Dying Behind Bars: A Capability Approach to End-of-Life Care in UK Prisons

Background: With a rapidly ageing prison population in the United Kingdom (UK), an increasing number of people in prison are dying from chronic and life-limiting illnesses. Methods: A sample of 487 independent investigation reports into deaths from natural causes in UK prisons (2017–2020) was examined to explore palliative care referrals, appropriateness of restraints, applications for early release on compassionate grounds (ERCG), and equitable access to healthcare. Results: Most of the reports were based on male prisoners aged 60+, and the leading cause of death was cancer. While care was regarded as ‘equivalent’ in 83.7% of cases, several reports indicated delayed diagnosis, poor care coordination, and limited access to palliative care, particularly for people with non-malignant diseases. Restraints were regularly criticised as inappropriate or inhumane, and early release was not considered in 42% of cases, often due to delays or procedural issues. When viewed through Nussbaum’s Capability Approach, being unable to access healthcare ‘when needed’ represents a failure to secure the basic capability of bodily health, and reflects a profound restriction on practical agency. Conclusions: Delays in diagnosis, treatment, and referral are not merely inefficiencies but constitute structural barriers that constrain individuals’ real opportunities to achieve health and well-being. It is anticipated that older people in prison will experience layered capability inequalities, arising from age, health status, and custodial context. These findings suggest that prisons function as sites of punishment and environments in which capability deprivation is intensified towards the end-of-life.