Call to end shackling of prisoners during end-of-life care

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Pictured above: Co-author Dr Stacey Panozzo (left) and Professor Jennifer Philip

Palliative care experts from St Vincent’s Hospital Melbourne have called for an end to the use of shackles on hospitalised prisoners receiving end-of-life care.

“People are dying in shackles in Australia and around different parts of the world today, and it needs to stop,” said Professor Jennifer Philip, a palliative care physician at St Vincent’s.

“There is an urgent need to overhaul the processes by which decisions are made about the use of shackles. For those patients from correctional settings who are at end-of-life and are too sick to get out of bed or may be unconscious, we should not be deferring all clinical decisions and best practice to prison policy,” Prof Philip said.

“When people are dying, they shouldn’t be in chains – it is a fundamental human right.”

Prof Philip has co-authored a published article in the Medical Journal of Australia, advocating for a review of the practice, which the paper describes as ‘highly disproportionate to the risks posed’.

“We are asking for the policy to be overhauled for prisoners who have reached a point in their palliative care journey when dying is imminent, so they can be granted the right to a dignified death,” Prof Philip said.

In the article, the authors noted: ‘while we recognise the use of restraints is a reasonable strategy in certain circumstances to maintain community safety, it is not clear that age, illness or immobility are always factored into these decisions'.

Prof Philip said using shackles was not just an issue for the patient but was also distressing for the family whose lasting memories may be coloured by seeing their loved one chained to the bed, along with the healthcare workers involved in their care.

“It has a big effect emotionally on everyone involved,” said Prof Philip, who has worked as a palliative care physician for more than 25 years.

Leaders in compassionate care

St Vincent’s has a long-standing expertise in the area of correctional health and aged care. Its founders, the Sisters of Charity, first arrived in the mid-1800s to provide healthcare to vulnerable population groups, including prisoners. 

St Vincent’s Hospital Melbourne is the only hospital in Victoria to offer a correctional health ward. Shackling of palliative care patients is not required within this secure unit.

St Vincent’s also provides healthcare to prisoners at Parklea Correctional Centre in Sydney and is in the process of establishing a secure palliative care unit in Brisbane for frail prisoners who require specialist, high-level palliative or nursing-home care which cannot be provided in either a correctional or general health setting.

“These types of specialist units – as we have at St Vincent’s in Melbourne, and are planning for Brisbane – are great examples of how healthcare can be provided in a secure setting, where the safety of the community is paramount, and where shackling is unnecessary,” said Prof Philip.

“But it’s important to recognise that these types of environments are uncommon in the Australian health landscape, and as result, it’s a continued sad fact that some prisoners are still dying in shackles in hospital settings.”

“What we’d like to see is for patients who are not within these types of specialised secure units to be granted that same level of compassion when they are dying.”