Saturday, April 28, 2007

Health Risks of Punishment

When someone commits a criminal offence we punish them. If the offence is serious enough we incarcerate them. How long they are imprisoned depends on the severity of the crime. As the saying goes- “The punishment should fit the crime”.

Different justifications are offered for punishment- deterrence, rehabilitation and retribution are popular answers that are often given to justify punishment. Justifying punishment in theory is of course very different from justifying it in practice. That is, justifying the actual institutions of punishment, as they are practiced in our own societies, raises many non-ideal considerations that might not come to the fore when our attention is focused exclusively in the abstract. For example, considerations about discrimination in the criminal justice system will muddy the waters in terms of how our actual institutions fare with respect to the theory of punishment. And these kinds of non-ideal considerations should themselves inform the theory of punishment.

The New England Journal of Medicine published a very important study in the Jan. 11th 2007 issue on the rate of the risk of death for former prison inmates (see here). Here is the abstract:

Release from Prison — A High Risk of Death for Former Inmates
Ingrid A. Binswanger et. al.

The U.S. population of former prison inmates is large and growing. The period immediately after release may be challenging for former inmates and may involve substantial health risks. We studied the risk of death among former inmates soon after their release from Washington State prisons.

We conducted a retrospective cohort study of all inmates released from the Washington State Department of Corrections from July 1999 through December 2003. Prison records were linked to the National Death Index. Data for comparison with Washington State residents were obtained from the Wide-ranging OnLine Data for Epidemiologic Research system of the Centers for Disease Control and Prevention. Mortality rates among former inmates were compared with those among other state residents with the use of indirect standardization and adjustment for age, sex, and race.

Of 30,237 released inmates, 443 died during a mean follow-up period of 1.9 years. The overall mortality rate was 777 deaths per 100,000 person-years. The adjusted risk of death among former inmates was 3.5 times that among other state residents (95% confidence interval [CI], 3.2 to 3.8). During the first 2 weeks after release, the risk of death among former inmates was 12.7 (95% CI, 9.2 to 17.4) times that among other state residents, with a markedly elevated relative risk of death from drug overdose (129; 95% CI, 89 to 186). The leading causes of death among former inmates were drug overdose, cardiovascular disease, homicide, and suicide.

Former prison inmates were at high risk for death after release from prison, particularly during the first 2 weeks. Interventions are necessary to reduce the risk of death after release from prison.

This kind of empirical information is important for it shows how complex the challenge of linking theory to practice really is. We may feel society is justified in incarcerating a criminal so that a retributive principle is satisfied. But if the punishment also imposes unexpected burdens, like an increase in the risk of death after release, this will have very important implications for determining what constitutes proportionality in this context.

So the slogan “The punishment must fit the crime” needs to be informed not only by considerations of the harm of the crime, but also by the realities of the burdens punishment, as it is currently practiced, imposes on a criminal’s life prospects. Otherwise we risk jeopardizing the sense of proportionality that underlies retributive principles of justice.