The Implications of Denying Healthcare to Inmates: Originalism and the Supreme Court

As the United States continues to grapple with the meaning and interpretation of its Constitution, issues relating to abortion, affirmative action, and, most recently, the issue of healthcare for incarcerated individuals have grown increasingly contentious. The same originalist approach that has been deployed to challenge the landmark Roe v. Wade ruling could also be used to curtail the healthcare rights of those who are incarcerated, thus directly contravening the provisions of the Eighth Amendment and disregarding the legal precedents established by the 1976 Supreme Court decision in Estelle v. Gamble.

The constitutional right to healthcare for incarcerated individuals, as established through Estelle v. Gamble, maintained that failing to provide "adequate medical care" violated the Eighth Amendment's prohibition of cruel and unusual punishment. The case involved a respondent state inmate who claimed he had been subjected to "cruel and unusual punishment" following inadequate back injury treatment. The district court dismissed the prisoner's pro se complaint, which had previously maintained that an "allegation of inadequate medical care was insufficient to be classified as a cause of action" under the Eighth Amendment [1]. Nonetheless, the U.S. Court of Appeals of the 5th Circuit reversed and reinstated the complaint, ultimately granting the defendants' certiorari petition and establishing that denial of healthcare equated to "cruel and unusual punishment." [1] Ultimately, the notion of "deliberate indifference" set a legal definition that prohibits ignoring the plight of prisoners who require healthcare, translating into a mandate meant to provide all persons in custody with access to medical care. Beyond healthcare, Estelle's significance lies in that the Court contended that prison conditions could amount to "cruel and unusual punishment," proposing a more focused approach to providing care for incarcerated individuals [2].

However, as the recent Supreme Court ruling in Dobbs v. Jackson Women's Health Organization has taken the world by storm, legal scholars have contended that it is "highly likely that the Court may employ a highly similar approach to upend the precedent set forward by Estelle v. Gamble" [3]. In Dobbs, Justice Samuel Alito, writing for the Court, overturned the constitutional right to abortion by returning to an originalist interpretation of the Fourteenth Amendment's guarantee of liberty. Originalism is an interpretative approach that seeks to adhere strictly to the Constitution's original intent. Originalists argue that the Constitution should not be subject to evolving societal norms, as its meaning remains constant. In line with this argument, Alito defined "liberty" as not having any ties to the rights recognized in the 20th and 21st centuries. The Court ultimately concluded that the right to abortion was not "deeply rooted in the Nation's history and tradition" [4].

This shift towards originalism suggests reexamining previous decisions, including those regarding inmate healthcare, to ensure they align with the "framers' intent," which Alito highlighted in his dissenting opinion following the 2012 case of Miller v. Alabama. The case resulted in the Supreme Court concluding that it would violate the Eighth Amendment to impose a sentence of life imprisonment without the possibility of parole, holding that mandatory "life-without-parole sentences for all children 17 or younger convicted of homicide are unconstitutional" [5]. In his dissent, Alito suggested that the Court had chosen to abandon the Eighth Amendment's "original" meaning by holding that its proscription of "cruel and unusual punishment" reflects the "evolving standards of moral decency," an integral component of the Estelle decision. Alito indicated that "the provenance and philosophical basis for this standard was problematic from the start," suggesting the possibility of a new interpretation of the Eighth that rejects the consideration of "evolving standards of decency" [4].

Furthermore, violating the Eighth Amendment as per the cruel and punishment clause establishes the "deliberate indifference" standard, requiring the inmate to indicate that prison officials were fully aware of a severe medical condition and deliberately failed to provide adequate medical care. Under this standard, mere negligence cannot amount to a valid claim of medical mistreatment under the Eighth Amendment. To state a "cognizable claim, a prisoner must allege acts or omissions sufficiently harmful to evidence deliberate indifference." Ultimately, only such indifference can offend the "evolving standards of decency" in violation of the Eighth Amendment [6].

Subsequently, the adherence to "indifference" is evident when analyzing past cases. As a result, an originalist interpretation of the Constitution remains a distinct possibility, given the Supreme Court's precedent of rejecting inmate claims of inadequate healthcare. Notably, Wilson V. Seiter (1991) involved petitioner Wilson, an Ohio prison inmate, filing suit under 42 U.S.C. § 1983 against respondents, stating that certain conditions of his confinement constituted cruel and unusual punishment—namely, "housing with mentally and physically ill inmates, as well as unclean and inadequate restrooms" resulting in further deteriorating physical health conditions [7]. The Court cited its earlier decisions in the case of Francis v. Resweber as well as in Estelle v. Gamble to reiterate that cruel and unusual punishment required the "unnecessary and wanton infliction of pain" —-for this to occur, prison officials would have had to purposefully demonstrate intentional cruelty, resulting in a "culpable state of mind" [8]. However, "deliberate indifference" to a prisoner's conditions also constituted abusive treatment according to this standard, an aspect of Wilson's grievances that should have been considered but was not. Instead, the Court undertook a more originalist understanding of the Eighth Amendment by maintaining a high threshold for demonstrating an Eighth Amendment violation—requiring inmates to show more than just negligent behavior by prison officials and the notion of "severe and intentional" acts of punishment.

Arguably, the Court's inclination towards originalist interpretation is evident, possibly resulting in an overly literal comprehension of laws without due regard for individual circumstances and context. This approach is exemplified by using specific legal terms that significantly influence verdicts. Evidently, in Farmer v. Brennan, the Court favored an originalist interpretation of the term "punishment," interpreting how it was utilized in the Eighth Amendment within the context of the Bill of Rights. The Bill of Rights exists to curb the influence of the government rather than that of private actors [8]. In most legal contexts, "punishment" is a sanction—such as a fine, penalty, confinement, or loss of property, right, or privilege—assessed against a person who has violated the law." In Farmer v. Brennan, most of the Court observed that the Eighth Amendment does not necessarily outlaw cruel and unusual 'conditions' but outlaws cruel and unusual 'punishment' [8]. Writing for the Majority in Farmer v. Brennan, Justice Thomas highlighted that "from the time of the founding through the present day, [punishment] has always meant a 'fine, penalty, or confinement inflicted upon a person by the authority of the law and the judgment and sentence of a court, for some crime or offense committed by him.' Such a narrow definition thus neglects the inmates' experiences within confinement and the deteriorating, potentially harmful conditions of prisons themselves.

This is evident in the case of Rhode v. Chapman, which involved inmates at the South Ohio Correctional facility challenging the validity of "double-celling," a practice of confining two prisoners in a cell designed for one individual [9]. The district court identified five factors– the lengthy sentences of inmates, overcrowding, small cell sizes, prolonged periods of cell confinement, and prison officials' view of double-celling as a permanent remedy for overcrowding— that rendered the practice unconstitutional. However, the Supreme Court reversed the district and circuit court's holding, instead maintaining that double-celling's physical, mental, and emotional impact and its poor and intolerable conditions are usual consequences of incarceration. As there is no "deliberate indifference" to be shown, practices such as double-celling are not cruel or unusual in their purpose or effect. Similarly, in a medical context, malpractice or "inadvertent" failure to provide adequate care does not become a constitutional violation simply because the prisoner is a victim.

There is no evident "deliberate indifference," and the Court's originalist approach to the notion of punishment overlooks the potential relevance of prison conditions and inmate circumstances when considering the "cruel and unusual punishment" provision of the Eighth Amendment [10]. The denial of medical care is thus differentiated from the "type of punishment" that the state has chosen to impose, and it is not something that the state "intends to inflict when incarcerating offenders" [11]. According to this rationale, the direct denial of medical care should not even amount to "punishment" within the framework of the Eighth Amendment. However, such an interpretation seems to disregard the evolving standards of human decency and the fundamental principle that protection against cruel and unusual punishment should incorporate all aspects of an individual's well-being—including their access to medical treatment. Ultimately, terms such as "deliberate indifference" lack specific standards and specific auditing, leading to massive heterogeneity in how the Court treats people [12].

In an era where a precedent set by Roe v. Wade—one codified for nearly half a century—can be easily overturned and invalidated, prisoners are likely to face increased medical negligence or complete lack of access. The Court has traditionally interpreted the specific provisions of the Eighth Amendment in light of the historical context in which they were drafted. The meanings of several phrases— such as "cruel and unusual," "punishment," or "excessive" are not explicit within the Constitution. However, even if we find an obvious, unanimous definition of such words, applying these definitions to unanticipated cases unforeseen by the founders only broadens the scope of ambiguity and interpretation. Arguably, rather than the "originalist" perspective adopted by Justice Scalia and similar contenders that view laws in isolation from current social movements, a more comprehensive approach would be to follow the "founders'" intent by utilizing a modern interpretation of constitutional language in light of our moral norms. As such, though phrases such as "cruel and unusual" are relatively vague, they purposefully do not set a specific punishment and, instead, serve to encompass acts that future generations might consider morally reprehensible. Rather than being open to diverse modes of interpretation, the Court's steadfast adherence to a singular approach has resulted in the potential overturning of long-established precedents. Ultimately, requiring inmates to evidence factors such as "deliberate indifference" makes it more challenging for those incarcerated to fight for their rights and establish constitutional violations. Addressing this issue is critical in ensuring that inmates' rights are protected, that they can seek justice, and that they are not susceptible to ongoing mistreatment and abuse.

[1] “Estelle V. Gamble, 429 US. 97 (1976).

[2] Philip Genty, “Confusing Punishment with Custodial Care: The Troublesome Legacy of Estelle v.

[3] Gamble .” Columbia Law Review, (1996): 388. https://scholarship.law.columbia.edu/cgi/viewcontent.cgi?article=2068&context=faculty_scholars hip

[4] Christina Pazzanese, “Supreme Court May Halt Health Care Guarantees for Inmates,” Harvard Gazette, March 1 2023. https://news.harvard.edu/gazette/story/2023/03/supreme-court-may-halt-health-care-guarantees-fo r-inmates/.

[5] Miller v. Alabama, 567 U.S. 460 (2012).

[6] Miller v. Alabama, Oyez, https://www.oyez.org/cases/2011/10-9646

[7] Martin Schwartz, “Supreme Court Defines ‘Deliberate Indifference,” Hein Online, no. 3 (1994):159. https://heinonline.org/HOL/LandingPage?handle=hein.journals/suemrtpre3&div=36&id=&page=

[8] Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990).

[9] Farmer v. Brennan, 511 U.S. 825 (1994).

[10] Richard Seiver, “HMOs Behind Bars: Constitutional Implications of Managed Health Care in

[11] The Prison System .” Vanderbilt Law Review 58, no. 4 (2005): 1375. https://scholarship.law.vanderbilt.edu/cgi/viewcontent.cgi?article=1649&context=vlr

[12] Rhodes v. Chapman, 452 U.S. 337 (1981).

[13] T G Ronan, “Constitutional Law - Eighth Amendment: Double-Celling in Long-Term Prisons."

[14] New York Law School Law Review 28, no. 2 (1983): 15. https://www.ojp.gov/ncjrs/virtual-library/abstracts/constitutional-law-eighth-amendment-double-celling-long-term

[15] Matt Kellner, "Excessive Sentencing Reviews." Yale Law Journal Forum 132 (2022). https://www.yalelawjournal.org/forum/excessive-sentencing-reviews