Food refusal occurs for a variety of reasons. It may be used as a political tool, as a method of exercising control over others, at either the individual, family or societal level, or as a method of self-harm, and occasionally it indicates possible mental illness. This article examines the motivation behind hunger strikes in prisoners. It describes the psychiatrist's role in assessment and management of prisoners by referring to case examples. The paper discusses the assessment of an individual's (...) competence to commit suicide by starvation, legal restraints to intervention, practical difficulties and associated ethical dilemmas. Anecdotal evidence suggests that most prisoners who refuse food are motivated by the desire to achieve an end rather than killing themselves, and that hunger-strike secondary to mental illness is uncommon. Although rarely required, the psychiatrist may have an important contribution to make in the management of practical and ethical difficulties. (shrink)

This report examines the issue of restraining prisoners undergoing medical treatment from several angles: Cases illustrating the situation regarding shackling since Physicians for Human Rights-Israel's establishment; the issues and ramification raised by this phenomenon, both in terms of human rights and medical ethics, as well as from the governmental point of view, and the PHR-Israel point of view.

Antipsychotic medications are sometimes imposed on psychiatric patients deemed dangerous to themselves and others. This is based on the assumption that treatment is safe and effective, and that recovery depends on biological adjustment. Under new laws, patients can be required to remain on these medications after leaving hospitals. However, survivors attest that forced treatment used as a restraint can feel like torture, while the consequences of withdrawal can also be severe.

If one can judge a society by how it treats its prisoners, one can surely judge a society by how it treats cognitively- and learning-impaired children. In the United States children with physical and cognitive impairments are subjected to higher rates of corporal punishment than are non-disabled children. Children with disabilities make up just over 13% of the student population in the U.S. yet make up over 18% of those children who receive corporal punishment. Autistic children are among the (...) most likely to receive corporal punishment. -/- Although they may deny or redescribe particular instances of corporal punishment or their use of restraints, educators defend such actions as legitimate punishment. In this paper, I assess the logic underlying the use of restraints and corporal punishment on autistic children by educators. The rationalizations for the corporal punishment or restraint of autistics stems from the educator’s desire to control the autistic children so as to end typical autistic behaviors such as rocking, repetitive verbalizations, or “flapping” but also the autistic child’s non-affective responses such as not appearing to feel remorse or shame or the absence of a verbal acknowledgement of remorse or shame. The educators assume that the autistic’s failure to exhibit the desired responses is evidence of the autistic’s moral incorrigibility and is, therefore, evidence of the appropriateness of corporal punishment. But this assumption of the incorrigibility of the autistic child is questionable. -/- Indeed accepting this incorrigibility assumption reveals two important problems. First, instructors using physical punishment on autistic children do not understand autism. Second, they are not working with a tenable conception of punishment. Any action undertaken to induce socially acceptable behaviors (whether it be the end of autistic acts or responses such as remorse) is to fail to understand what the legitimate punishment of children is about. (shrink)

Restraint has recently become an important legal and clinical issue in England and Wales with the introduction of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards introduced by the Mental Health Act 2007. The requirements of these two new pieces of legislation are complex, and therefore pose major challenges to the provision of high quality and patient-centred care, support and treatment in a range of health and social care settings. In this paper, the legal and ethical (...) aspects of physical restraint in an acute medical care environment are considered, and practical guidance is provided to individuals adopting methods of restraint to care for general hospital patients. Aspects of the Introduction below are written in the first person to reflect the personal experiences of the lead author. (shrink)

In jails, the prisoners are often maltreated by the jail authorities.They are abused, and, their fundamental rights as human beings are frequentlyviolated. Although laws upholding the rights of prisoners are plenty,unfortunately, these seem ineffective in preventing the abuse of prisonersin jails. This paper examines the problems of jailed prisoners in general andhighlights their violations of human rights. In particular, this paper discussessexual abuse of prisoners, their mental and physical tortures, and enforcement ofprison labour laws. The paper (...) also focuses on overcrowding in jails, inadequateeducational facilities for prisoners and poor health care facilities. This articleanalyses these issues from the perspectives of Islamic Law and attempts toprovide a conceptual frame work of solutions. An analytical approach isemployed in this study. (shrink)

The controversy over abusive interrogations of prisoners during the war against terrorism spotlights the need for clear ethics norms requiring physicians and other clinicians to prevent the mistreatment of prisoners. Although policies and general descriptions pertaining to clinical oversight of interrogations in United States' war on terror prisons have come to light, there are few public records detailing the clinical oversight of an interrogation. A complaint by the Federal Bureau of Investigation (FBI) led to an Army investigation of (...) an interrogation at the United States prison at Guantanamo Bay. The declassified Army investigation and the corresponding interrogation log show clinical supervision, monitoring and treatment during an interrogation that employed dogs, prolonged sleep deprivation, humiliation, restraint, hypothermia and compulsory intravenous infusions. The interrogation and the involvement of a psychologist, physician and medics violate international and medical norms for the treatment of prisoners. (shrink)

Roughly 80,000 U.S. prisoners are held in solitary confinement at any given time. A significant body of research shows that solitary confinement has severe, long-term effects, and the United Nations has condemned the practice of solitary confinement as torture. For years, prisoners have been organizing hunger strikes in order to protest solitary confinement. But such action is not without consequences, and some inmates have suffered serious injury or death. The question I raise in this paper is whether we (...) ought to force-feed hunger striking prisoners when serious harm is imminent. Both the World Medical Association and the American Medical Association have denounced the practice of force-feeding prisoners on hunger strike, and yet, the practice is common. Such prevalence is likely a result of the tension between the person-as-patient and person-as-prisoner and cannot easily be resolved. Instead, we must take seriously the complaint that solitary confinement is inhumane and avoid placing health professionals in the position where they must choose to force-feed the prisoner against his will or not. I argue that a conventional bioethics debate centering on polarizing principles of prisoner autonomy and a duty-to-protect the prisoner from harm is an inadequate framework for this complex issue. Instead, we must examine the prisoner’s intent and his right to freedom of speech. I argue that when the prisoner’s intent is to raise awareness and communicate with others, his hunger strike is a form of speech. Protest-as-speech is constitutionally protected—even for prisoners—and remains a minimum ethical obligation for society to uphold. (shrink)

An incisive and sympathetic examination of the case for ending the practice of imprisonment Despite its omnipresence and long history, imprisonment is a deeply troubling practice. In the United States and elsewhere, prison conditions are inhumane, prisoners are treated without dignity, and sentences are extremely harsh. Mass incarceration and its devastating impact on black communities have been widely condemned as neoslavery or “the new Jim Crow.” Can the practice of imprisonment be reformed, or does justice require it to be (...) ended altogether? In The Idea of Prison Abolition, Tommie Shelby examines the abolitionist case against prisons and its formidable challenge to would-be prison reformers. Philosophers have long theorized punishment and its justifications, but they haven’t paid enough attention to incarceration or its related problems in societies structured by racial and economic injustice. Taking up this urgent topic, Shelby argues that prisons, once reformed and under the right circumstances, can be legitimate and effective tools of crime control. Yet he draws on insights from black radicals and leading prison abolitionists, especially Angela Davis, to argue that we should dramatically decrease imprisonment and think beyond bars when responding to the problem of crime. While a world without prisons might be utopian, The Idea of Prison Abolition makes the case that we can make meaningful progress toward this ideal by abolishing the structural injustices that too often lead to crime and its harmful consequences. (shrink)

The movement to try to close the ever-widening gap between demand and supply of organs has recently arrived at the prison gate. While there is enthusiasm for using executed prisoners as sources of organs, there are both practical barriers and moral concerns that make it unlikely that proposals to use prisoners will or should gain traction. Prisoners are generally not healthy enough to be a safe source of organs, execution makes the procurement of viable organs difficult, and (...) organ donation post-execution ties the medical profession too closely to the act of execution. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 23 (2003) 135-137 [Access article in PDF] The 2002 Meeting of the Society for Buddhist-Christian Studies Alice Keefe University of Wisconsin-Stevens Point "Religious Responses to Violence" was the theme for the program at the SBCS Annual Meeting in Toronto, Canada, on November 22-23, 2002. Speaking from Christian and Jewish perspectives, the presenters in Session I were Harold Kasimow, Professor Emeritus of Grinnell College; Elaine MacInnes, O.L.M.; Sarah (...) Pinnock of Trinity University; and Rebekah Miles from the Perkins School of Theology. Responding from a Buddhist perspective was Virginia Strauss of the Boston Research Center. Session II offered reflections on Buddhist responses to violence from Gene Reeves of the International Buddhist Congregation; Christopher Ives of Stonehill College; and John Makransky, professor of Religious Studies at Boston College and a Buddhist teacher, with a Christian response from Theodore Walker of Perkins School of Theology, noted for his work in Black theology.Opening Session I, Harold Kasimow explored Jewish responses to violence, which he finds similar in many ways to responses to violence in Mahayana Buddhism. Both traditions unequivocally condemn violence. Basic to Jewish reflection on violence is the great commandment that one shall love one's neighbor as oneself, along with the principle that all humans are created in the image of God; therefore, as Rabbi Akiva taught, whoever sheds blood diminishes God's presence in the world. But like Mahayana Buddhism, the Jewish tradition admits to rare cases where violence may be legitimately used in a spirit of compassion when the lives of others are at stake. On this point, Kasimow, himself a Holocaust survivor, cited Abraham Heschel, who said that "indifference to evil is more insidious than evil itself." Heschel dreamed of a world rid of evil by human effort, and he suggested that interfaith dialogue serves as a step toward this goal as it works against the evil of demonizing the "other."Sarah Pinnock, who has written on the religious journeys of Holocaust survivors, explored the themes of memory, solidarity, hope, and mystical faith as compelling Christian modes of survival and resistance in the face of evil. Logic cannot solve the problem of evil, but through memory, suffering is not forgotten; through solidarity, we identify and join with the victimized in resistance to evil; and through hope, we find the energy for resistance. Mystical faith discovers divine transcendence in all things, while abandoning egotistical demands that God be the world's puppet master; [End Page 135] in mystical faith, Christians do not look for divine intervention, but for human beings to act for God against evil.Rebekah Miles, a Christian ethicist, offered a lucid outline of three distinct Christian approaches to violence: (1) absolute pacificism, which rejects the use of violence for any reason; (2) the "crusade" perspective, which justifies war when it can be construed as a conflict between good and evil and which calls for the total eradication of evil in the form of the enemy; and (3) the "just war" perspective, which stipulates precise criteria for instances when the use of violence may be justified and places restraints on any exercise of violence. In addition to this helpful overview, she engaged arguments (put forth by Rosemary Ruether, SharonWelch, and ReginaSchwartz) that there is something inherent in the nature of Western monotheism that serves to legitimate and encourage violence, and argued for divine transcendence as undergirding the effective power of the prophetic critique against all forms of idolatry and tyranny.The final Christian presenter was Elaine MacInnes, O.L.M., a Catholic nun and Zen master who is noted for her activist work in prison ministry in the Philippines and in Canada. She reminded us that even as violence brings suffering, it is at the same time a mystery in that it carries a redeeming potential to rid us of all that is false. It is the cultivation of silence that allows the sacred inner life to do its work.Responding from a Buddhist perspective, Virginia Strauss returned to the problem of the human desire for retributory justice and looked to Buddhism... (shrink)

The issue of interrogation of detainees has received much attention in the psychological literature and by the media. Some estimate that more than 300 articles have been published in psychological journals on this topic. This article reiterates the content of the Presidential Task Force on Psychological Ethics and National Security and provides a brief history and background. This is followed by a section on the torture of prisoners and the role of psychologists. It includes discussion of resolutions passed by (...) American Psychological Association (APA) on this topic and briefly reviews criticisms of these resolutions. The article concludes with a summary concerning the current status and reviews the referendum sent to APA members on whether APA members can work in detention settings that exist in violation of international law or the U.S. Constitution. Pro and con statements are discussed as is the formation of a task force to implement the referendum which was passed by a vote of 8792 in favor and 6,157 opposed. (shrink)

Book reviewed in this article: Just War Tradition and the Restraint of War: A Moral and Historical Inquiry. By James Turner Johnson.

ABSTRACT The 2006 Institute of Medicine (IOM) report, ‘Ethical Considerations for Research Involving Prisoners’, recommended five main changes to current US Common Rule regulations on prisoner research. Their third recommendation was to shift from a category‐based to a risk‐benefit approach to research review, similar to current guidelines on pediatric research. However, prisoners are not children, so risk‐benefit constraints on prisoner research must be justified in a different way from those on pediatric research. In this paper I argue that (...) additional risk‐benefit constraints on prisoner research are unnecessary: the current Common Rule regulations, omitting category‐based restrictions but conjoined with the IOM report's other four main recommendations, ensure that prisoner research is as ethical as non‐prisoner research is. I explain why four problems which which may be more prevalent in prisons and which risk‐benefit constraints may seem to address – coercion, undue inducements, exploitation, and protection from harm – are in fact not solved by adding further risk‐benefit constraints on prisoner research. (shrink)

Background:Prisons are contexts where nurses are required to have specific skills to ensure that, in a setting designed for the expiation of crime, prisoners receive the same type of care as anyone else. But this is not always the case, giving rise to ethical issues.Research questions:‘How do correctional nurses describe their working experience in prisons? What issues emerged?’Methodology:This is a qualitative descriptive study. Following purposive sampling, we conducted five focus groups. Thematic analysis was used to analyse the data.Participants and (...) research context:Our sample included 31 correctional nurses in seven prisons in Northern Italy.Ethical considerations:The scientific merit of this study was recognized by the Academic Board of the University of Genoa. Approval to conduct the study was obtained from the Liguria Regional Government that funded this study and from the Local Health Authority that was the prison nurses’ employer. Formal consent was obtained from all the nurses who volunteered to participate in this study.Findings:Five themes emerged from the focus groups: prisoners’ healthcare needs, negotiation between custody and care, satisfaction of working in prisons, obstacles to quality care and safety. ‘Manipulation’ was a transversal theme that emerged from all the focus groups.Discussion:The problems generated by the clash between prison security and nursing care priorities did not enable nurses to practice autonomously and provide the best possible to care prisoners, giving rise to ethical issues and moral distress. This in turn causes high nursing turnover rates that negatively impact continuum of care.Conclusion:In Italy, correctional nurses urgently require specific education interventions with the participation of all those who work in prisons. Interventions based on the post-modern concept of restorative nursing could offer prison nurses the opportunity to both resolve ethical issues and reduce moral distress. (shrink)

Law journals permit submission of scholarly manuscripts to multiple journals concurrently, but biomedical journals strictly forbid submission of manuscripts to more than one journal at a time. Law journals may then compete for the publication of manuscripts. This article examines whether the single-submission requirement of biomedical journals may constitute restraint of trade in violation of Section 1 of the Sherman Antitrust Act.

This paper explores the issue of prisoners' rights. The conditions of incarcerated people in jails and prisons include psychological and physical deterioration brought on by their condition of confinement. The one sanction that has been debated extensively in the United States is the death penalty. Yet there are numerous losses or deprivations short of death that we might impose on legal offenders. In addition to broader issues such as the nature of rights and the basic moral rights possessed by (...) individuals, issues specific to the rights of serious legal offenders are distinguished and discussed. The latter issues include whether offenders forfeit all or some of their moral rights, whether their retained rights are less stringent, whether the state has any obligation to facilitate exercise of their retained rights, and what specific rights prisoners retain or acquire. (shrink)

This book brings together a collection of social justice scholars and activists who take Foucault’s concept of discipline and punishment to explain how prisons are constructed in society from nursing homes to zoos. This book expands the concept of prison to include any institution that dominates, oppresses, and controls. Criminologists and others, who have been concerned with reforming or dismantling the criminal justice system, have mostly avoided to look at larger carceral structures in society. In this book, for example, scholars (...) and activists question the way patriarchy has incapacitated women and imagine the deinstitutionalization of people with disabilities. In a time when popular sentiment critiques the dominant role of the elites, the state’s role in policing dissenting voices, school children, LGBTQ persons, people of color, and American Indian Nations, needs to be investigated. A prison, as defined in this book, is an institution or system that oppresses and does not allow freedom for a particular group. Within this definition, we include the imprisonment of nonhuman animals and plants, which are too often overlooked. (shrink)

Senate Bill 1435, the “Prison Rape Elimination Act of 2003,” was introduced into the Senate on July 21, 2003, and in less than a week passed both the Senate and House by unanimous consent. The Bill was presented to President Bush on September 2, 2003, and he signed it two days later on September 4, 2003. The stated purposes of the Act are far-reaching and ambitious:establish a zero-tolerance standard for the incidence of prison rape in prisons in the United States;make (...) the prevention of prison rape a top priority in each prison system;develop and implement national standards For the detection, prevention, reduction, and punishment of prison rape;increase the available data and information on the incidence of prison rape, consequently improving the management and administration of correctional facilities;standardize the definitions used for collecting data on the incidence of prison rape. (shrink)

Senate Bill 1435, the “Prison Rape Elimination Act of 2003,” was introduced into the Senate on July 21, 2003, and in less than a week passed both the Senate and House by unanimous consent. The Bill was presented to President Bush on September 2, 2003, and he signed it two days later on September 4, 2003. The stated purposes of the Act are far-reaching and ambitious:establish a zero-tolerance standard for the incidence of prison rape in prisons in the United States;make (...) the prevention of prison rape a top priority in each prison system;develop and implement national standards For the detection, prevention, reduction, and punishment of prison rape;increase the available data and information on the incidence of prison rape, consequently improving the management and administration of correctional facilities;standardize the definitions used for collecting data on the incidence of prison rape. (shrink)

Many people believe that when you go to prison, prison staff will keep you safe and that if others prisoners have power, they'll use it against you. It turns out that neither assumption is true. In many prisons, staff have little control over how safe and orderly a prison feels. Prisoners are often in charge. When they are, they often do a good job of governing life behind bars. This book looks at the hidden and informal world of (...) life in prison to reveal why prisoners play such a major role in the everyday life of prisoners, and why they often do a good job at it. (shrink)

Herbert, Dilinie The lived experiences of prisoners and the delivery of healthcare into this population raise important ethical issues. The prison population is made up largely of people who have experienced social and economic disadvantage, and who often have a diagnosed mental health condition. International and national authorities recognise that the health needs of prisoners are complex but that slow progress is being made to reform and improve existing practices. This article will demonstrate that alongside the provision of (...) primary care, healthcare in prisons must also focus on the social and psychological issues and behaviours of prisoners in order to prevent recidivism. (shrink)

This paper discusses whether the collateral harm of imprisonment to the close family members and children of prison inmates may give rise to special moral obligations towards them. Several collateral harms, including decreased psychological wellbeing, financial costs, loss of economic opportunities, and intrusion and control over their private lives, are identified. Two competing perspectives in moral philosophy are then applied in order to assess whether the harms are permissible. The first is consequentialist and the second is deontological. It is argued (...) that both of them fails and therefore it is hard to defend the position that allowing for these harms would be morally permissible, even for the sake of the overall aims of incarceration. Instead, it is argued that these harms imply that imprisonment should only be used as a last resort. Where it is necessary, it should give rise to special moral obligations. Using the notion of residual obligation, these obligations are defended, categorized and clarified. (shrink)

With 5,000 convicts, most of them lifers, working soy, corn, and cotton crops, Angola’s “penal slavery” system today eerily recalls Louisiana’s past investment in the peculiar institution. Present-day form of discipline (chain gangs and striped uniforms) also indicate that dehumanization and popular vengeance are the selling points of a new punishment order. Using “America’s worst prison” as a case study, the author charts an archeology of the penal system in the U.S. South, arguing that prison revolts, and particularly the heelslinger (...) revolution of 1951, have historically ushered in significant if short-lived improvements in the penal system, and that activists in the free world must heed them in their efforts to bring about prison reform. (shrink)

With 5,000 convicts, most of them lifers, working soy, corn, and cotton crops, Angola’s “penal slavery” system today eerily recalls Louisiana’s past investment in the peculiar institution. Present-day form of discipline (chain gangs and striped uniforms) also indicate that dehumanization and popular vengeance are the selling points of a new punishment order. Using “America’s worst prison” as a case study, the author charts an archeology of the penal system in the U.S. South, arguing that prison revolts, and particularly the heelslinger (...) revolution of 1951, have historically ushered in significant if short-lived improvements in the penal system, and that activists in the free world must heed them in their efforts to bring about prison reform. (shrink)

It has been argued that the social circumstances of many children of prisoners goes against established principles of social justice. In this paper the proper allocation of responsibility for remedying this social injustice is discussed. Through a discussion of four principles for allocating remedial responsibility, it is argued that the responsibility for children of incarcerated parents is shared among several actors, including the incarcerated parent, remaining caregivers, prison officials, social work professionals, and, to some extent, members of the wider (...) community. While incarcerated parents are partially responsible for remedying the harm caused to their children, prison officials have the responsibility to uphold the types of prison conditions under which incarcerated parents are able to fulfill their responsibilities to their children and socially contribute to their well-being. Similarly, whereas the main responsibility to care for the children of incarcerated parents falls on the caregivers (such as the remaining parent or other family relatives), states are at the same time responsible for implementing social welfare policies of the sort that can help caregivers fulfill their responsibilities for the well-being of these children. As for individual members of the wider community, they have an obligation not to contribute to the stigmatization and marginalization of the families of incarcerated individuals. (shrink)

Equally conversant in the tradition of black American thought and contemporary Anglo-American political philosophy, Tommie Shelby is one of those rare scholars.

Book reviewed in this article: Prison Health Care. By Richard Smith. London: British Medical Association, 1984.