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On Tuesday, former Massachusetts House Speaker Salvatore DiMasi regained his freedom, granted compassionate release from federal prison. DiMasi, who has been in federal custody since 2011 for corruption, has suffered from both oral cancer and prostate cancer since his incarceration.
His successor, Speaker Robert DeLeo, has praised the court’s decision, even as the House earlier this year killed a bill to allow Massachusetts’ state prisoners the same opportunity. Massachusetts now has the dubious honor of being one of five states without a mechanism for compassionate release.
One of the great privileges of my career as a physician has been helping patients die the way that they choose to. I have witnessed the tremendous grace that people can bring to the end of their lives, the compassion of caregivers that eases the final days, and the forgiveness of loved ones that many of us desperately need. Life is complicated and messy, and death no less so. For almost every dying person, some sense of control over death is the most important preoccupation, even more important than pain control.
To die in prison is, in most cases, to die without autonomy. Dying behind bars will become more common as the prison population becomes older and sicker. Often, dying in prison happens even in cases like DiMasi’s that were never meant to be life sentences. To pass away in prison, separated from your family, seems tragic under the best of circumstances. When medical disease is complex and painful, it is cruel.
In his opinion on the DiMasi case, U.S. District Court Judge Mark Wolf noted that “inmates have a Constitutional right to adequate medical care. They do not have a right to optimal medical care.”
But what may be considered “adequate” is not well defined. Prisons may be run by the federal government, individual states or private companies. Each is left to define “adequate care” on their own terms. Some, like the California state prisons, have aggressively embraced compassionate end-of-life care, while other prison systems are ill-equipped to deal with the dying.
In considering the ex-speaker’s release, Judge Wolf worried that DiMasi’s release could appear to be “a form of unwarranted disparity based on power or privilege, which would injure respect for the law.” By specifically mentioning concern about sentencing disparities in his opinion, he seemed to be calling on lawmakers to expand options for compassionate release.
There is no question that DiMasi has benefited from privileges that many of our state prisoners do not have. For one, he is a lawyer, while most prisoners cannot even read well. Illiterate prisoners are unlikely to be able to navigate a complicated appeals process without formal guidelines, let alone while dying.
He also has a family to advocate for him, as his wife has so forcefully done. Many prisoners are far from their relatives, and their families tend to be much poorer than the general population.
Finally, DiMasi was in a federal prison with clear guidelines on compassionate release. So far, our state lawmakers have declined to create a process for compassionate release for prisoners in Massachusetts.
One of our core values as Americans is equal protection under the law. The state cannot easily fix the problems of literacy or poverty in our prisons. But it can easily create a fair and transparent process to apply for compassionate release, modeled on the carefully considered guidelines of the federal government, which were updated this year.
DiMasi’s release was applauded by his successor, DeLeo, who said he was glad that his former colleague would be “reunited with his family.” But the speaker has not formally supported compassionate release for state prisoners.
The issue is expected to come before the Legislature again next year. Senate President Stanley Rosenberg says he supports compassionate release, the State House News Service reports, while DeLeo says he thinks it's very much in order "under certain circumstances," such as DiMasi's release.
State lawmakers have resisted compassionate release even though it would save the state money. Their care is the responsibility of the prisons that are entrusted with their punishment. This is a financial burden for the states that oversee them — one that is only likely to grow as the prison population ages.
Prisoners tend to be among the most vulnerable in society because they are not powerful or sympathetic. It takes significant moral courage to advocate for inmates that we cannot identify with. Lawmakers have also raised concerns of public safety. But creating a transparent process for compassionate release does not mean automatic release of sick and dying prisoners. It means a fair and accessible process where the public's safety can be weighed against the human rights of the individual prisoner.
I applaud the court’s decision to let DiMasi go. He reportedly needs assistance with eating and drinking to prevent him from choking, and ongoing oncology care. In the opinion of the court, his family is better able to provide adequate care than the prison.
But my relief for him is tinged with sadness that the very institution he once presided over, the Massachusetts House of Representatives, has not allowed other prisoners the same chance.
Dr. Elisabeth Poorman is a graduate of Cambridge Health Alliance and a primary care physician in Everett. She tweets at @DrPoorman.