Protection as Punishment: When Medical Need Becomes a Justification for Incarceration

Adira Hulkower, JD, MS, HEC-C – Director, Bioethics Consultation Service, Montefiore Medical Center

Abstract: This paper examines the bioethicist's role in legal advocacy through the case of a capacitated, incarcerated individual denied parole under the pretext of needing specific medical care upon release—care the prison failed to provide. Although an open parole date had been granted, he was not released because of the claim that adequate medical care could not be arranged in the community. We collaborated with the prisoner’s legal team, contributing to legal arguments, engaging in strategic discussions, and supporting an amicus brief to challenge his continued detention. The paper reflects on the ethical tensions of ethicists participating in legal processes, including concerns about unintended consequences of raising medical and capacity-related arguments in advocacy efforts.
Beyond individual advocacy, this case highlights structural injustices in the carceral and healthcare systems. It illustrates how medical vulnerability can be weaponized to justify indefinite incarceration, turning access to care into a mechanism of prolonged punishment. It also underscores the ethical imperative of ensuring humane access to dialysis and other essential treatments within prison settings. The case exposes systemic failures that complicate finding placements due to lack of accessible, community-based care, disproportionately affecting marginalized populations.
We explore broader implications: Should bioethicists assume independent advocacy roles, particularly when systemic failures create ethical dilemmas beyond immediate issues? Does our responsibility extend beyond advocating for release to addressing structural conditions that hinder reintegration or advocating for patients’ autonomous choice regarding health care and release, even absent assured placement? This case critically examines bioethicists’ evolving role in carceral health justice advocacy.

Keywords: Medical vulnerability, Carceral healthcare, Legal advocacy