HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Saturday, November 5, 2005

Maine's Prisoner Case: Right to Die? To Commit Suicide?

Here's a follow-up on our earlier report about a prisoner in Penobscot County, Maine, who has refused most food and fluids for the 30 days.  On Thursday Superior Court Justice Andrew Mead upheld his previous order to force-feed prisoner James Emerson.  As reported by the Bangor Daily News, the judge handed down a four-page ruling, which said:

The sheriff cannot - by law - turn a blind eye to circumstances within his knowledge which threaten the wellbeing of individuals in his custody.  This applies equally to circumstances which such individuals bring on themselves. If an overt threat of suicide is brought to his attention, the sheriff must take reasonable measures to prevent the inmate from following through on his threat.

In [this] matter, the sheriff has concluded, and the court agrees, that the defendant's stated intention to discontinue life-sustaining sustenance constitutes a suicide threat.  If the sheriff fails to take reasonable steps to intervene after he is aware that a suicide attempt is being undertaken, he fails to discharge his constitutional duties. Among a host of repercussions is the fact that he (and the county) would be immediately liable in a civil wrongful death action.

This doesn't make a lot of sense to me.  If a prisoner dies while on a hunger strike, after the county tried all reasonable means, including an application for a court order to authorize force-feedings, and a court sided with the prisoner, would the prisoner's next of kin really have a wrongful death cause of action?  I don't see it.  I also don't see that there's an 8th Amendment compulsion to administer unwanted nutrition and hydration.  At least as long as the prisoner is competent, isn't it plausible that the duty to provide medical care doesn't extend beyond the willingness of the prisoner to accept it?  I would assume that the 8th Amendment imposes a duty upon the state to provide medical care that is needed and wanted (presumptively or otherwise).  But when the prisoner says no, is it obvious that the 8th Amendment requires treatment over the objections of the prisoner?

A more plausible rationale for the forced-feeding of prisoners is that the state has an interest in punishing the prisoner, including seeing that the prisoner lives long enough to carry out his sentence.  This interest is sufficiently important that it trumps the prisoner's interest in being left alone.  On this account of the matter, the prisoner's privacy rights pretty much cease at the entrance to the jail. 

There are obvious limits to this argument.  Plenty of cases hold that prisoners have the right to avoid forced administration of psychotropic medications, even when the state's rationale relates to its interest in carrying out a sentence or rendering the prisoner competent to stand trial.  In the Emerson case, perhaps the court has a duty to balance the state's penal interest against the prisoner's right of autonomy.  Emerson may still lose, especially since his own decision to thwart the county's interest in punishing him is responsible for the medical need for more nutrition and hydration, but shouldn't the court at least have its eye on the right ball? [tm]

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