Literature Review
The following literature review will be analysing all available peer reviewed
articles relating to persons living with dementia in various criminal justice systems
globally. Then this paper will examine the topic in the Canadian context. Methods
and results will be discussed.
This portion of the paper will summarize and synthesize results found in
existing literature to illustrate what is known, where gaps exist, and potential
problems around the topic of dementia in prisons. This paper will be conducting
a scoping review to analyze all the available literature on the topic of dementia in
the criminal justice system. Table 1 contains the results of systematic searches
and shows the resources consulted to obtain articles, the terms used in the search,
the dates of the articles, number of results, refined, and used sources. This
literature search was conducted using Medline, PubMed, SafetyLit, EBSCO,
JSTOR, and ProQuest from 1950 to present using the following keywords:
dementia, crime, law, and excluding the terms abuse and end-of-life. In addition
to these databases the organization Dementia Justice’s research library was
examined. The dates are restricted to as far back as 1950 as to gather as much
data as possible, although there are few, if any, articles dating back that far. The
“refined” results were based on titles and abstracts from the given results whereas
“used” articles were chosen following a thorough reading.
A large body of literature focused on crimes being committed against persons
living with dementia, very rarely were there articles looking at them as perpetrators
of crime. Table 2 presents inclusion and exclusion criteria used to refine the articles
that will be used in this review. Articles were not used if they did not meet the
inclusion criteria or if they were already being used from a different resource.
Inclusion Criteria Exclusion Criteria
People diagnosed with dementia People diagnosed with psychosis,
psychopathy, or other mental illnesses
People being arrested, charged with a crime, People not being charged with a crime or
or going through court processes facing civil suits
People living in minimum, medium, or Living at home, in long term care, acute
maximum security prisons or psychiatric care in hospitals, or asylums
hospitals
Published between 1950 and 2019 Published before 1950
Written in English Written in languages other than English
Focus on social sciences Focused on biology, chemistry or other
sciences
PLWD as perpetrators of crime PLWD as victims of crime
Discusses a program, policy or resource Does not mention a program, policy or
resource, or, is purely demographic data
Table 2
This review uses papers from any geographic area as long as they are in
English. All methodologies are acceptable. This literature review will be using peer
reviewed sources. Some news articles and periodicals will be included as examples
and case studies later in this paper, however they are not included in this systematic
search. Papers where dementia was not present or was compounded with another
mental illness were excluded to keep the focus solely on dementia. Persons living
outside of a correctional setting are excluded if they have not been arrested or
charged with an offense to ensure there is a connection to the criminal justice
system. Papers with a heavy focus on biology, chemistry, or other medical sciences
were also excluded in order to maintain a social gerontological lens. Articles that
focused on demographics and statistics or that did not discuss or suggest any
programs, policies or resources were excluded.
Results
For the purpose of this paper programs will be defined as a set of activities,
policies will be described as rules or regulations, and finally, resources will be
explained as additional assets or tools that can be utilized by criminal justice workers
(police, lawyers, judges, prison staff, etc.). Needs will be identified by synthesizing
information from across the literature. Persons living with dementia specifically in
the Canadian criminal justice system will also be touched upon to highlight the
relevance of the topic in a Canadian context.
Programs
Of the articles examined, twelve discussed programs in relation to
dementia and the criminal justice system. Many of these programs are simply
suggestions that have not yet been implemented or have been implemented on a
small scale and have no evidential backing. Wang et al. (2018), Maschi et al.
(2012) and Birkhoff et al. (2016) emphasize the need for more psychiatric care
and psychological therapy in prisons. The introduction of programs where
psychiatric care is available would provide evaluations, support, and treatment for
persons living with dementia in correctional institutions. In addition to this, health
promotion and cognitive stimulation programs are suggested to help improve
cognitive abilities and quality of life (Maschi et al., 2012; Combalbert et al.,
2017). Dillon et al. (2019) and Brooke et al. (2018) both identify the need for
programming that would encourage independence while still accommodating for
persons living with dementia in prisons, but it is also recognized that privacy
could be breached by sharing information on a person's medical diagnosis and
these programs would need to be culturally appropriate since prisoners living with
dementia are not homogenous.
Several articles discuss implementing a “dementia-buddy” system where
prisoners with dementia would be paired with other prisoners for assistance, support,
and kinship (Dillon et al., 2019; Brooke et al., 2018; Gaston, 2017; Maschi et al.,
2012; Shelley et al, 2018). It is noted that peer support programs have been
successfully implemented in some correctional institutions globally, however, they
continue to raise a privacy concern. Another recommended program involves
encouraging prisoners' families to support them through their sentence to promote a
sense of continuity with life outside of prison and maintain valued relationships
(Dillon et al., 2019).
Also suggested are programs where physical environments could be altered
to help persons living with dementia navigate their surroundings including the use
of high contrast colours, clear signage, visual meal choices, and identifying features
on cell doors (Dillon et al., 2019; Feczko, 2014; Gaston, 2017; Maschi, 2012;
Shelley et al., 2018). Modifying the environment can help to reduce risk factors of
dementia in prisons including changes to diet, increased physical activity, smoking
cessation, more socializing, and prevention of head injuries (Gaston, 2017;
Christodoulou, 2012). Other environmental modifications could be made to make
the prison setting more geriatric and dementia friendly by altering certain factors in
the Prison Activities of Daily Living (PADLs) such as implementing velcro shoes,
being allowed to remain seated for head counts, and longer time allotments for
completing tasks (Feczko, 2014; Gaston, 2017).
Shoji et al., (2019) explain that the use of “person-centered” rehabilitation
programs have previously been successful in calming reactive behaviors.
Berryessa’s (2016) research on frontotemporal dementia shows support for
environmental and behavioral programs on recidivism rates. Finally, the
introduction of palliative and hospice care programs into the prison regime would
be an ideal way of dealing with aged prisoners who are near the end of life and
require this type of specialized care (Maschi et al., 2012; Sfera et al., 2014).
Policies
Twenty-five articles discussed policies relating to dementia in the criminal
justice system. The most frequently mentioned was implementing policies for
screening and the early detection of dementia as this would ensure that fewer
diagnoses would be missed and more people would receive the appropriate treatment
when they need it, policies would also be needed for proper procedures to follow
after diagnoses have been given (Heinik et al., 1994; Dinniss, 1999; George, 2019;
Rayel et al., 1999; Liljegren et al., 2015; Brooke et al., 2018; Ahalt et al., 2018;
Combalbert et al., 2017; Christodoulou, 2012; Feczko, 2014; Gaston 2017; Maschi
et al., 2012; Shelley et al., 2018; Sfera et al., 2014). Also, if dementia is to be used as
a defense there must be rigid screening policies put in place to weed out the
deceivers and prove that the individual is actually experiencing dementia (Dufner,
2013; Power, 1977). In addition to this, the screening policies must be culturally
appropriate as Indigenous people are known to be overrepresented in the criminal
justice system (Gaston, 2017).
Policies involving moving a person living with dementia following a
diagnosis to an area or environment more suited to their needs is also regularly
suggested through the literature and has been shown to decrease aggressive
behaviors by mitigating situational factors (Seena, 2008; Cipriani et al., 2016; Fazel
et al., 2002; Hindley & Gordon, 2000; Haller et al., 1989), however, there are
downfalls associated with a policy like this such as inadvertently causing social
isolation, especially when the policy leads to segregation. The possibility of
compassionate release to parole or hospice care is suggested but faces opposition
from those who view the purpose of prison as largely punitive, while others point out
the chance of public risk and recidivism which could potentially be mitigated by
having rigorous screening policies and transitional supports (Combalbert et al.,
2017; Feczko, 2014; Maschi et al., 2012; Gaston, 2017). The Project for Older
Prisoners (POPS) is a group of lawyers and law students throughout the United
States who attempt to reduce overcrowding in prisons by releasing older prisoners
who are no longer a risk to society (Feczko, 2014). Geriatric and memory care units
can be considered for inmates who are labeled as high risk offenders (Maschi et al.,
2012).
The article by Dillon et al. (2019) highlights the need for policies around
privacy for persons living with dementia. These individuals may not consent to their
medical diagnosis being shared with others and some lack the capacity to consent to
this in the first place. Darby et al. (2016) and Birkhoff et al. (2016) both call for
policy makers to redefine the definitions of legal culpability, capacity, moral
responsibility, and the eligibility for an insanity defence. Appelbaum (2019)
discusses a recent policy change in the United States around persons living with
dementia facing the death penalty ruling that executing a person with no
understanding of what is about to happen to them and why it is happening is not
concurrent with the purpose of the law. Since Canada does not use capital
punishment as an option for sentencing this is not applicable, but nonetheless it
shows movement forward for the rights of prisoners living with dementia.
The final policy change discussed is a call for culturally appropriate language
when referring to dementia and the persons living with it (Maschi et al., 2012). The
use of language has a tremendous impact on how we perceive and treat persons
living with dementia and by shifting to culturally appropriate terms such as “persons
living with dementia” it is possible to dramatically improve their quality of life by
showing respect and understanding rather than stigma and fear.
Resources
Resources for criminal justice workers to use with persons living with
dementia were mentioned in eleven articles. Dillon et al. (2019) point out the
difficulty in identifying dementia in prisons because of the regimented environment
and some symptoms being consistent with ageist stereotypes. Several pieces of
literature emphasized dementia specific training for criminal justice workers to
avoid misinterpreting behaviors, to facilitate understanding, and to ensure proper
medical care is given (Seena, 2008; Cipriani et al., 2016; Fazel et al., 2002; Dillon et
al., 2019; Brooke et al., 2018; Feczko, 2014; Gaston, 2017; Maschi et al., 2012;
Shelley et al., 2018). As an example of how this could be implemented, Behavioural
Supports Ontario (2019) provides dementia training through their Behavioural
Education & Training Support Inventory (BETSI) program for staff. An instructor
comes and provides an interactive lecture on what dementia is, what it can look like,
and how to support and appropriately respond to reactive behaviors. This can allow
for early detection of dementia and facilitate proper treatment earlier. It is also
suggested that training prisoners on dementia would be an extremely useful resource
as it would allow individuals to notice changes amongst their peers or themselves
which could lead to faster and more accurate diagnoses (Maschi et al., 2012; Shelley
et al., 2018).
Berryessa (2016), Maschi et al. (2012) and Birkhoff et al. (2016) suggest the
use of pharmacological interventions that target behavioral charges as another type of
tool that could be used to assist staff in dealing with reactive behaviors, although this
is a complex issue that would require improved and more available medical care.
Medications can also have adverse side effects which may incidentally decrease an
individuals quality of life.
Finally, Maschi et al. (2012) highlight the usefulness of advocacy and
public awareness campaigns as a resource for persons living with dementia across
the criminal justice system as they would help to bring more awareness and
understanding of the disease.
Figure 1
Identifying needs
From the literature it is clear that there are a number of needs specific
to persons living with dementia and some that are more general and can be
applied to the whole population of older offenders. Dillon et al. (2019) in
particular identify a number of needs relating to dementia and the criminal
justice system: the need for support (mentally, physically, and emotionally)
across the entire criminal justice system while not diminishing their sense of
independence, the need to be understood, the need for personal privacy, the
need for dignity, for well-being, to be free from victimization and social
isolation, for adequate health care, and finally, for a safe living environment.
Support for these needs can be inferred from the literature.
Canadian Context
There is very little literature available from a Canadian standpoint. In fact,
none of the articles focused solely on the Canadian criminal justice system but
occasionally alluded to similarities found amongst all Western societies.
Discussion on the Literature
The following discussion will evaluate whether or not the programs,
policies and resources discussed in the literature are sufficiently meeting the needs
of persons living with dementia. Table 3identifies which programs, policies and
resources affect which needs.
Need Program/Policy/Resource
Support ●Psychiatric care
●Psychological therapy
●Peer support
●Family visitors
●Trained staff
Independence ●Functional programming
●Cognitive stimulation
●Modifying PADLs
Being understood ●“Person-centered” rehabilitation programs
●Screening/early detection
●Peer support
●Trained staff
● Advocacy and awareness campaigns
● Redefining legal culpability, capacity, moral
responsibility, and eligibility for an insanity
defence
Privacy
Dignity ●Trained staff
●Palliative/hospice care
● Use of dementia friendly language
Wellbeing ●“Person-centered” rehabilitation programs
●Not facing execution
●Palliative/hospice care
●Compassionate release
Positive peer relationships ●Peer support
●Trained staff
●Encouraging family visits
Healthcare ●Psychiatric care
●Psychological therapy
●Screening/early detection
●Trained staff
● Available medical care and medications
●Palliative/hospice care
●Health promotion
● Reducing risk factors for dementia
Environment ●Dementia/geriatric friendly modifications
●Relocation
● Reducing risk factors for dementia
Table 3
There is a financial burden associated with several of the proposed programs, policies
and resources which may cause difficulty in implementing them, this includes: psychiatric care,
psychological therapy, staff training, “person-centered” rehabilitation programs, screening/early
detection, introducing palliative/hospice care, available medical care, medications, and
environmental modifications.
Addressing the need for support, a peer support system would be virtually
costless but risks an individuals need for privacy regarding their medical history.
Encouraging family members to visit is also practically costless to the criminal
justice system but it is not rational to assume every person has a family to come visit
them or that they are on good terms with what family they do have. Although more
costly, psychiatric care and psychological therapy can prove effective for supporting
persons living with dementia. Having staff trained in dementia care would prove to
be invaluable as it would facilitate further social interaction and comfort.
For independence, providing functional programming and cognitive
stimulation would allow PLWD to be included in activities reducing boredom.
These activities could be cost effective on their own or by making changes to
existing programming depending on what they consist of. Functional programming
and cognitive stimulation that promotes independence would be relatively easy to
implement and could be low cost depending on the type of programming offered.
Modifying prison activities of daily living is essential for maintaining the
independence of a person living with dementia because activities such as bathing,
toileting, and dressing are fundamental to a person’s sense of self and feelings of
depression and humiliation are likely to occur when assistance is needed with these.
The need for being understood can be met by taking a “person-centered”
approach to rehabilitation programs which focuses on personhood and
individuality. Screening, early detection, staff training, advocacy and awareness
campaigns can lead to an understanding of why a person may be exhibiting certain
behaviours. Educating other prisoners to facilitate peer support can also aid in
meeting the need for being understood. These programs, policies, and resources
come at various costs but offer an important first step in meeting the general needs
of persons living with dementia.
The need for privacy has no programs, policies or resources geared
towards it and therefore this need cannot logically be met.
Dignity is a need that can also be met by training staff on dementia which
can reduce misunderstandings and infantilization. Palliative/hospice care is
intended to maintain a person's dignity at the end of life and since dementia is a
progressive disease it will eventually lead to a need for this type of care. As
discussed previously, these options are relatively expensive. Promoting the use of
dementia friendly language challenges the stigma surrounding the disease and can
aid in maintaining dignity and exists as a virtually free solution.
The need for wellbeing can be addressed through “person-centered”
rehabilitation which emphasizes an individual getting better so that they are
functional in the future, if rehabilitation programs are already offered then
modifying the program to capture personhood would not be overly costly.
Palliative/hospice care is also focused on the wellbeing of an individual, although it
focuses solely on the end of life and can be expensive to implement. Compassionate
release, although not suitable for all prisoners or their crimes, is a way to increase
the wellbeing of prisoners with dementia exponentially. Prison can be extremely
distressing to anyone and this can be amplified by a dementia diagnosis when a
person struggles to comprehend their surroundings. Compassionate release could
actually save correctional institutions money by releasing older individuals who no
longer pose a threat to society and incidentally reduce overcrowding. When it
comes to positive peer relationships training and education of both prisoners and
staff can facilitate authentic, meaningful relationships. Having these relationships
can aid in improving many of the other needs including support, being understood,
dignity, and wellbeing. Again, disclosing a person's medical history risks their need
for privacy but perhaps this can be balanced by meeting other needs and limiting
the amount of information disclosed. This option has some costs associated with
training but as previously discussed, training goes a long way by meeting an
assortment of needs.
A fundamental need for all humans is healthcare, but moreso for individuals
living with dementia and potentially other comorbidities in prisons. Although more
expensive, Correctional Service Canada (2019) states that essential health services
are a fundamental right of prisoners which should absolutely include screening/early
detection, psychotherapy, palliative/hospice, psychiatric and medical care for
persons living with dementia. Screening and early detection is essential for
identifying when a person has or is at risk for dementia. A combination of
psychiatric care, psychological therapy, and medication are all extremely valuable
for the treatment and management of a dementia diagnosis. It is known that prisons
generally have substandard healthcare compared to what is available outside of
prisons and improvements to overall healthcare would be beneficial to all prisoners.
Palliative and hospice care also factor into healthcare that should be available in
prisons. In addition to this, training staff about dementia would assist in diagnosis
and treatment for the disease. Health promotion would be fairly inexpensive to
implement in prisons and could have drastic impacts along with conscious efforts to
reduce risk factors associated with dementia.
The environment plays a key role in meeting the needs of persons living
with dementia. Modifications like signage, bright colours, and large lettering can
help prisoners navigate their surroundings more easily. Relocation to memory
care or geriatric units have been shown to reduce aggressive behavior as
previously mentioned, however, they isolate individuals from their peers.
Compassionate release may be less expensive but the evaluation and monitoring
of the individual would have to be thorough. Reducing risk factors associated
with dementia could be effective and inexpensive by modifying prisoners diets,
encouraging physical activity, discouraging smoking, enhancing socialization and
preventing head injuries so that less people in prisons develop a dementia
diagnosis.
The most important piece of data gathered from the literature is that none of
these programs, policies or resources are currently being utilized in the Canadian
criminal justice system. This analysis supports the hypothesis finding that the
majority of needs for persons living with dementia in the Canadian criminal justice
system are not being sufficiently met. Without the use of the outlined programs,
policies and resources it is not possible to adequately meet the needs of persons
living with dementia and therefore they are not able to have dignified and equitable
experiences in the Canadian criminal justice system.
Limitations
The limitations of this research stem from the general lack of attention given
to persons living with dementia in the criminal justice system within academia.
There was an extremely small body of literature available on the subject in general
and even less from a Canadian context. The majority of the studies focused on
persons living with dementia in prisons rather than at the point of arrest or through
the court system. In the available studies limitations arose from small,
unrepresentative sample sizes. Underdiagnosing and underreporting of dementia
may also contribute to the limitations outlined. Certain measures of inappropriate or
illegal behavior may be country specific as norms and values can differ across
regions.
Summary
To conclude, it is evident from the literature that there are a variety of
programs, policies and resources potentially available for persons living with
dementia in the Canadian criminal justice system. The programs, policies and
resources that are available are being underutilized or completely unused. The needs
of persons living with dementia in the criminal justice system are complex and
require greater attention and further research in order to avoid potential negative
health outcomes, ethical, and legal implications.
Scope
As much of the literature touched upon, people living with dementia in
prisons face a variety of challenges. Most of the focus has been on people living
with dementia in prisons while there is much less attention focused upon the
challenges of persons living with dementia being arrested, going through the court
system, on parole, or after release from prisons. The following portion of this paper
intends to detail programs, policies, and resources available that were not found in
the literature as well as examining gaps that still exist. The following section will
contain a variety of case studies in order to exemplify the scope of the problem and
show that the Canadian criminal justice system is ill prepared to deal with the
looming influx of persons living with dementia in all spheres of justice from arrest
to release. Programs, policies, and resources in this section were identified through
the use of web searches and examination of news media articles. Search terms
included combinations of: dementia, and program, policy, resource, initiative.
Arrest
An individual’s first point of contact with the criminal justice system is
typically with the police and it is presumably rare to find first responders who are
thoroughly educated on dementia. Concerns are raised when considering how much
force is appropriate to use with an older individual who is exhibiting violent or
illegal behaviors. Further considerations need to be made regarding suitable charges
being laid. Police need to consider whether arresting and charging someone who has
dementia is actually doing the public a service or not. It is likely that many
individuals with dementia who do come into contact with police are given a warning
rather than charged. As mentioned previously, this contributes to the lack of data on
dementia in the criminal justice system.
The Guelph Police Department in partnership with the Waterloo-
Wellington Alzheimer Society has developed a program called Safe Pathways
which aims to reduce the likelihood of persons living with dementia entering the
criminal justice system by focusing on education and awareness, creating a specific
response program, and designing support systems for those already in the judicial
system (Alzheimer Society, 2015). Similarly, the Vancouver Police Department in
partnership with the Alzheimer Society of B.C. has launched an initiative to
recognize and assist persons living with dementia in the community who may be
lost or confused by knowing the signs, knowing what to do, and knowing what to
say (Vancouver Police Department, 2015).
In addition to these two programs, the Alzheimer Society offers educational
programs for first responders which includes information on how to recognize
dementia, communication strategies, MedicAlert Safely Home bracelets, search and
rescue, and reuniting the family (Alzheimer Society, 2018). They have also
developed a first responder handbook which expands on the information from their
educational programs (Alzheimer Society, 2018). These resources are evidently
invaluable as they increase the likelihood of equitable treatment for persons living
with dementia during arrest or contact with first responders. These resources are
readily available through the Alzheimer Society yet this raises the question of
whether they are actually being utilized by Canadian police departments.
Arrest
Mr. Murphy’s daughter did everything she could think of to help her father when
he was diagnosed with dementia: put him on a list of vulnerable persons,
approached the Alzheimer Society for advice, and gave his photograph to police
so they would know he had dementia in case he ever got into trouble (Motluk,
2019). He was only one day away from a meeting to get him into a long-term
care home when he assaulted his wife and she had to call the police out of fear for
her safety (Motluk, 2019). Due to existing domestic abuse laws in Canada, Mr.
Murphy was charged with a crime and labeled as violent which prevented him
from being accepted into any long-term care homes- because of the law, he could
not return home and was confined to a hospital where he died a year later
(Motluk, 2019).
Figure 2
Court
The court system is a daunting experience for anyone, let alone someone
living with dementia. The Canadian Charter of Rights and Freedoms(1982), s.
10(b), states that every person in Canada has the right to retain and instruct counsel.
The branch of Elder Law specializes in laws affecting seniors including age
discrimination, care planning, elder abuse, and power of attourney, there is,
however, no mention of criminal defense or dementia in the enumerated topics
(Canadian Bar Association, n.d.). Similarly, it is challenging to find a criminal
defense lawyer who has experience with the elderly or persons living with dementia.
Persons living with dementia may find it challenging to communicate with their
lawyer or comprehend court proceedings. Persons in advanced stages of dementia
are more likely to be found unfit to stand trial or not guilty by reason of insanity than
a person with mild dementia. The Criminal Code of Canada outlines the legal
requirements for which a person could be found unfit to stand trial: they do not know
they are in a courtroom, who the people in the room are, what those peoples
functions are (E.g. judge, lawyer, etc.), or why they are there; or, they cannot
understand what they are charged with, what pleas exist, what pleading a certain way
could result in; or, they cannot communicate their wishes to their lawyer, even in
simple terms (Legal Aid Ontario, n.d.). If it is suspected that a person is unfit to
stand trial then a judge can order a fitness assessment which is conducted by a
licensed psychiatrist (Legal Aid Ontario, n.d.). For a person in late stage or
potentially even mid-stage dementia it would be obvious that the individual is not fit
to stand trial as they would likely not meet the aforementioned criteria. On the other
hand, for people in the early to mid stages of the disease it may be much harder to
determine as these individuals can still possess some semblance of competence.
Even if the person is able to meet the enumerated criteria it is inevitable that their
condition will worsen in the future.
There are no programs, policies, or resources available in Canada for
persons living with dementia throughout the court process. The best they can hope
for is to be found not criminally responsible or unfit to stand trial. From the
literature it is clear that many people living with dementia, however, end up being
found fit to stand trial regardless.
Court
In 2011 Joe McLeod, who was living with dementia in a long-term care home in
Winnipeg, shoved a fellow resident who died as a result four days later (Barghout,
2019). He was arrested and charged with manslaughter, the charges were later
dropped as he was found unfit to stand trial following a psychiatric assessment
(Barghout, 2019).
In 2016 Fred van Zuiden murdered his wife of nearly sixty years in their
Calgary home (Martin, 2019). He was found unfit to stand trial in 2017 and the
second-degree murder charge against him was withdrawn following his death at a
secure care facility in 2019 (Martin, 2019). Mr. van Zuiden was Jewish and had
survived World War II in the Netherlands by hiding from the Gestapo, an ordeal
he detailed in a book he had published, and he was known to show fear and often
confuse people for Nazis following his arrest (Martin, 2019).
Figure 3
Imprisonment
As mentioned previously, the goals of sentencing are to to denounce
unlawful conduct, to deter the offender and others from committing crimes, to
separate dangerous offenders from society, to rehabilitate the offender, to provide
reparations for wrongdoings, and to promote acknowledgement and responsibility
for the harm done (Department of Justice, 2018). A dementia diagnosis can render
these objectives ineffective. The majority of the literature focused on imprisonment
and suggested a number of programs, policies, and resources related to persons
living with dementia who are incarcerated for a crime. In Canada, the most severe
sentence for a crime is imprisonment as it denies a person their freedom
(Department of Justice, 2018). This is in contrast to the United States criminal
justice system where the most severe sentence is the death penalty. If a person is
found or pleads guilty then the court must impose an appropriate sentence.
Imprisonment
In 1985 Madison was arrested and charged for killing a police officer and
remained on death row in the United States until 2019 (Zimmerman, 2019). Held
in solitary confinement for the last 30 years, Madison suffered several strokes
resulting in blindness and vascular dementia; additionally, he is incontinent,
cannot ambulate without assistance, suffers memory loss, and cannot remember
his crime (Zimmerman, 2019). Madison’s case caused controversy as people
began to debate whether it was ethical to execute a frail individual with no
memory of their crime who could not possibly understand why they were being
executed (Zimmerman, 2019). As discussed previously in Appelbaum (2019) this
case created a precedent that individuals who cannot remember their crimes due to
dementia cannot be executed without violating the Eighth Amendment, which
prohibits cruel and unusual punishment. Although capital punishment does not
exist in Canada, this case highlights the need for adjusting certain existing laws
for persons living with dementia.
