Australian euthanasia activist Dr Philip Nitschke recently mused that euthanasia could become the "last frontier in prison reform". This is far from likely, but California’s ballooning budget for geriatric prison inmates shows that it might seem plausible to some people. Of California’s 168,000 prison inmates, one in six, or 28,470, are in for life, mostly as a result of tough sentencing laws.

The more elderly, the more costs," says Dr Nadim Khoury, chief deputy for clinical services at the California Medical Facility. There’s no debate about it." The government estimates that by 2022 geriatric inmates will make up 16% of the prison population, rising from 5% at the moment. Older inmates have a much higher incidence of expensive ailments like diabetes, hepatitis, hypertension and liver disease. The average expense for inmates is US$34,000 per year, but older ones cost $70,000 and severely ill inmates can cost much more. The state prison system needs 100 to 200 elderly-care beds, says Dr Khoury.

Although voters often resent paying medical bills for prisoners, Dr Khoury says that it is the only ethical choice. Ethically speaking, there are no prison walls for medical care. "My job isn’t to save money — it’s to provide health care in a cost-efficient way," he says. "What I can’t be is in the lack-of-care business."