Restricting a person’s liberty presents society with many inherent ethical challenges. The historical purposes of confinement have included punishment, penitence, containment, rehabilitation, and habilitation. While the purposes are indeed complex, multifaceted, and at times ambiguous or contradictory, the fact of incarceration intrinsically creates many ethical challenges for psychiatrists working in correctional settings. Role definition of a psychiatrist may be ambiguous, with potential tensions between forensic and therapeutic demands. Privacy may be limited or absent and confidentiality may be compromised. Patient autonomy may be threatened to address real or perceived security concerns. Care delivery may actually have harmful consequences in court cases for pretrial detainees or lethal consequences for those under a death sentence. An absence of data and targeted research hampers the development of evidence-based care delivery for the disenfranchised, understudied, and disproportionately ill prisoner population. In this review paper, I discuss a few of the challenges and dilemmas routinely faced and present a series of questions. Where feasible, proposed resolutions are offered.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Abramsky, S., and J. Fellner. 2003. Ill-equipped: U.S. prisons and offenders with mental illness. New York: Human Rights Watch. http://www.hrw.org/reports/2003/usa1003/usa1003.pdf. Accessed May 25, 2014.
American Medical Association. 1978. Health and ethics policies of the AMA House of Delegates. http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf. Accessed May 25, 2014.
American Psychiatric Association. 2000. Psychiatric services in jails and prisons, 2nd ed. Arlington, VA: American Psychiatric Association.
American Psychiatric Association. 2012. Position statement on segregation of prisoners with mental illness. http://www.psychiatry.org/File%20Library/Learn/Archives/ps2012_PrisonerSegregation.pdf. Accessed May 25, 2014.
Amnesty International. 2014. Abolitionist and retentionist countries. http://www.amnesty.org/en/death-penalty/abolitionist-and-retentionist-countries. Accessed May 28, 2014.
Andrews, D.A., and J. Bonta. 2010. The psychology of criminal conduct, 5th ed. New Providence, NJ: Elsevier.
Appelbaum, P.S. 2012. Law and psychiatry: Treatment of incompetent, dangerous criminal defendants: Parsing the law. Psychiatric Services 63(7): 630–632.
Bersot, H.Y., and B.A. Arrigo. 2011. The ethics of mechanical restraints in prisons and jails: A preliminary inquiry from psychological jurisprudence. Journal of Forensic Psychology Practice 11(2–3): 232–264.
Birmingham, L., S. Wilson, and G. Adshead. 2006. Prison medicine: Ethics and equivalence. The British Journal of Psychiatry 188(1): 4–6.
Bonnie, R.J. 2005. Mentally ill prisoners on death row: Unsolved puzzles for courts and legislatures. Catholic University Law Review 54(4): 1169–1313.
Bourgon, G., and B. Armstrong. 2005. Transferring the principles of effective treatment into a “real world” prison setting. Criminal Justice and Behavior 32(1): 3–25.
Christopher, P.P., P.J. Candilis, J.D. Rich, and C.W. Lidz. 2011. An empirical ethics agenda for psychiatric research involving prisoners. American Journal of Bioethics Primary Research 2(4): 18–25.
Cislo, A.M., and R. Trestman. 2013. Challenges and solutions for conducting research in correctional settings: The U.S. experience. International Journal of Law and Psychiatry 36(3–4): 304–310.
Coyle, A. 2002. A human rights approach to prison management: Handbook for prison staff. London: International Centre for Prison Studies. http://www.prisonstudies.org/resources/human-rights-approach-prison-management-handbook-prison-staff-first-edition-english. Accessed May 25, 2014.
Council of Europe Committee of Ministers. 2006. European prison rules. https://wcd.coe.int/ViewDoc.jsp?id = 955747. Accessed May 25, 2014.
Death Penalty Information Center. 2014. Innocence: List of those freed from death row. http://www.deathpenaltyinfo.org/innocence-list-those-freed-death-row. Accessed May 30, 2014.
Dlugacz, H., and C. Wimmer. 2013. Legal aspects of administrating antipsychotic medications to jail and prison inmates. International Journal of Law and Psychiatry 36(3): 213–228.
Elger, B.S. 2008. Towards equivalent health care of prisoners: European soft law and public health policy in Geneva. Journal of Public Health Policy 29(2): 192–206.
Elger, B.S. 2011. Prison medicine, public health policy and ethics: The Geneva experience. Swiss Medical Weekly 141: w13273. doi:10.4414/smw.2011.13273.
European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. 2011. CPT standards. Strasbourg: Council of Europe. http://www.cpt.coe.int/en/documents/eng-standards.pdf. Accessed December 18, 2013.
Felthous, A.R. 2012. The involuntary medication of Jared Loughner and pretrial jail detainees in nonmedical correctional facilities. The Journal of the American Academy of Psychiatry and the Law Online 40(1): 98–112.
Gostlin, L.O., C. Vanchieri, and A. Pope. 2007. Ethical considerations for research involving prisoners. Washington, DC: Institute of Medicine, National Academies Press.
Jotterand, F., and T. Wangmo. 2014. The principle of equivalence reconsidered: Assessing the relevance of the principle of equivalence in prison medicine. The American Journal of Bioethics 14(7): 1–8.
Metzner, J., and J. Dvoskin. 2006. An overview of correctional psychiatry. Psychiatric Clinics of North America 29(3): 761–772.
Metzner, J.L., and J. Fellner. 2010. Solitary confinement and mental illness in U.S. prisons: A challenge for medical ethics. The Journal of the American Academy of Psychiatry and the Law 38(1): 104–108.
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. 1979. The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. Washington, DC: Office for Protection From Research Risks. http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.html. Accessed May 30, 2014.
National Commission on Correctional Health Care. 2007. Position statement: Correctional health care professionals’ response to inmate abuse. http://www.ncchc.org/correctional-health-care-professionals%E2%80 %99-response-to-inmate-abuse. Accessed May 25, 2014.
National Commission on Correctional Health Care. 2008. Standards for mental health services in correctional facilities. Chicago: National Commission on Correctional Health Care
Prison Reform Trust. 2014. Prison: The facts. London: Prison Reform Trust. http://www.prisonreformtrust.org.uk/Portals/0/Documents/Prison%20the%20facts%20May%202014.pdf?dm_i = 47 L,2GWMH,1KH8TB,8ZHO8,1. Accessed May 29, 2014.
Restellini, J.P., and R. Restellini. 2014. Prison-specific ethical and clinical problems. In Prisons and health, edited by S. Enggist, L. Møller, G. Galea, and C. Udesen, 11–18. Copenhagen: World Health Organization.
Rivlin, A., L. Marzano, K. Hawton, and S. Fazel. 2012. Impact on prisoners of participating in research interviews related to near-lethal suicide attempts. Journal of Affective Disorders 136(1): 54–62.
Shannon, B.D., and V.R. Scarano. 2013. Incompetency to be executed: Continuing ethical challenges and time for a change in Texas. Texas Tech Law Review 45(2): 419–452.
Society of Correctional Physicians. 2013. Position statement: Restricted housing of mentally ill inmates. http://societyofcorrectionalphysicians.org/resources/position-statements/restricted-housing-of-mentally-ill-inmates. Accessed May 25, 2014.
United Nations.1966a. International covenant on civil and political rights. http://www.ohchr.org/en/professionalinterest/pages/ccpr.aspx. Accessed May 29, 2014.
———. 1966b. International covenant on economic, social and cultural rights. http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx. Accessed May 29, 2014.
United Nations. 1977. Standard minimum rules for the treatment of prisoners. http://www.unodc.org/pdf/criminal_justice/UN_Standard_Minimum_Rules_for_the_Treatment_of_Prisoners.pdf. Accessed May 29, 2014.
United Nations. 1984. Convention against torture and other cruel, inhuman or degrading treatment or punishment. http://www1.umn.edu/humanrts/instree/h2catoc.htm. Accessed May 29, 2014.
United Nations Committee on Economic, Social and Cultural Rights. 2000. CESCR general comment no. 14: The right to the highest attainable standard of health (Art. 12 of the Covenant). Office of the High Commissioner for Human Rights, E/C.12/2000/4. http://www.refworld.org/docid/4538838d0.html. Accessed May 29, 2014.
United Nations Committee Against Torture. 2006. Consideration of reports submitted by States parties under Article 19 of the Convention: Conclusions and recommendations of the Committee Against Torture, United States of America, CAT/C/USA/CO/2. http://www.refworld.org/docid/453776c60.html. Accessed May 29, 2014.
United Nations General Assembly. 2011. Interim report of the Special Rapporteur of the Human Rights Council on torture and other cruel, inhuman or degrading treatment or punishment, A/66/268. http://solitaryconfinement.org/uploads/SpecRapTortureAug2011.pdf. Accessed May 29, 2014.
United Nations Human Rights Committee. 1992. CCPR general comment no. 20: Article 7 (prohibition of torture, or other cruel, inhuman or degrading treatment or punishment). http://www.refworld.org/docid/453883fb0.html. Accessed May 29, 2014.
United Nations Human Rights Committee. 2006. Consideration of reports submitted by States parties under Article 40 of the Covenant: Concluding observations of the Human Rights Committee: United States of America, CCPR/C/USA/CO/3. http://www.refworld.org/docid/45c30bb20.html. Accessed May 29, 2014.
World Medical Association. 1997. Declaration of Hamburg concerning support for medical doctors refusing to participate in, or to condone, the use of torture or other forms of cruel, inhuman or degrading treatment. http://www.wma.net/en/30publications/10policies/c19/index.html. Accessed May 29, 2014.
World Psychiatric Association. 1996. Madrid declaration on ethical standards for psychiatric practice. http://www.wpanet.org/detail.php?section_id = 5&content_id = 48. Accessed May 29, 2014.
About this article
Cite this article
Trestman, R.L. Ethics, the Law, and Prisoners: Protecting Society, Changing Human Behavior, and Protecting Human Rights. Bioethical Inquiry 11, 311–318 (2014). https://doi.org/10.1007/s11673-014-9560-1
- Human rights
- Ethical behavior