Scenes of Prison
Addendum:
64. Dignified Dying
P assing away is universal. The longer we live, and the more pain, tragedy, and loss we endure, the more acceptable our own approaching deaths become. Life comes with an eventual ending.
When we speak at funerals of those who have recently died, we often remark that the deceased are now beyond the suffering which accompanied their passing. They are free of the previous pain and limitations, and they have entered a spiritual realm occupied by God and by those who have already passed away.
When we hear these words, we are comforted in our grief, and we feel some relief that our newly deceased family member or friend may actually be better off for having died. The sting of death seems blunted. Still, for those facing an imminent approaching death, the mixture of fear and relief in their minds requires a compassionate and well-thought-out response from the rest of us. For those with a terminal diagnosis, that response is the availability of hospice care.
Hospice care is the well-thought-out, compassionate help that we provide for the dying. We expect this care to address the fear and relief of one’s passing and to ease the pain of serious illness, and we encourage those facing this transition from life to death to choose hospice care for themselves or for their loved ones. Hospice services include appropriate counseling and medication to ease pain, and hospice care is offered to inmates in Nebraska prisons who are terminally ill.
I raised the subject of hospice care to introduce the principle that individuals have a right to dignity and assistance with the transition from life to death.
Here’s a question. We have inmates living on death row with a death sentence. Would you consider them to have a terminal illness? No, they’re not sick, but they are going to die. When an execution date has been set, we even know the exact day they are going to die.
In the prison, we are often perplexed when a death-row inmate tries to end his own life with a suicide attempt, and our policies require that we prevent it. Is this some punitive attempt to prolong the inmate’s distress merely to preserve our ability to execute him?
What about inmates with a forever prison sentence, like a life sentence without parole? They will die in prison, too. Is this a terminal condition?
I ask these questions because I think it’s reasonable to allow inmates who must die in prison some dignity in their own dying, and I consider self-control to be an exercise of dignity.
In an earlier chapter on suicide, I described the measures we employ in Nebraska prisons to prevent inmate suicides. Here, in this chapter, I’d like to suggest two exceptions to these policies for inmates who must die in our prisons.
The first would be permitted suicides.
It is customary in care centers for the elderly in our communities for staff to ask family members this question: “Do you want us to resuscitate your loved one if he/she experiences a health emergency and is in cardiac arrest? The appropriate life-saving response is CPR, but we know that CPR will inflict serious injuries to a patient’s ribs and lungs. Knowing this, do you want us to employ CPR with this patient?”
Typically, the compassionate answer is “no,” and this leads staff to identify the patient as a do-not-resuscitate (DNR) patient, meaning that any staff member who may find this person in cardiac arrest or some other critical need should not use life-saving means like CPR to prolong their lives. In most instances, when a health crisis occurs, the patient dies.
Here’s a suggestion for all of us to consider. For inmates who must die in prison, we should allow them to sign a Do Not Resuscitate directive for themselves that includes suicide.
Inmates generally know how to commit suicide. A DNR directive would stop our staff from interfering with a suicide attempt that would prevent the inmate from successfully carrying it out. For them, it would be a permitted suicide.
In order to sign a DNR, an inmate would need to meet with a psychologist within our Department to establish his eligibility and to meet any other criteria the Department may choose to include. For example, a psychologist may wish to assess an inmate’s will-to-live to determine if this desire to die is a short term manifestation of a suicide infection. If it is, then the request for a DNR designation may be denied. However, if a psychologist determines that the inmate’s request is a well-thought-out, reasonable, and responsible management of the inmate’s own continued life and death inside our prisons, then a DNR designation may be approved.
Once the document has been signed, the inmate would be considered to have permission to commit suicide. We would not interfere with him if and when he chose to exercise this right as long as he did so in a way that didn’t endanger anyone else.
Once a DNR document has been signed, a psychologist can provide written materials that would answer questions an inmate might have that would help him carry out an act of suicide. The psychologist could also help an inmate create a last will, which would direct staff to distribute his belongings according to his wishes.
The second exception I’d like to suggest to the policy of preventing all suicides would be assisted suicides.
There may be some inmates who feel they need help to actually end their lives. They may have already attempted suicide and failed in the attempt, or they may fear they might fail and merely injure themselves, which might result in great pain and prolonged disability. They could be handicapped for the rest of their lives, and they might be unable to attempt suicide again.
It would be difficult to set up a procedure in the prison for staff to assist inmates in ending their own lives, but it wouldn’t be impossible. It may not be needed anyway, and there may be very little demand for this service if it was offered, but it might be useful to think through how such a service would be provided if it were requested.
Personally, I feel we should respect an inmate’s wishes. If his sentence can never be completed, if he must die in prison, and if he longs for this ending to come sooner rather than later, I believe we should respect this decision.
Permitted suicide and assisted suicide introduces dignity and self-control to the experience of dying in prison. An inmate may choose the time and manner of his own passing. He may choose to distribute his belongings to friends and relatives. He may choose to say something that is important to him and leave behind a document for others to read and consider. Finally, an inmate may choose to pass from this life quietly and painlessly at a time of his own choosing with others learning of the event only after it has occurred. For those with a death sentence, the terror of being dragged into a death chamber and executed can be avoided, and for those with a forever sentence of incarceration, the experience of an unending incarceration can come to an end and be completed when the inmate makes the choice to end it.
In a previous story, Butch had warned the district judge hearing his case that he would kill again, and Butch suggested a death sentence be imposed upon him to protect others from him. When a life sentence was the judge’s decision, Butch could have taken matters into his own hands and ended his own life by suicide. If the choices for permitted suicide and assisted suicide had been available to him, and if he had chosen to use them, Larry, the roommate he murdered, would still be alive today. Instead, with our current policies, if Butch had tried to end his life, we would have taken all measures sufficient to prevent it.
For inmates who must die in prison, I believe we should recognize their needs and desires for a painless, dignified death. Permitted suicide and assisted suicide provides a compassionate, well-thought-out response to this need.
Discussion
- Dying in prison is a universally neglected topic, yet everyone who enters the prison without a release date will have a personal encounter with death through the process of decline and dying.
- Name topics that need to be addressed related to this need.
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