Medical parole is once again in the spotlight with Clive Derby-Lewis’s most recent application making headlines.
Derby-Lewis – who is serving a life sentence for the murder of South African Communist Party secretary-general Chris Hani in 1993 – is suffering from prostate cancer that has spread to his lungs. It seems he only has 6 months to live.
His first application for medical parole was on diagnosis in 2011. This was turned down. Could the fact that he is still alive – although very unwell 3 years later – reflect the fact that this was a very wise decision? Or perhaps it is indicative of a reluctance to endure a repeat performance of the enormous fallout triggered by the Shabir Shaik medical parole case of 2009 and Jackie Selebi’s release on the same grounds in 2012. Both of these high profile terminally ill patients are seemingly doing remarkably well since being released from prison on medical parole with press reports of them dining out and shopping abounding.
The law governing medical parole was amended and put into effect on 1 March 2012. Since then all applications for medical parole have to go through a single central Medical Parole Review Board, rather than decisions being made at a local level. Applications can now be made on the grounds of incapacitating disease as well as terminal illness.
Despite these changes very few ill prisoners are actually granted medical parole and some die while waiting for their application to be processed. Many die within the prison walls their deaths often extremely painful and undignified.
The critical question must be asked whether or not this is a violation of their basic human rights? Some argue that when an individual commits a serious offence they give up their rights – or should have their rights terminated – but this is incorrect and has no basis in law.
As a medical practitioner specialising in the palliative care of terminally ill patients and their families I would suggest that a terminal illness is significant punishment in its own right. Whatever your personal beliefs about medical parole and prisoners in general, The South African Constitution protects the rights of prisoners and their access to health care. This should include access to good palliative care. This is defined as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering and through treatment of pain and other problems; physical, psychosocial and spiritual.
Since 2010 the Hospice and Palliative Care Association of South Africa (HPCA) has been working in conjunction with the Department of Correctional Services. Their aim is not only to put palliative care policies in place but also to train prison staff and selected inmates to provide palliative care services to dying prisoners. This ensures good pain and symptom control and a comfortable dignified end.
Whilst this is truly ground-breaking work palliative care also entails the psychological and spiritual aspects of patient care. Can this be done in isolation from family and friends? Good psychosocial support goes a long way but cannot replace time spent with loved ones.
Palliative care is possible in the prison environment but universal access is a long way off. Obtaining recent accurate figures is not simple but between 2007 and 2010 3000 inmates died of natural causes in prisons in South Africa. This represents an enormous opportunity to provide good palliative care in prisons.
There is no doubt that the medical parole system needs urgent review – in particular the time it takes for medical parole cases to be assessed. With literally thousands of criminals behind bars in South Africa causing a chronic overcrowding issue it would seem to make some sense to release on medical parole those who present no further risk to society.
Could it be that we have allowed the high profile cases of Shabir Shaik and Jackie Selebi to taint our whole view of medical parole and its benefits – not only to dying prisoners, but to the entire prison system? Are we now so afraid of making the wrong call – or being perceived to be making politically expedient calls – that we would rather see Clive Derby-Lewis along with thousands of unknown dying prisoners – spending their last days behind bars?
Dr Julia Ambler is Co-founder and Deputy Director of NGO Umduduzi – Hospice Care for Children.