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Punishing Prisoners: Corporal Style?

Whipping, Strapping, Spanking, Lashing, are all better known to the political world as corporal punishment.  While the proponents of corporal punishment in schools have died down, the use of physical punishments in jail has always been a hot debate.

The debate has been sparked again following a brutal beating of a homeless man in jail in South Carolina and the proposed legislature in Montana to use corporal punishment instead of jail time. In this case, he argues the beatings would be more humane. And for beatings in jail, some argue that beating prisoners shapes them up and builds an environment of control. However, I cannot forget what we are thinking about doing –beating a human being.

If we beat them, what message are we sending? Are they not human beings? Are they exclusions to the rule?

Looking at corporal punishment systems used in the past, there were many problems. First off, the system was inconsistent because of the amount of subjectivity involved. The force used to beat somebody is not an exact science, and there are always guards who put the matters into their own hands. When physically punished I postulate that the prisoners will either fall apart or not care. Some people may be affected, but most likely in a negative way. Then there are the tough guys who are used to physical violence and couldn’t care less. If anything, we are just sending them the message that violence is an okay answer.

To examine the influence of corporal punishment on a prisoner, I looked at the study of prisoners in Canada in the 1950’s, when strapping was employed as a method of punishment. The prisoners were later interviewed and the majority of their sentiments are similar to the stories below:

“He felt humiliated because he considered it was a child’s punishment. He did not think the strapping had done him any particular harm. It had no real effect in influencing his subsequent conduct … He had not cried out when strapped although he knew others who had. The other inmates had kidded him somewhat after his strapping but had shown no particular sympathy towards him. His skin was not broken but he remained bruised for about two weeks.”

“During the interview, the hatred he felt for those who had subjected him to corporal punishment was very obvious and his testimony was given in an electrified atmosphere. He stressed that he had had nine strokes and did not utter a groan. He felt that he had been unjustly punished.”

“The witness said that the strapping had not influenced his conduct for good. It was a degrading punishment worthy of ‘Julius Caesar’. It was outmoded. It was torture. The pain from the strapping was much less important than the loss of pride and the humiliation. The principal feeling is that of humiliation and embarrassment resulting from being tied down and subjected to a childish punishment in the presence of prison staff. The witness had not cried out when strapped but he had exhibited his hostility to the guards by talking back to them afterwards. He had to do this to relieve the tension after being strapped. The strapping had made him a little more cocky, a little more belligerent with the guards.”

The last man chose to be strapped and stay out of jail, and it was all part of his plan to get out. He did get out, and he did at this time commit two murders.

The study’s research confirmed that adrenalin output increases sharply during fear, anger and physical punishment. “When this is prolonged or often repeated, the endocrine balance fails to return to baseline. The victim becomes easily angered and prone to poor impulse control and spontaneous violent outbursts.” The study then considered whether delinquents grew from lack of discipline, or from too much discipline.

Dr. Alan Button reports, “This, it now appears is the wrong question. We should be asking about sequence. Parents of delinquents, all of them, report physical beating in the first ten to twelve years of the child’s life, but rarely thereafter. They ‘wash their hands’ of the kid because ‘nothing works.’ Then the judge, finding that the boy has no supervision, denounces permissiveness.”

If it didn’t work then, why would it work now?

 

Links:

http://www.corpun.com/canada2.htm

http://saiv.net/SourceBook/Storage/documents/doc_maurer.pdf

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Morals Meets Finance: Doctor-Assisted Suicide

Cartoon following the failure of a Massachusetts ballot measure that would have legalized doctor-assisted suicide, by Dan Wasserman

Cartoon following the failure of a Massachusetts ballot measure that would have legalized doctor-assisted suicide, by Dan Wasserman

Other than marijuana (see last week’s post), my home state of Oregon is known for its Doctor Assisted Suicide.

Currently doctor-assisted suicide in Oregon is dealt with the Death with Dignity Act. In order to qualify for the life-ending medication, the patient must be diagnosed as terminally ill with a prognosis of less than six months to live. It is, of course, completely voluntary on both the patient’s part and the doctor’s part. The Death with Dignity Act does not qualify legally as “suicide.”1

How frequent is this program? The 2012 Oregon Health Authority reported that 115 prescriptions were written last year in Oregon. The median age was 69 years old, and the most frequent diagnosis was cancer.2

Is right for our doctors to aid in ending a life? According to the 2011 Gallup poll, 45% of respondents agreed it was morally acceptable and 48% found it morally unacceptable, making it the most hotly debated topic in the survey.3 The moral debate can go on for ages –some will always view doctor-assisted suicide as cold-hearted justification for taking a life too soon while others will be comforted by the option of choosing death rather than being forced to live in pain.

So instead of telling you my opinion, I turn instead to the economics of doctor-assisted suicide. As we all know, end of life care can be expensive. So economically speaking, such measures could ultimately decrease the costs of terminal illness in cases where the patient will not recover and does not want to be sustained. According to an estimate from Emanuel and Battin, legalizing physician-assisted suicide could save as much as $627 million annually in the United States.

It is precisely because of its cost effectiveness that causes some to worry. The New York State Task Force on Life and the Law explains that “patients may be pressured to consent… when their care is expensive or burdensome to others.”  Even if not explicitly pressured by others, they may feel guilty about continuing their life for financial reasons.

Furthermore, those in the health care sector might be a source of pressure. Emanuel and Battin calculate, for example, that a large managed care plan could save around $3.3 million a year from doctor-assisted suicide. More than just care plans, hospitals also stand to save money from such a program.4

How should we deal with these competing economic factors? A bioethics and law expert Maxwell J. Mehlman, J.D., urges us to think about how a financial motivation would affect the situation. Suppose a patient is poor and seeks to participate –should we stop him or her from participating? Are we forcing them to die? But then, does denying the option of doctor-assisted suicide improve their condition in any way?5

Many questions can be asked about doctor assisted suicide, and they should be if we wish to develop comprehensive health-care for the terminally ill.

Links:

1.http://public.health.oregon.gov/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/faqs.aspx

2.http://public.health.oregon.gov/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/faqs.aspx

3.http://www.gallup.com/poll/147842/doctor-assisted-suicide-moral-issue-dividing-americans.aspx

4.http://www.nejm.org/doi/full/10.1056/NEJM199807163390306

5.http://www.thedoctorwillseeyounow.com/content/bioethics/art1976.html?getPage=4

Medical Marijuana For PTSD Treatment?

Medical Marijuana with its perscription“PTSD is like a virus. It infects you. It infects your kids, your friends, your family. It slowly eats away at your stability, your sleep, your ability to be happy.” –Jack Moran, The Veterans’ PTSD project1

This is the battle that people with Post-Traumatic Stress Disorder (PTSD) face every day. The National Institute of Mental Health estimates a lifetime prevalence of PTSD in 6.8% of Americans, with about half receiving treatment.2 There is not one prevailing treatment, but rather a range of options from medication to psychotherapy. Now the country is considering adding a more controversial treatment for PTSD: marijuana.

That’s right –cannabis. Just yesterday in my home state of Oregon, The Senate Health Committee approved a bill 4-1 that would add PTSD patients to the list of qualifiers for medical marijuana.

Proponents for the bill argue that controlled marijuana use can increase the quality of life for persons with PTSD. With little research on marijuana and PTSD specifically, those for the bill reference a birth of anecdotal evidence, specifically from New Mexico, where PTSD patients are eligible for the state’s medical marijuana program.3

Teens in front of a banner reading "Marijuana is Medicine"

Looking into New Mexico’s program, NPR interviewed some of its members who received subscriptions with a PTSD diagnosis. One such couple was veteran Paul Culkin and his wife Victoria, who credit marijuana with saving their marriage.

“‘He’s a different person. He’s a better person. He’s more open. He’s more communicative,’” wife Victoria explains. “‘At one point, we almost got a divorce, and I can honestly say that I think medical cannabis saved our marriage and our family.””4

Despite such testimony, medical experts explain the need for more research before allowing cannabis as a treatment. Current research is controversial. Some research, such as an Israeli study by Dr. Ganon-Elazar and Dr. Akirav founds that if given in a certain window of time, rats given cannabis had decreased symptoms to the rat equivalent of PTSD.5 Other research suggests that cannabis use causes temporary impairment and that prolonged use can result in dependency and psychosis.6

The U.S. government continues to quibble over what research to allow. Dr. Sisley from the University of Arizona developed a triple-blind placebo-controlled study but is stuck waiting for authorization. “I can’t help but think they simply don’t want to move forward,” she complains. As for the political motives in the field, she wants nothing to do with it. Dr. Sisley explains that she and fellow researchers “just want to do real research, or read real research, and not operate around all of these agendas.”7

The controversy and lack of progress puts legislators in a bind. Some advocate for moving forward unless evidence against treatment is presented. Others propose waiting for more research. The dissenting voice in Oregon’s Senate Committee doesn’t argue against marijuana, but rather that medical marijuana programs should change their approach. I tend to agree with him and Dr. Steiner Hayward:  “If we’re treating it like medicine, we should treat it like a medicine and we should have ongoing medical care.”8

LINKS:

  1. http://veteransptsdproject.com/blog/uncategorized/what-those-affected-by-ptsd-want-you-to-know/
  2. http://www.nimh.nih.gov/statistics/1AD_PTSD_ADULT.shtml
  3. http://www.statesmanjournal.com/article/20130228/UPDATE/130228047/Senate-committee-advances-bill-add-PTSD-medical-marijuana-list
  4. http://www.npr.org/templates/story/story.php?storyId=126827410
  5. http://www.nature.com/npp/journal/v37/n2/full/npp2011204a.html
  6. http://www.ijdp.org/article/S0955-3959(09)00050-4
  7. http://www.theatlantic.com/health/archive/2012/01/the-case-for-treating-ptsd-in-veterans-with-medical-marijuana/251466/
  8. http://www.thelundreport.org/resource/marijuana_ptsd_bill_clears_senate_health_committee