The Right to Refuse: Should Prison Inmates Be Allowed to Discontinue Treatment for Incurable, Noncommunicable Medical Conditions?

Daniel R. H. Mendelsohn

In July of 2007, Troy Reid was a very sick man. Reid was suffering from high blood pressure, and his kidneys were shutting down due to end-stage renal failure. Reid’s treatment required him to undergo kidney dialysis three times a week. In April 2008, after spending nine months shuttling back and forth from dialysis treatments, Reid decided he had had enough, and he made the difficult and personal decision to end his medical treatment, and let nature take its course.

Howard Andrews’s story is even more tragic. After falling from a wall, Andrews became a quadriplegic. His injuries left him without “any physical sensation or control of his body below the shoulders.” His condition required “[m]edical personnel [to] assist in the performance of all bodily functions.” And because Andrews’s condition was irreversible, he would have to live like that for the rest of his life. So Andrews decided that he wanted all medical attention to stop, and for medical personnel to simply leave him alone and let him die.

Although the United States Constitution provides free citizens a general right to refuse treatment, Andrews and Reid were both convicted felons serving extended sentences. Luckily for both men, the courts in Stouffer v. Reid and Thor v. Superior Court, respectively, rejected prison officials’ speculative evidence and allowed these inmates to execute their constitutional right. However, in past cases, prison officials had successfully used speculative security threats and nonspecific claims of system manipulation to force inmates suffering from incurable, noncommunicable conditions to undergo treatment against their will. The Supreme Court of the United States in Turner v. Safley enacted a universal standard of review for constitutional challenges to prison regulations and articulated a doctrine of deference that places the burden on inmates to prove that a specific prison regulation is unconstitutional. But the application of this standard to an inmate’s legitimate request to refuse medical treatment while incarcerated demonstrates its potential for abuse. While designed as a universal standard, the Turner test developed around interpersonal rights that are different in kind from the right to refuse medical treatment.

Courts typically borrow the reasoning used to compel medical treatment from inmate hunger-strike cases, a topic with significantly more jurisprudence. Some courts have incorrectly analogized an inmate’s refusal of medical treatment to situations involving inmate hunger strikes, an inappropriate comparison when considering the two situations’ foundational differences in choice.