One doc’s point of view

2 Book CoversYesterday, I wrote about the Canadian Supreme Court’s decision on physician assisted death. Dr. Bill Wright, the doc who has written two books featured in these pages on prison medicine, wrote me. He offered these thoughts and has allowed me to reprint them:

“I’m not afraid of death; I just don’t want to be there when it happens.” ― Woody Allen

Since I’m not literate enough in legalese to interpret the Canadian Supreme Court’s decision, I’ll present the medical side.

Doctors are philosophically split on the issue of physician-assisted suicide, just as they are on issues like abortion. It’s fine to have these differences as long as they don’t interfere with the job we signed up for — taking care of patients.

I take care of end-of-life patients every day. I have patients who cling to life despite incredible incapacity and physical pain. Others with incurable illness may not be that physically disabled yet, but they see the handwriting on the wall and don’t want to experience what they see as a horrible end to their lives.

As their physician it’s not my responsibility to make the decision about ending life for them. It is my responsibility to be their advocate, helping them to understand what the nature of their disease is and the treatment options available. One of the options, I believe, is to throw in the towel.

That doesn’t mean that it’s the best option, but right now in Colorado it’s not an option at all.

The law says I have to stand by the bedside of my patient with an abdomen swollen to obscene proportions from end-stage liver disease and simply watch until he eventually vomits enough blood to exsanguinate. There’s something wrong here.

Assuming my patient says he’s tired of this existence and wants to end it, telling him that he has to stick it out until the grim reaper decides to amble by one day in the indefinite future is cruel in the extreme.

Some argue that hospice care keeps such a patient comfortable, but lying in that pool of desolation taking narcotics is not what most of us would see as comfortable. We wouldn’t allow one of our pets to endure such misery, and yet we deny the same surcease to our fellow humans.

Since Brittany Maynard’s death, more states, including Colorado, are pursuing “death with dignity” statutes. It can’t come too soon for me.

Bill Wright, M.D.
2/8/15

My thanks to Dr. Wright. We probably should listen closely to physicians who will see us through to the other end, whatever that might be.

RGK

Dr. Bill Wright on another way to run a prison

wright

I have previously written about Doc Wright, and his fabulous book Maximum Insecurity. Dr. Wright has written a new book that I hope to review soon. Jailhouse Doc is a memoir of his time as Medical Director of the El Paso Criminal Justice Center in Colorado Springs.

“Hoards of desperate people fresh from the streets, homeless addicts, illegal aliens, and gangbangers all ruled by a corrupt sheriff and his concubine sidekick made the supermax look almost pastoral. Told with humor and biting wit by the best-selling author of Maximum Insecurity, Jailhouse Doc follows Dr. Wright and his struggles with scamming inmates, corporate bureaucrats, and a sheriff who wants to be a doctor.”

For now, I am privileged to post Chapter 30 of Jailhouse Doc.* If  you care about prisons and inmates and money and crime and recidivism and humanity, you will be interested in Wright’s serious observations about another way to run a prison:

 

Chapter 30 – Philosophy: Enter at Your Own Risk

America is the land of the second chance—and when the gates of the prison open, the path ahead should lead to a better life.” – George W. Bush

In my country we go to prison first and then become President.” – Nelson Mandela

 

After nine years at this game of correctional medicine, I’ve got some thoughts on jails, prisons and in particular our system in the U.S. We’ve got lots of agendas when it comes to putting people behind bars, and not all of them seem very productive.

The first thing to remember is that most people in jails and prisons get out. They’re your neighbors again, working (or not) in your community around you, your spouse, and your children.

It’s a sad fact that the majority of people released from U.S. jails and prisons commit further offenses and head back behind bars again to repeat the cycle. What’s wrong with these guys? Didn’t they learn their lesson the first time?

Well, they did. They just learned the wrong lesson.

When someone commits a crime against another person, there’s a lot of emotion on both sides. What we want is for everything to be put back the way it was, like nothing ever happened. In this world, that’s not going to happen.

As the next best thing, society wants punishment of some kind. Just like when we were children, if we did something wrong and were punished, we’d learn to not do that again.

It seems reasonable, but it makes a lot of assumptions.

It assumes we’re in an environment where we have a model for better behavior and encouragement to follow that model. Jail isn’t famous for being a nurturing and supportive environment. Mom and Dad aren’t here, but Professor Butch and Professor Bubba are. Guess what the lesson today is. Breaking and Entering 102 or maybe Sexual Predation 203. Most inmates don’t learn new skills in jail; they learn new hustles.

So what do we do with thieves, rapists, and murderers? We might take a look at the Swedish model.

At over 700 imprisoned per 100,000, the United States leads the world in incarcerating its citizens. That’s like locking up the entire population of Houston, Texas, the fourth-largest city in the U.S. It’s more than ten times the rate in Sweden. The incarceration rate, while climbing in the U.S., is falling in Sweden, down a whopping 6 percent last year. Are we missing something?

If you look at prisons in Scandinavia, like Skien maximum security prison in Sweden or the island prison of Bastoy in Norway, we see a very different physical setup from supermax prisons in the U.S.

In Colorado’s maximum security prison, Colorado State Penitentiary (CSP), inmates are confined 23/7 to individual cells with steel bunk, desk, stool and toilet. A solid steel door with a tray slot for passing medication and food is the only contact a prisoner has with the outside. Exercise is also solitary in a spare room with a chin-up bar as the only furnishing.

In Sweden, their prison rooms look like a Motel 6 with TV, computers, bookshelves, rugs on the floor, curtains at the windows and separate areas for reading and recreation. The prisoners, with some exceptions, aren’t isolated, but are part of a community where each has a job with responsibilities and free time. They live in small, brightly painted wooden bungalows that accommodate up to six people.

Every man has his own room, and they share kitchen and other facilities. The idea is to get them used to the social situation they’ll encounter when they’re released. They earn about $10 per day and get a food allowance of about $120 per month. They fix their own breakfasts and dinners from items available in the prison’s supermarket.

For these prisoners, loss of freedom is their only punishment. Administration puts emphasis on cultivating individual responsibility and functioning in a community environment. Recidivism is about 30 percent in Sweden and only 16 percent for those released from Norway’s Bastoy prison, versus 65-70 percent in the U.S.

Bastoy’s governor, Arne Nilsen, a clinical psychologist by profession, makes a point: “In the law, being sent to prison has nothing to do with putting you in a terrible prison to make you suffer. The punishment is that you lose your freedom. If we treat people like animals when they are in prison, they are likely to behave like animals when released.”

Granted when I went to work at CJC I’d already had years of experience in corrections, but many start the job with zero corrections knowledge. In contrast, Norway requires three years of training to become a prison guard.

So is treating prisoners like human beings rather than people who should be shunned the secret to the Scandinavian success? That’s certainly part of it.

A second feature is placing greater emphasis on reaching young people at risk for trouble before they get into the formal justice system. It’s a compelling fact that 80 percent of death row inmates in the U.S. are products of the juvenile justice system.

Maybe these men could have been rehabilitated if reached early enough in their lives or if they were taught a different way when they started down the slippery slope of antisocial behavior. I don’t know if this is true, but it’s something we should think about in view of the Swedish model’s superior results.

Although it’s expensive to spend on preventive measures like education and social work to intervene in bad situations, it’s more expensive to let the problems develop. One estimate claims that $1 spent in prevention saves $17 in later costs of property loss and incarceration, let alone personal misery. Like the old oil filter commercial said, you can pay me now, or you can pay me later.

Regardless of one’s outlook on punishment, I think we can all agree that the best outcome of any crime is if it never happens. I’m way out of my depth proposing sweeping social change, but I think we need to rethink our concept of imprisonment. Is vengeance better than rehabilitation?

Any crime is horrible for the victim. The desire to lock up the perpetrator and throw away the key is strong. Society has a different stake. Most of the offenders are going to be out again, and we have an interest to prevent additional offenses.

Is loss of freedom enough of a punishment? Having worked around that atmosphere for nine years, I can vouch that loss of freedom is a major deal. If we could make the time in jail or prison actually productive for the offender, maybe it will be productive for us as well. Maybe treating criminals like human beings is an idea whose time has come.

Please tell me what you think.

RGK

*Doctor Wright has given me a one-time license to publish Chapter 30. He retains the copyright. No republication of Chapter 30 is permitted without Dr. Wright’s express written permission.

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