Ethics classes in U.S. philosophy departments are pathologically obsessed with imaginary scenarios, often involving trollies, that purport to demonstrate some people’s greater acceptance of causing death or suffering if they don’t have to physically, directly, immediately cause it. Some people would supposedly pull a switch so that a trolley killed one person rather than staying on another track and killing five people, but wouldn’t push one person onto a track to save five people.

I say “supposedly” because, luckily, nobody’s gotten the funding to actually try out an experiment (as far as we know, I can’t speak for DARPA).

The purpose of all this imaginary murdering is unclear for two major reasons. First, some professors will simply conclude that people are weak and ought to know better (which they could have told you to begin with), while other professors will tell you that whatever people imagine they would do simply is what they should do because their inner whatchamawhoochie is intuitively in touch with the great cosmic whatchamacoochie. So, what have we learned?

Second, there was never anything we needed to learn. We can all observe for ourselves that politicians and generals who order troops to destroy cities suffer moral injury, depression, and suicide at far lower rates than those troops or the people they attack. Nobody can possibly be unaware that burning fossil fuels and eating meat is tolerated by millions of humans disinclined to directly torture their children.

Which brings us to the line that can be drawn between death camps and the majority of U.S. prisons. If a death camp is a place that lines people up and shoots them or poison gasses them to death, most U.S. prisons are, for the most part, not that. But the typical treatment of U.S. prisoners who are ill, including with life-threatening illnesses, is absolute denial of any medical care.

There are exceptions. One of the most famous of all U.S. prisoners, Mumia Abu Jamal, finally received life-saving treatment after a major public campaign denouncing a prison for medical execution. But, according to the testimony of numerous prisoners and witnesses to prison behavior, Mumia’s medical execution was simply standard practice.

Paul Singh, a doctor, was in prison as a prisoner and made a study of the medical treatment, or lack thereof, of numerous prisoners. He took their statements. He smuggled their medical records out. He checked their claims. And he published a book called Public Torture in America: Shocking Tales from the Inside, along with a companion text simply reproducing all the background paperwork. The book is rather surprisingly not overly monotonous, while at the same time resembling a sort of update to Kafka without all the levity.

Prisoners in Singh’s accounts are denied treatment over and over again, while gradually being told that they have received treatment, being denied access to their own information on a sort of free-floating basis of “national security” without any war or other danger actually being alleged at all, and being locked into solitary confinement as punishment for requesting medical treatment that they are told that they do not need, although its denial may — of course — kill them (a minor concern, they are given to understand).

While Singh was in only one prison, he studied prisoners who had been transferred among many prisons. The lack of treatment didn’t seem to vary. Prisoners were told that problems were in their heads. Evidence to the contrary was not recorded. Doctors excused themselves as not being specialists but refused to call in specialists. Only heart attacks and other collapses threatening immediate death resulted in any treatment, and that from outside hospitals, which were consistently lied to, as were courts. For prisoners who survived emergency treatment outside of prisons, every effort was made to eliminate any record of the diagnosis and recommendations from non-prison doctors. No prescriptions of particular diets were ever followed. Many prescriptions of medicine were ignored.

Anything short of immediate death was a ticket to bureaucracy. Get in line. Take a number. Come back next week. You have already been here 10 times; if you haven’t been treated yet whose fault is that? Prisoners died, nearly died, lost limbs. There were outbreaks of medieval diseases. Both pets and farm animals in the United States receive far better medical treatment. At what point does failure to treat while refraining from murdering become engagement in torture?

A 77-year-old man was severely injured at work on a farm in a prison. What is he doing in prison? What is he doing at forced labor in prison? And why isn’t he given any medical treatment when injured? Why are broken bones left untreated for years? Why do people suffer agonizing pain for years that could be alleviated with a few pills?

Not by accident. Papers are doctored even if prisoners are not. Papers are forged, destroyed, altered, and never created. Two sets of records are established, those to be shared with hospitals or courts, and those not to be. Prisoners’ complaints and concerns are not admissible into any records. The pre-incarceration medical records of new prisoners are excluded as well. Something called the “Administrative Remedy process” exists, according to Singh, “only in the minds of those who are new to the prison and still hopeful.” Many prisoners learn the futility of requesting medical treatment and cease to request it. Another “scam,” as Singh documents, is the “Sick Call.” A prisoner who is seriously ill can request to be seen at a “Sick Call,” but must do so for months in many cases, and is then simply told he’s doing fine.

Of course, the millions of people locked away in the Land of the Free are not in death camps. This isn’t murder. But if it isn’t murder, if some prisoners have not been given death sentences, then where does one draw the line? What limits are to be placed on the barbarism? If U.S. society treated healthcare as a right, if thousands of people weren’t dying for lack of healthcare outside of prisons, perhaps the limits would be different.

People ask why someone in a prison should be allowed to vote, and what they would vote for. Well, I can think of a million things, but one of them is this. They might vote for a god damned doctor. Obviously people outside of prisons aren’t going to do it for them.