Prison Healthcare and Human Rights: Addressing Medical Neglect in the U.S. Penal System

The U.S. prison system can house about 1.9 million people, making it the world’s largest incarcerated population [1]. However, despite the mandate under the Eighth Amendment prohibiting cruel and unusual punishment, incarcerated individuals frequently experience inadequate healthcare. This issue has raised significant ethical concerns regarding human rights and systemic disparities in access to care. Prisoners, regardless of their crimes, have the right to proper medical treatment. However, a combination of underfunding, staff shortages, and systemic barriers often leads to substandard care.

The Ethical Foundations of Prison Healthcare

Medical ethics is grounded in four key principles: Autonomy, Beneficence, Nonmaleficence, and Justice [2]. While incarcerated individuals inherently have limited personal freedoms, these principles are crucial in the ethics of prison healthcare. Autonomy, in a medical context, refers to a patient’s right to make informed decisions about their own care. However, prisoners often have little to no control over when they receive medical attention, frequently experiencing long wait times for physician visits, dental treatments, and specialist care. Justice means that prisoners, like all individuals, should receive equal access to healthcare. However, the systemic disparities in healthcare between the general and prison populations fail to uphold this ethical standard. Regarding beneficence and nonmaleficence, medical professionals have a duty to act in the best interests of their patients and avoid causing harm. Yet in prison, there are daily reports of delayed treatments, inadequate chronic disease management, and preventable deaths [3].

Medical Neglect in U.S. Prisons: Case Studies and Systemic Barriers

Where should we point the blame? Despite the legal requirement to provide healthcare, there is widespread neglect due to systemic deficiencies. Many prisons operate with limited medical staff, which can lead to delays in treating conditions. Prisons also house a disproportionately high number of individuals with chronic conditions such as diabetes, hypertension, and HIV, which can exacerbate health disparities [4]. Another factor is mental health. Over 40% of incarcerated individuals suffer from mental health disorders [5]. Punishments like solitary confinement have been linked to worsening psychiatric symptoms, raising ethical concerns regarding inhumane treatment.

Role of Private Healthcare Providers in Prisons

Many prisons attempt to contract private healthcare companies to provide medical services [6]. While privatization is intended to cut costs, many argue that for-profit companies have incentives to minimize care, reducing expenses at the cost of prisoner health. As a consequence, prisons may fail to provide necessary treatments, delay access to life-saving medications, and refuse specialist referrals due to cost concerns.

International Standards & U.S. Shortcomings

International human rights frameworks support the right to healthcare for incarcerated individuals. The United Nations Standard Minimum Rules for the Treatment of Prisoners state that prisoners must receive the same medical care available to the general population [7]. However, the U.S. has consistently fallen short of these standards, with reports of neglect, medical rationing, and underfunding being common across state prison systems.

Medical neglect in U.S. prisons represents an ethical failure that undermines the principles of justice and human dignity. Although incarcerated individuals have lost certain freedoms, their right to healthcare remains protected under both legal and ethical frameworks. In order to address prison healthcare disparities, we must recognize that access to care is a fundamental human right.

Edited By: Makayla Gorski

Designed By: Eugene Cho

References

[1] Wagner, Wendy Sawyer and Peter. “Mass Incarceration: The Whole Pie 2024.” Prison Policy Initiative, 14 Mar. 2024, www.prisonpolicy.org/reports/pie2024.html. 

[2] - Beauchamp, T., & Childress, J. (2019). Principles of Biomedical Ethics: Marking Its Fortieth Anniversary. The American Journal of Bioethics, 19(11), 9–12. https://doi.org/10.1080/15265161.2019.1665402

[3] - Maruschak, Laura M. “Medical problems of jail inmates.” PsycEXTRA Dataset, Nov. 2006, https://doi.org/10.1037/e500022007-001. 

[4] “The health status of soon-to-be-released inmates: A report to Congress, volume 2.” PsycEXTRA Dataset, Mar. 2002, https://doi.org/10.1037/e514682006-001. 

[5] - James, Doris J., and Lauren E. Glaze. “Mental health problems of prison and jail inmates.” PsycEXTRA Dataset, June 2017, https://doi.org/10.1037/e557002006-001. 

[6] Noga Shalev, “From Public to Private Care The Historical Trajectory of Medical Services in a New York City Jail”, American Journal of Public Health 99, no. 6 (June 1, 2009): pp. 988-995. https://doi.org/10.2105/AJPH.2007.123265

[7] - The United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules), 26 Mar. 2016, https://doi.org/10.18356/9789213589427.

SSRIs in Teens: A Growing Mental Health Dilemma

Teen mental health is in crisis. Although depression and anxiety have long impacted America’s youth, these mental disorders are increasing at an unprecedented rate. Nearly one in seven 10 to 19-year-olds experience a mental disorder, accounting for 15% of the global burden of disease, with depression, anxiety, and behavioral disorders as the leading cause [1]. The COVID-19 pandemic has only exacerbated this crisis. Between 2017 and 2021, diagnosed cases of depression among American youth rose by 60%, while anxiety disorders increased by 31% [2]. 

Yet, as the demand for mental healthcare continues to grow, access to affordable treatment remains limited. In response, more teens than ever are being prescribed selective serotonin reuptake inhibitors (SSRIs) - but is this a necessary solution or an ethical concern?

In mid-February, the White House released a statement regarding the establishment of President Trump’s Make America Health Again Commission [3]. The administration points to the fact that, despite the increased prescription of medication (specifically for ADD and ADHD), health burdens for both adolescents and adults remain persistent. The mission of this new Commission is to study childhood chronic disease and assess the threat of identified-risk factors including “potential over-utilization of medication” [3]. This medication includes SSRIs, antipsychotics, mood stabilizers, stimulants, and weight loss drugs [3]. 

SSRI use among minors has increased significantly in recent years. Between 2016 and 2022, the number of people ages 12 to 17 with an antidepressant prescription rose 43% [4]. This rise is partially attributed to growing rates of depression and anxiety following the COVID-19 pandemic. Recently, Health and Human Services Secretary Robert F. Kennedy Jr. expressed concern over the overmedication of children and the risks of antidepressants. 

SSRIs are the most commonly prescribed class of medications for treating depression. They work by inhibiting the reuptake of serotonin, thereby increasing serotonin activity [5]. Variants of these medications have clinically proven to be safe, efficient, and well-tolerated in both adult and pediatric patients. For many children and adults in the U.S. with severe health health disorders, SSRIs can play a critical role in their treatment. Major depressive disorder in adolescents can cause serious morbidities, including difficulties in maintaining social relationships, poor academic performance, risky sexual behavior, and increased risk of physical illness and substance abuse [6]. It is also strongly associated with the rising rate of adolescent suicides, which is now the second leading cause of death among individuals aged 10 to 24. For young adults, SSRIs may then be a life-saving intervention. 

Given their importance, why are SSRIs now under political scrutiny? Much of the concern arises from beliefs that these medications are addictive. During his Senate confirmation hearing, Secretary Kennedy even claimed to know family members who had a harder time going off SSRIs than heroin [4]. However, medical research has shown that SSRIs are not addictive. The most extreme side effects identified among SSRI users is a minor increase (2%) in suicidal ideation in children and teens. Physicians worry that unsupported statements like Kennedy’s could deter patients from accessing antidepressants they need. Therefore, the decision to prescribe these medications should be between a physician in their patient, rather than being in the hands of politicians. 

Despite misconceptions, SSRIs remain a safe and effective treatment for both adolescents and adults. That said, the criticism surrounding these medications does draw attention to another important issue: the need for more accessible and affordable mental healthcare. While therapy is often the preferred first-line treatment, a nationwide shortage of therapists has led many individuals with mild to moderate symptoms to rely on medication instead [4]. If the U.S. ever considers restricting access to SSRIs, it must first ensure that alternative forms of treatment are both available and affordable for those struggling with mental health conditions.

Designed By:

Edited By: Aditi Avinash

References:

[1] World Health Organization: WHO. (2024, October 10). Mental health of adolescents. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health

[2] Xiang, A. H., Martinez, M. P., Chow, T., Carter, S. A., Negriff, S., Velasquez, B., Spitzer, J., Zuberbuhler, J. C., Zucker, A., & Kumar, S. (2024). Depression and anxiety among US children and young adults. JAMA Network Open, 7(10), e2436906. https://doi.org/10.1001/jamanetworkopen.2024.36906

[3] The White House. (2025, February 13). Establishing the President’s Make America Healthy Again Commission. https://www.whitehouse.gov/presidential-actions/2025/02/establishing-the-presidents-make-america-healthy-again-commission/

[4] RFK Jr. thrusts antidepressants into the spotlight — unnecessarily, advocates say. (2025, February 21). NBC News. https://www.nbcnews.com/health/health-news/rfk-jr-ssri-antidepressants-children-doctors-risks-studies-rcna192722

[5]  Chu, A., & Wadhwa, R. (2023, May 1). Selective serotonin reuptake inhibitors. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK554406/

[6] Dwyer, J. B., & Bloch, M. H. (2019, September 1). Antidepressants for pediatric patients. https://pmc.ncbi.nlm.nih.gov/articles/PMC6738970/

[7] Friedman, R. A. (2014). Antidepressants’ Black-Box warning — 10 years later. New England Journal of Medicine, 371(18), 1666–1668. https://doi.org/10.1056/nejmp1408480

Healthcare Pricing Transparency: An Ethical Debate

Graphic by Nancy Chen

Healthcare pricing has long been a subject of confusion and frustration for Americans. Despite being one of the most significant financial burdens on families, healthcare pricing remains notoriously obscure, leaving consumers at a disadvantage when it comes to understanding and navigating costs. In an effort to address this issue, President Donald Trump issued an executive order on February 25, 2025 mandating that hospitals and insurance companies disclose more detailed pricing information to patients; this executive order represents progress towards a more transparent and patient-friendly system. However, it has sparked debate about its effectiveness in lowering healthcare costs and empowering patients.

The hidden nature of pricing contributes directly to the financial anxiety many Americans experience. Health insurance companies, hospitals, and physicians traditionally negotiate rates behind closed doors, making it nearly impossible for patients to compare prices and make informed decisions about their care. Nearly 20% of American patients undergoing in-network elective surgery or giving birth report receiving surprise bills. [1] This lack of transparency has led to significant financial strain for many individuals, especially when faced with unexpected medical bills for services they did not anticipate or understand the cost of in advance. According to KFF polling, approximately half of U.S. adults claim it is challenging to afford health care costs. Additionally, one in four report that they or a family member in their household have faced difficulties paying for health care in the past 12 months. [2]

President Trump’s executive order, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information,” seeks to prioritize patients by providing them with more meaningful and accessible price information. It requires hospitals and health plans to maintain consumer-friendly displays of pricing details, including negotiated rates with providers, out-of-network payments, and the actual prices paid by them or their pharmacy benefit managers for prescription drugs. [3]

Price transparency is a cornerstone of patient welfare and health equity. By knowing the accurate costs of their treatment, patients gain the ability to make informed decisions about their healthcare while considering their financial circumstances. This transparency fosters competition among providers, driving down costs and benefiting consumers who might otherwise face limited or costly options. Additionally, clear pricing information helps reduce the occurrence of surprise medical bills, enabling patients to anticipate expenses and avoid unexpected charges. Greater transparency also holds hospitals and insurance companies accountable for their pricing practices, promoting fairness and equity across the healthcare system.

A significant concern regarding transparency in healthcare is its potential to reduce competition. Public disclosure of pricing information might lead hospitals to engage in price collusion, aligning rates with each other rather than competing to lower costs. This issue has been observed in Denmark, where concrete price postings resulted in unintended negative outcomes. [4] Such practices could undermine the competition that transparency advocates aim to promote, ultimately inflating costs for consumers.

Another ethical concern is the risk of prioritizing price transparency over more critical healthcare reforms. While transparency may address certain financial aspects, it fails to tackle deeper systemic challenges, such as improving access to care, expanding insurance coverage, or enhancing the overall efficiency of the healthcare system.

While increasing transparency holds great promise by empowering patients, fostering competition, and mitigating surprise medical bills, it also comes with ethical concerns, such as the risk of price collusion and overshadowing more urgent systemic reforms. Transparency is undeniably a vital component of healthcare reform; however, it is only one piece of the puzzle. Achieving a truly affordable and equitable healthcare system will require a multifaceted approach that addresses the deeper, structural challenges faced by all Americans.

Reviewed by Abby Winslow

Resources

[1] Lopes, L., Montero, A., Presiado, M., & Hamel, L. (2024, March 1). Americans’ Challenges with Health Care Costs. Kaiser Family Foundation. https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/

[2] Pollack, H. A. (2022). Necessity for and Limitations of Price Transparency in American Health Care. AMA Journal of Ethics, 24(11), E1069-1074. https://doi.org/10.1001/amajethics.2022.1069 

[3] The White House. (2025b, February 25). Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information. The White House. https://www.whitehouse.gov/presidential-actions/2025/02/making-america-healthy-again-by-empowering-patients-with-clear-accurate-and-actionable-healthcare-pricing-information/ 

[4] Albaek, S., Mollgaard, P., & Overgaard, P. B. (1997). Government-Assisted Oligopoly Coordination? A Concrete Case. Journal of Industrial Economics, 45(4), 429–443. https://doi.org/10.1111/1467-6451.00057