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  • Leah Kim

“Is it Deserved?” Examining the Ethics of Palliative Care in Prisons

Imagine that you are the presiding judge of this courtroom, reviewing the case of Horacio Estrada-Elias⎯a 90-year-old inmate serving a life sentence for a nonviolent marijuana trafficking crime [1]. When you read about his crime, you are doubtful about his character. Yet, your eyes also linger on his spotless disciplinary record in prison. You then look at his medical records: “less than 18 months to live.” He has requested for a compassionate release. 

Now, what decision should you make? Do you maintain “justice” for those who have suffered from his crime by keeping the sentence and letting him die in prison? Or do you allow him to spend the last 18 months of his life outside of prison on supervised release?



This debate becomes an ethical dilemma within the justice system when an inmate’s death is anticipated to be near. Incarcerated individuals remain one of the largest populations with the most complex health needs; more than 4,000 people have died annually in prison since 2003 from various health diseases, such as heart disease and cancer [2]. Palliative care needs are prevalent within prisons, yet the population remains poorly underserved with current measures. For instance, hospice services of prisons were only available at 69 out of 1,719 state correctional facilities and often lacked quality care [2].  The reason behind is countless: mistrust between staff and prisoners, concerns of safety, potential misuse of services (e.g., medications), and the financial cost associated with providing such quality services [3].

However, with consideration to the growing palliative care needs of this population, 48 states within the United States have implement some form of early release for incarcerated individuals with serious health illnesses [2]. A common form of such mechanism is called “compassionate release” and is designed to grant inmates release from prison when their death is near due to health-related causes [4]. However, mechanisms like compassionate release remains rarely accessed and even more rarely successful. For instance, the Federal Bureau of Prisons only granted 3.24% of the small number of requests for compassionate release in one year [2]. Therefore, even though these current measures remain an option, most inmates perceive them to be almost impossible to be used successfully and protect their well-being. 

To examine this issue further, the debate must return to the fundamental question of ethics. Do prisoners deserve the same rights to provision of care as any other individual? From possession of drugs to series of murders, these individuals are in prison for a reason; they have committed some form of harm to others through their actions. If such level of care is offered, is justice truly being served for the victims?

From a human rights perspective, it is important to consider that inadequate palliative care may be considered a “cruel and unusual punishment” [3]. Activists claim that these rights are basic and must be provided to individuals regardless of the nature of their crime. They further argue that current measures do not conserve the dignity that all humans deserve to have before their deaths. For instance, staff have recounted encounters of terminally ill inmates being “shackled, put in an orange jumpsuit” even just a few days before their deaths [2]. 

The conservation of dignity for these individuals crosses over to the responsibilities of medical professionals. The American Medical Association (AMA) Principles of Medical Ethics states that physicians have “a responsibility to see changes in those [legal] requires which are contrary to the best interests of the patient” [2]. This principle has been considered to urge medical professionals to become more involved with the issue of offering appropriate palliative care to even the incarcerated. As asserted by McParland et al. (2023) in their review, the provision of such care must be an interdisciplinary effort between the custodial and healthcare staff [4]. Custodial staff must maintain the security of prison systems and ensure the well-being of inmates, while the healthcare staff must assess the needs of prisoners and administer treatment as they would do for any other patient. This becomes especially crucial as many inmates lack the support of loved ones when they spend their last days in prison alone. 

Whether you made the choice to grant Horacio compassionate release or not in the beginning, it remains imperative to consider the different ethical perspectives of the debate. In the end, to strike a balance between punishment and rehabilitation within a prison environment, there must be a stronger collaboration between various individuals involved within the justice and healthcare system.


Reviewed By: Laura Wang

Designed By: Shanzeh Sheikh


Citations:

[1] Tolan, C. (2021, September 30). Compassionate release became a life-or-death lottery for thousands of federal inmates during the pandemic. CNN Investigates. https://www.cnn.com/2021/09/30/us/covid-prison-inmates-compassionate-release-invs/index.html 

[2] Mitchell, A. & Williams, B. (2017). Compassionate release policy reform: Physicians as advocates for human dignity. AMA Journal of Ethics, 19(9), 854-861. 

[3] Maschi, T., Marmo, S. & Junghee, H. (2014). Palliative and end-of-life care in prisons: A content analysis of the literature. International Journal of Prisoner Health, 10(3), 172-197. https://doi.org/10.1108/IJPH-05-2013-0024

[4] McParland, C., Johnston, B., & Ouwehand, I. E. I. (2023). Caring for people in prison with palliative and end-of-life care needs. Current Opinion in Supportive and Palliative Care, 17(3), 224-230. https://doi.org/10.1097/SPC.0000000000000661


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