End-of-life care is essential for meeting the needs of those in their last stages of life. This type of care is becoming more in demand as the worldwide proportion of older people grows and as people live longer with life-limiting health conditions. Despite many dying people’s wishes to remain at home, “hospitals remain the provider of end-of-life care for 70% of Canadians and 10% to 15% of patients are admitted to the intensive care unit (ICU) on their final hospital admission” (Fowler and Hammer, 2013).
End-of-life care becomes more complex when discussing older prisoners, who despite limited care options require the same level of care and dignity at their end of life. Yet, today Canada’s federal correctional investigator and the Canadian Human Rights Commission made public their concern that as numbers of older prisoners rise, some prisoners are not receiving the level of care required when nearing their end of life. Both parties called on the Correctional Service of Canada to “meet the unique needs and rights of older people behind bars.” Dr. Fiona Aspinal is an expert in palliative care provision and quality who can speak to the requisites for end-of-life care provision and the logistics of providing end-of-life care in various settings.
According to the article, published today in the Globe and Mail, the number of older inmates is on the rise. Currently, older inmates make up one-quarter of the prison population in Canada, a number which has risen by fifty percent in the past year. A CBC report from January 2018 shows that many older inmates granted parole remain in prison because the system is not equipped for the current influx of older inmates and has no plan for where they will go when care is required in the community.
The correctional system in Canada, and throughout much of the world, is not equipped to deal with an influx of older prisoners, who often have higher incidence of chronic diseases associated with their living conditions. What’s more, the correctional system is not prepared to deal with the most vulnerable within their community who have life-limiting illnesses requiring end-of-life care. What are the solutions? According to the Huffington Post Canada, one option is the compassionate release for dying inmates, although this happens only in a handful of situations and is not an enduring solution. To ensure the rights of older people are protected, a longer-term solution is necessary to make certain that prison infrastructure can support older people and that those nearing the end of their lives can achieve comfort in their final days.
Dr. Fiona Aspinal Research Fellow
Fiona Aspinal is a research fellow at York University, United Kingdom