View from a prison doctor: ‘A humane death is a very reasonable expectation’

Dr Des Crowley, GP, addiction specialist and medical officer in charge of the drug treatment programme in Mountjoy Prison in Dublin, has been working as a doctor in the Irish prison service for more than 20 years.

Over the past five years in particular Crowley has noticed that prisoners are getting older, resulting in an increase of complex medical needs, such as long-term respiratory conditions due to heavy smoking as well as chronic conditions such as cancer and arthritis.

A number of older prisoners who were injecting drug users in the past are now also suffering from health conditions due to complications from Hepatitis C, he says.

According to Crowley, prisoners are suffering from chronic conditions up to 20 years earlier than their counterparts in the general population.

“A 50-year-old drug user probably has a lot of the conditions that a 70-year-old non drug user has . . . . just in terms of lifestyle, adverse living and social conditions, health inequality and disparity as well access to services, access to medical care, all confounding to have them a lot sicker than they, in theory should be, compared to their population cohorts,” he explains.

This phenomenon is also seen in the drug services where patients are also getting older, he says. The increasing age profile of prisoners and the resulting complex medical conditions have a number of implications for prisoner healthcare, such as the need for trained staff to assist older frail prisoners with tasks such as personal care. The infrastructure in prisons is also a challenge as older prisoners need access to wheelchair-friendly areas and disability toilets and showers.

Crowley says other issues, such as the provision of palliative care for the terminally ill, can also arise. There is the provision of the healthcare itself to patients so you have the skilled trained staff, resources and funding to do it, he says.

“I think as a society how we treat people who are dying is a reflection of what we are as a society and the values that we hold and I think a humane death is … a very reasonable expectation, no matter what has gone before that.”

He suggests carrying out a healthcare needs assessment among the older prisoner population which would also look at their specific needs in five or 10 years’ time. He is also in favour of developing a specially adapted older prisoners’ unit.

Crowley also says there is a need for an increased emphasis on health prevention and promotion generally within prisons, including advice on diet, exercise, smoking cessation, early treatment for Hepatitis C, health screening and diabetic checks.

This, he says, would allow the service to “embed a screening and prevention element to the care of all our prisoners.”

Crowley is also a specialist in addiction treatment and says the issue of ageing prisoners is also seen in the drug services where people have been maintained on treatment for a years and are now suffering from complications of old age at a much younger age.