Time to act : Vulnerabilities of aging prisoners in Switzerland

The worldwide phenomenon of population aging and a rise in indeterminate and long-term sentences due to a “punitive turn” in justice have led to rising numbers of aging prisoners. Their health needs are distinct when compared to other inmate groups or the general population. However, prison budgets and capacities are not adapted to respond to such a specialized population. This thesis discusses vulnerabilities of aging prisoners in order to identify moral obligations that can be derived from them to provide older prisoners with specific interventions that respond to their increased health care needs. One type of care will receive special consideration, namely end-of- life care. To identify vulnerabilities of aging prisoners, two definitions will be used: Luna’s layers of vulnerability and Hurst’s claim-based model. This thesis draws from the results of the study about health care of older prisoners (Agequake-study) as well as the study with mental health professionals working in prisons(Confidentiality-study). Several vulnerabilities relevant to aging prisoners could be identified.The prisoner-layer, revealed a loss of autonomy, social isolation, and psychological suffering that is induced, especially when the prisoner-layer overshadows all other aspects of a person. In health care, the doctor-patient relationship suffers because of issues related to dual-loyalty of physicians and when the duty of protection of prisoners merges into paternalism. Additionally, access to health care is not always up to the standard set by the principle of equivalence. The age-layer exacerbates some of these vulnerabilities, as aging prisoners use health care services more often and have more complex health needs. Other vulnerabilities are specific to old-age, such as negative health outcomes resulting from an unsuitable prison environment and the uncertainty and lack of perspective that accompany indeterminate sentences. Thus three obligations arise for the care of aging prisoners: avoiding double-loyalty and paternalism in the doctor-patient- relationship, adapting the environment to the health needs of older prisoners, and facilitating access to all types of care available to older adults in the community including end-of- life care. These obligations need to be translated into interventions and policies to safeguard their dignity and rights.