Prisoners with dementia - the moral challenges of cognitive impairment

Today, I read Pam Belluck’s Sunday New York Times article about prisoners with dementia. Her story reminds me about why I decided to focus my medical practice on persons with late-life cognitive disorders.

She chronicles how symptoms of disease, such as agitation and confusion, are often mistaken for misbehaviors that receive prison mediated discipline. She describes the “gold coats” – prisoners who are charged with caregiving duties that include cleaning up an incontinent inmate’s urine, and feeding and bathing an inmate. For some of these prisoners-as-caregivers, these raw tasks restore in them a sense of dignity and respect for humans. Some see it as a way to parole.

During my geriatrics fellowship, I came to see how dementia explains as much about us, the non-demented, as it does about the people who suffer from it. I was assigned the care of several residents of a nursing home that was attached to a retirement community. All of them had some degree of cognitive impairment.
One of my patients hated the nursing home food. Rather than eat in his room in the nursing home, he started to visit the retirement community’s “main dining room,” where, he had discovered, the food was in truth better. In time, the residents of the “independent living apartments” protested. He should eat in his own room, they insisted. They claimed he used his fingers to take food from the buffet. They wanted him out. And the staff complied.
I remember when I visited him in his room, he said to me how he hated the food in the nursing home and the food in the main dining room was much better. Though he was demented, he was right. He knew what he wanted, and he figured out a way to get it. I give him credit for that. I do.
A few years later, I started studying how people respect the voting rights of persons who have cognitive impairment. I discovered how some commit acts we ought to revile, such as stealing votes, while other rise up and do great things, such as assisting all who wish to vote.

Demented prisoners. Nursing homes don’t want them. Many of their families, if they have families, know they couldn’t care for them as the prisons can. Or they simply don't want to. So we have other prisoners care for them. Or we build prisons as nursing homes. Read the 180+ comments the article generated.