prolonged or long term
placements but clinical evidence is pointing to a different direction as
prisoners deal with constant psychological and physical torture to withstand
these stressors and overcome or survive their existence within these darkened
corridors and walls.
Many have been locked away
for decades and have already submitted to the ever increasing pressure to
remain human beings instead of becoming animals. Their mere existence within
these isolation cell areas creates violence and more difficult conditions for
staff to handle. This is most difficult for medical providers as their safety
is never assured when treating one of these isolation prisoners no matter how
heavily shackled they are when they arrive at the infirmary strapped tightly
onto a steel gurney with straps for the legs, the hands and the head along with
spit masks or other protective gear in place to avoid harm.
Strangely enough, such a
trip outside of their cell is a luxury many will brag about as they are locked
inside their cells 23 hours a day with perhaps 6 hours out for the week based
on good behavior or staffing available.
Living inside these small cells for such duration alone can turn any man
insane for wanting to claw out of their concrete box called a cell to be free
to move around a little, smell fresh air for a quick breath and feel the
sunshine on their face for just momentary satisfaction he is still alive.
The adverse living
conditions inside solitary confinement are significant factors to recognize for
doctors and psychologists assigned there for the purpose of treating the
mentally ill and the behavioral disruptive prisoners. They are exposed
psychotic episodes, suicides, and much too frequently self-harm gestures or
serious unstable where prisoners decompensate because of this isolation
creating crisis care almost 24 / 7 seven days a week. Since the option of
sending them to a psychiatric hospital is rarely provided, they must move them
to suicide watch cells where correctional staff is assigned to watch them and
preserve life if possible. Needless to say, the odds of these prisoners getting
better are almost nil to say the least.
Medical and mental health
providers rarely have the ability to mitigate fully the impact or harm created
by isolation. Mental healthcare is limited and only provided as a means to
ensure compliance with psychotropic medication that are “watch and swallow” but
time does not allow thorough inspections of the “swallow” thus many may “cheek”
their meds and trade them for something else.
Exams are rare [ and usually
done off-site] and based on critical status rather than preventive or routine.
There are no in-cell programs thus the occasional visit by a nurse or doctor is
welcomed with numerous complaints of pains, aches etc. just to get the
attention of another human being that is standing close to them without the
bars blocking their view or even brief contact as they take their vitals and
temp to record the visit as being performed.
The use of isolation cells
is not the question here. The use of segregation to confine the mentally ill is
also not the main interest in this presentation. The main focus of this article
is the lack of care provided due to strict physical plant limitations, the
non-existence of sound facilities for both medical and mental health treatment
services and the lack of adequate staffing to deal with this huge number of
prisoners kept in isolation cell areas in many states.
Because of these
limitations, many prisoners do not get the required care as needed and are
often at risk for complications or infections due to the delay of treatment and
the inability to treat them as often as necessary to meet mandated standards of
care established for both medical and psychological professionals hired to do the
job to take care of prisoners in solitary confinement. These contributors to
more dysfunctional and disabled persons inside the isolation cell areas impact
preventive care and intervention methods to adequately do their jobs.
Their jobs are difficult by
any standard. They work with persons neglected and out of scope of normality
thus acting bizarre, annoying or even potentially dangerous as they reach out
for help in their own manner or fashion to be treated.
One must wonder if their
oath applies when assigned within one of these isolation cell areas and if
their ethics can be compromised because of limitations imposed by their
employer and the associated budgeting and staffing associated with the delivery
of proper care and meeting minimum medical standards of care as established by
those who took the oath.
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