Among America's aging prison inmates, dementia is growing more prevalent. This reality came into sharp focus when, this summer, an inmate with Alzheimer’s was executed, sparking discussion about the humanitarian issues involved in the incarceration — and execution — of people who no longer understand why they are in prison.
In June, after a 17-year hiatus, the Federal Bureau of Prisons resumed the scheduled execution of four death row prisoners. One of them, Wesley Ira Purkey, was living with Alzheimer’s disease. The news sparked debate surrounding inmate competency, mental illness and the flaws in the federal justice system.
Purkey was said to have schizophrenia, Alzheimer’s and PTSD. As one of his lawyers, Rebecca Woodman, told Newsweek in mid-July, “He has long accepted responsibility for the crime that put him on death row, but as his dementia has progressed, he no longer has a rational understanding of why the government plans to execute him.”
On July 15, following his lawyers’ urging for a Supreme Court ruling which would possibly find him incompetent to be executed, his execution was temporarily stayed by a judge. But the Supreme Court overruled his judicial stay, and Purkey was executed by lethal injection in Indiana on July 16.
The Ethical Implications of Alzheimer’s in Prison
Purkey was in prison for the rape, murder and dismemberment of a teenage girl in Kansas City in 1998. In a moment of lucidity before his death, Purkey expressed deep regret for the pain and suffering he caused the victim’s family and his own. Despite that clear awareness of his crime, Purkey’s defense and prisoners’ rights advocates had argued leading up to the execution that the progression of his illness may have deemed him unfit to be sentenced to death.
And speaking more broadly about the increasing prevalence of Alzheimer’s among the U.S.’s aging prison population, advoactes say there are both ethical and legal implications to executing a prisoner who doesn’t remember his crime. A 2012 American Civil Liberties Union report predicted that by 2030, one third of all inmates will be older than 55. According to the Alzheimer’s Association, one in 10 people older than 65 have Alzheimer’s, and 80 percent of those with dementia are 75 or older. Purkey’s case sheds light on the reality that death row is growing older and emphasizes the importance of declaring an inmate mentally competent for trial or execution.
Critics say executions like that of Purkey may qualify as cruel and unusual punishment, thus defying the eighth amendment. Continuing with the detention or execution of an elderly inmate with Alzheimer’s disease may also go against what legally constitutes justifying incarceration.
The case draws attention to the need to accurately diagnose elderly inmates with similar cognitive diseases.
“Prisons were never designed to be geriatric facilities,” senior counsel for the United States Program of Human Rights Watch Jamie Fellner stated, “Yet U.S. corrections officials now operate old age homes behind bars.”
As the American population of elderly inmates continues to rise, there is a clear need for specialty units for inmates with dementia-related diagnoses. It is rare, but in some places, these already exist as models for the future of inmate care.
Dementia Care in the U.S. Prison System
Some within the U.S. prison system are actively working to pilot solutions to address this need. The Unit for the Cognitively Impaired, a 30-bed correctional unit located within the medium-security Fishkill Correctional Facility in about 70 miles north of New York City, is unique in concept: it is the first of its kind in the country that focuses specifically on housing inmates with dementia.
The complex, which typically houses inmates in their sixties, is designed to operate more like a nursing home than a prison ward. The coloring and lighting of the unit are both bright, and inmates are able to roam freely within it. Notably, the staff includes social workers, clinical psychologists and psychiatrists.
“As a basic design I think it’s very important that they have [the Unit for the Cognitively Impaired],” Prison Visiting Project at the Correctional Association of New York Director Jack Beck told the Marshall Project. According to Beck, prison life poses significant stressors to inmates with Alzheimer’s, dementia, and related neurological health conditions. Following orders from prison security, being exposed to loud noises and alarms, and maintaining strict routines can be especially challenging for inmates with cognitive impairments. Reportedly, inmates with dementia often go unnoticed in understaffed or overcrowded prisons.
The Federal Medical Center in Devens Massachusetts plans to open a Memory Disorder Unit (MDU) for inmates with a Dementia diagnosis. The facility shares a similar “nursing home model” to the Unit for the Cognitively Impaired, and hopes to implement new strategies to appropriately support the elderly prisoner demographic living with various mental illnesses. It will include highly extensive training for staff members in Alzheimer’s disease and Dementia care.
The Federal Bureau of Prisons recognizes the need for specialty care units. Within the prison system, inmates with dementia can exhibit an increase in depression, frustration with behavioral challenges, social anxiety, paranoia, and confusion. Without the care of specialized correctional officers, such inmates can lead to security threats or require higher levels of care, sometimes developing total dependency on staff-members.
Dementia in the aging inmate population is growing ever more prevalent. However, the prison system has a long way to go in addressing the humanitarian issues involved in the incarceration of people who no longer understand why they are in prison. Vernon Madison, another death row prisoner with Dementia, died earlier this year after battling serious mental illness due to multiple strokes. His case grasped national attention as the Supreme Court ruled in favor of Madison, offering him Eighth Amendment protections due to his dementia.
The advocacy surrounding cases such as Madison’s highlights the importance of the mental competency of inmates in the American prison system — especially when they are on death row. Advocates for inmates’ rights have used such cases to speak out and suggest the need for an increase in legal policies to protect inmates with similar cognitive diagnoses. Ohio’s oldest death row prisoner, 79-year-old James Frazier, is scheduled to be executed in October of 2021, despite his not understanding why.
