Vulnerability and Palliative Care in Detention
Holistic Care, Family Involvement, and Autonomy Under Pressure?
An ageing (detained) population, an increasing number of deaths resulting from chronic and degenerative diseases, and a continuing growth of the prison population mean that more and more people will die of natural causes while serving their sentence (United Nations, 2009). This population is confronted with a double vulnerability: an inherent vulnerability due to their health condition and a contextual vulnerability resulting from their subjection to the prison system.
Just like citizens in the free community, people in detention have the right to palliative care. In Belgium, where principles such as civic rights and the normalisation of detention are central to the legal framework, this means that healthcare in prison must be equivalent to that in the free community. The aim of this article is to analyze, based on a narrative literature review, to what extent the principles of palliative care can be upheld within a prison context. Three core aspects of palliative care are discussed: (1) holistic care, (2) the active involvement of family, and (3) the safeguarding of the patient’s maximum autonomy.
This article demonstrates how palliative care comes under pressure in a context where the inherent
vulnerability of individuals with life-threatening illnesses intersects with the contextual vulnerability of
a traditional prison regime.
The article concludes with critical reflections on the possibility of providing dignified palliative and endof-
life care in detention and on the implications for a democratic state such as Belgium. It argues that
temporary release on medical grounds may constitute a more humane practice, although the prison
system itself must also be adapted to meet the needs of people requiring palliative care.