CALGARY — A Belgian man three decades into a life sentence for rape and murder wanted doctors to help him die — and he nearly got his wish.
Frank Van den Bleeken suffered no terminal disease when he was granted a doctor-assisted death in September 2014. Rather, he sought to end his "unbearable'' psychological suffering, arguing his life behind bars was intolerable and there was no hope his violent sexual urges would ever go away.
The case underscores some of the prickly issues Canadian corrections authorities may have to tackle with the legalization of medically assisted dying. So far, there's been little clarity on how prisoner requests should be handled.
In January 2015, Van den Bleeken was supposed to die by lethal injection, but doctors backed out.
Canada's law still unclear
Belgium has allowed doctor-assisted death since 2002 and there, the practice is not limited to terminal patients. It's unclear whether or not Canada's law will be restricted to those close to death.
Howard Sapers, Canada's prison watchdog, wants to know how authorities will deal with the issue.
"We are in discussion with the Correctional Service of Canada to get a sense of the state of their planning, to see how advanced it is, to determine whether or not they're appropriately consulting, as they are required to by law, with the inmate population,'' he said.
By law, inmates must have the same standard of health care they would on the outside.
But Sapers has raised concerns about how inmates are cared for in their final years. About a quarter of the prison population is over the age of 50 and inmates tend to have more health problems and shorter life spans compared to the general public, he said.
Correctional Investigator of Canada Howard Sapers hold a news conference in Ottawa on March 7, 2013. (Photo: Sean Kilpatrick/Canadian Press)
"As that proportion of the population of inmates grows, we expect to see more deaths in custody, particularly since we're now looking at 20 per cent inside penitentiaries serving a life sentence,'' said Sapers.
"So we've been very concerned about how CSC responds to death in custody.''
The Correctional Service's Avely Serin said the department is closely monitoring the debate.
"So we've been very concerned about how CSC responds to death in custody.''
"Any policy changes developed to meet the legislative requirements would take into account CSC's unique operational context and the population under its responsibility, should it be required.''
The matter is likely to raise some tough issues for corrections officials, said Catherine Latimer, who leads the John Howard Society of Canada, which advocates for a "effective, just and humane'' corrections system.
"Their mandate is to protect the lives of these men and women who are serving sentences, so their mindset is to keep everybody going,'' Latimer said. "I think it will be difficult for them.''
It may be best for an independent body to oversee the matter, she said.
Context should be taken into account: Expert
Trudo Lemmens, Scholl Chair in Health Law and Policy at the University of Toronto, has cautioned against Canada adopting Belgium's open-ended approach to assisted dying.
As the Van den Bleeken case demonstrates, he said context needs to be taken into account.
"The prison system is quite unique because it's an environment in which there is a lot of anxiety, a lot of suffering, a lot of medical issues, a lot of mental health issues,'' Lemmens said.
"Are there particular components that make the person who is asking for physician-assisted dying more vulnerable? Is this indeed a prisoner who is suffering from a terminal illness? Could it be that the prisoner is asking just because he or she is in pain and there no adequate pain relief, because the prison system is not accommodating a more humane way of dying?''
"The prison system is quite unique because it's an environment in which there is a lot of anxiety, a lot of suffering, a lot of medical issues, a lot of mental health issues.''
Lisa Silver, who teaches criminal law at the University of Calgary, wonders whether prisoners will have the means to give their informed consent. That goes beyond mental health and competency — do they have the same access to medical and legal advice in making their end-of-life decisions?
The bill being debated in Ottawa, C-14, would amend the legislation that covers prisons — the Corrections and Conditional Release Act — so an investigation is not required if a prisoner dies with medical assistance.
But Silver said she would like to see the law clearly outline how the issue would play out in prisons.
"Why didn't the government take the time to really look at the Corrections and Conditional Release Act and amend it so that this can be meaningful?''
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Junge, Heiko/AFP/Getty ImagesNorway has one of the lowest re-conviction rates in Europe, at 20%, and 71 prisoners for each 100,000 population, roughly half the UK total.
Dubbed the "world's most human prison system" it operates on the principle that custodial sentences restrict the freedom of movement only - and not prisoners' other rights.
And there's an intense focus on rehabilitation. "Progression through a sentence should be aimed as much as possible at returning to the community," the government says.
One prison, Halgen in the north of the country, has attracted international media attention due to its design - likened to university halls by some media - as well as its ability to serve the prison system's priorities.
At Halgen Prison, prisoners:
- are able to cook meals for themselves
- have access to ensuite facilities
- can work in retail stores and other jobs
- earn points to spend on site
- have access to scenic running routes within landscaped, secure grounds
- have large windows with plenty of natural light
However, Norway's system became so overcrowded last year it sent 300 prisoners to the Netherlands.
© Catchlight Visual Services / AlamyThe Netherlands has just 69 prisoners per 100,000 population and has enough capacity in its prisons to accommodate criminals from other countries.
Routines exist to rehabilitate "persistent offenders", and those who are motivated can develop skills related to:
- self care and hygiene;
- spending of leisure time;
- financial administration;
- unsupervised settling; and
- social attitude
However, while it pursues many policies aimed at rehabilitation of inmates, some of these have been severely curtailed in recent years.
Single-use cells are no longer mandatory, while the amount of hours devoted to activities each week reduced still further.
Nonetheless in 2013, it was reported that declining crime rates in the Netherlands meant that although the country has the capacity for 14,000 prisoners, there were only 12,000 detainees.
Gitte13 via Getty ImagesDenmark has a reconviction rate of 29% -- as opposed to England & Wales' 49% -- and it has 61 prisoners per 100,000 citizens - far fewer than the UK.
The number of women guards in Danish prisons has been noted as having a calming effect on majority male inmates. Women are more likely to reduce tensions, and prisoners are more likely to make an effort to talk to them - more so than with their male counterparts.
Annette Esdorf, deputy director general of the prison and probation service in Denmark, explained the philosophy to the BBC:
"We make an effort to keep crime down by treating the prisoners in the best way. We have a rather humane regime, not because of the prisoners, but because we think it works better this way.
"Our prison regime is based on normalisation, a principle of openness and responsibility, because we think it's the best way of avoiding reconviction."
JONATHAN NACKSTRAND via Getty ImagesSweden has a remarkably low prison population rate at just 55 per 100,000 citizens.
"Sweden's remarkable prison system has done what the U.S. won't even consider," Mic.com reported last year, stating, "prisons in Nordic countries are designed to treat (prisoners) as people with psychosocial needs that are to be carefully attended to."
It is this philosophy which guides Sweden's correctional system.
Director-general Nils Öberg told the Guardian: "It has to do with whether you decide to use prison as your first option or as a last resort, and what you want your probation system to achieve.
"Some people have to be incarcerated, but it has to be a goal to get them back out into society in better shape than they were when they came in."
Rather than "static security" roles, guards in Swedish prisons adopt "dynamic security" - fostering interrelationships between staff and inmates for the benefit of rehabilitation and safety.
Â© imagebroker / AlamyUnlike many prisons across the world, Germany has placed an emphasis on pleasing decoration and home comforts - even those as simple as ceramic toilets and wash basins, opposed to the expected stainless steel.
It has roughly half the prison population of the UK, at 76 inmates per 100,000 citizens.
On a visit to a German prison alongside US justice officials, Vice News found: "Most prisoners have knives and forks in their cells. Though the prisoners cannot access the internet, they have telephones in their rooms, and they can call anyone—even the media."
While reconviction rates are around 48%, special efforts are made to reintroduce offenders into society - aided by German culture.