Doctors' dilemmas
Doctors working within the prison system may struggle against these concepts, but are unlikely to persuade those managing the system to make significant investment in care provision for those awaiting execution. But the nature of capital punishment in most countries, i.e., its use for cases of great brutality, means that many prisoners are likely to suffer from serious mental health disorders. In jurisdictions such as the USA, a large proportion are likely to have committed crimes while under the influence of narcotics and other powerful and addictive substances, others may have psychotic or personality disorders. While most countries in theory exclude from trial – or at least from capital trial – those with serious mental health problems, the reality is that few individuals are successful in getting themselves declared unfit to stand trial.
Doctors within the prison system will inevitably see and treat convicted prisoners who are mentally ill. Some of these might be suffering from depression and anxiety related to their imprisonment and sentencing, others might have psychotic illness including schizophrenia or bipolar disorder. Other prisoners may well have behavioural disturbances, or suffer from sociopathic or psychopathic disorders.
Many of these individuals will become more ill, or more obviously mentally ill, while in prison. This is inevitable, not only because of the natural history of their illness but is also compounded by the conditions in which they find themselves and the effects of the sentence they have received. This leads to a real dilemma for the doctor. The law invariably requires that a person being executed understands the issues involved and is therefore 'fit for execution'.