Palliative and End-of-Life Care in Correctional Settings

Abstract

The prison population in the United States has grown fivefold in the last 27 years. Like the general population, the inmate population is aging. With age comes infirmity, disability, and chronic conditions that may, over the course of years or decades, lead to death. Inmates enter the prison system in poorer health than their age-matched free counterparts. A growing number of inmates will die in prison. A few will receive medical or compassionate release in order to die ''outside the walls.'' Whether inside or outside, these dying men and women are entitled to receive high quality health care, including palliative care.

Older and Geriatric Offenders: Critical Issues for the 21st Century

“…Over the last several years, our nation has witnessed a remarkable rise in the number of programs oriented toward delivering quality end-of-life care to inmate populations. Although research has not maintained records of the specific number of facilities with formal hospice services, some have estimated the number of states with hospices to be in the vicinity of 25-with several including California, Texas, and New York having multiple hospices throughout the state (Anno et al, 2004;Linder & Meyers, 2009)-and growth projected to continue well into the 21st century (Hoffman & Dickenson, 2011). In the process, heightened attention is being placed on examining issues such as admission standards, need for interdisciplinary care, narcotics, special privileges, family support, and discharge procedures (Linder & Enders, 2011;Linder, Enders, Craig, Richardson, & Meyers, 2002).…”

“…In most facilities, records of criminal histories may prevent optimum care in that such care dissuades physicians, nurses, and other providers from engaging in the open communication patterns needed to establish treatment regimen and execute them to completion (Smyer, Gragert, & Martins, 2006). Of course, in prisons, other inmates may have their own insecurities (such as fears of deserving punishment, relapse, or violating religious convictions) that cause reservations about accepting certain medications whenever they may be available (Linder & Meyers, 2009).…”

Barriers Associated with the Implementation of an Advance Care Planning Program in a Prison Setting

“…The literature on end-of-life (EOL) care in prison settings has been growing over the past decade (e.g., Linder & Meyers, 2009;Hoffman & Dickinson, 2010;Stone, Papadopoulos, & Kelly, 2012), particularly as the prison hospice movement continues to expand in the United States. While prison hospice programs are one significant step in meeting the EOL care needs of offenders, ACP is another critical step, particularly for offenders who may feel they have a limited voice due to the policies and rules associated with incarceration.…”

End of Life in High-Security Prisons in Switzerland

“…Palliative care consists of holistic and continuous medical, psychological, social, and spiritual care for a patient over a longer period of time. According to Ratcliff (2000), it is possible to provide quality EOL behind bars, but this must include general care, pain and symptom management, family (and friend) involvement and visitation in order to overcome inmate isolation, positive institutional attitudes toward death and bereavement, the training of staff and interdisciplinary teams, and the involvement of inmates and community volunteers (see also Linder & Meyers, 2007, 2009).…”