In two separate cases Thursday, convicted murderers were released from prison on compassionate grounds, because each had only a few months to live.
Abdel Baset al-Megrahi, convicted in the bombing of Pan Am Flight 103 over Lockerbie, Scotland, which killed 270 people, was released from a Scottish prison after he was given three months to live from his terminal prostate cancer. And, in California, Deborah Peagler, convicted in the murder of her abusive boyfriend, was released after Gov. Schwarzenegger let the parole board's opinion stand, owing to her diagnosis with terminal lung cancer.
Meanwhile, Susan Atkins, convicted for her role in the murders of Sharon Tate and Jay Sebring in 1969, has been unable to gain a compassionate release from prison for more than a year despite her diagnosis of terminal brain cancer.
While regulations vary by state and country, these decisions bring light to a system designed to allow some compassion to prisoners in their final months, weeks or days.
"Generally, patients have either a 'terminal' disease or have a serious, irreversible condition which renders them incapacitated," said Dr. Joseph Blackston, assistant clinical professor of medicine at the University of Mississippi School of Medicine and adjunct professor of law at Mississippi College School of Law. "An example of the latter might be someone in a persistent coma, vegetative state, or someone who is totally paralyzed."
He has worked as both a doctor for terminally ill inmates, as well as a lawyer.
Most patients, like those making headlines, have been diagnosed with incurable cancer, likely having widespread disease.
Outside the prison walls, these same patients would be the ones considering hospice care, a comfort-only level of care, performed on an inpatient or outpatient basis. Hospice patients, in general, no longer qualify for further diagnostic testing or extraordinary therapies. Under Medicare guidelines, they are, to the best of the treating physician's estimation, not likely to live longer than six months.
A large number of the aging prison population could be eligible for compassionate release but, Blackston said, "Only a fraction of inmates who might actually meet the medical criteria for release end up being released."
Gaining release is a result of decisions by two separate bodies.
"In correctional care, you've got two sides of the house," said Dr. Kim Dunn, formerly the vice chairwoman for the Texas Department of Criminal Medicine. "They're really two distinct reasoning processes that have to come to bear."
On one side, there are the clinicians, who determine a patient's likely time for survival, while on the other side is what Dunn referred to as the "security side of the house," which determines the risks an inmate might pose when released.
"You cannot know what that individual did," Dunn said of being on the physician's side. "It's not part of their medical record -- you don't know, and as a physician you stay on your side of the house in terms of doing your best for the patient, because that's the oath that we took."
Dunn recalled one patient she attended to where she arrived at the room and found he had four armed guards.
"It was one of those times where you really have to dig deep as a doctor," she said.