Justice Behind Bars: The Ethics of Medical Care in Prisons

Graphic by Ariha Mehta

We often think of justice in terms of courts, verdicts, and prison sentences. But what happens when someone enters the prison system and becomes, in many ways, invisible? One of the most overlooked aspects of incarceration in the U.S. is healthcare. Not just access to it, but the quality, the ethics, and the enormous disparities between policy and practice.

“The U.S. incarcerates more of its population than any other nation, including nations that have similar rates of crime” [1]. And yet, the healthcare system inside those prisons is wildly under-examined by voters, by policymakers, and often by the medical community itself. Over 51% of incarcerated individuals in state prisons report having a chronic health condition—diabetes, heart disease, asthma, you name it—along with 43% in federal prisons [2]. But even more staggering is the number of people struggling with untreated mental illness. About two in five people who are incarcerated have a history of mental illness (37% in state and federal prisons and 44% held in local jails). This is about twice the amount of people in the U.S. who are impacted by mental illness [3]. Prisons weren’t designed to be hospitals. Yet somehow, they’ve become one of the largest providers of mental healthcare in the country. Perhaps this is not a design flaw, but more of a policy failure.

There’s a big dilemma within this discussion: What does it mean to provide “adequate” care to people society has deemed punishable? On paper, the Eighth Amendment prohibits cruel and unusual punishment, and courts have interpreted medical neglect as falling under that umbrella. But in practice? It’s a gray zone. Some prisons outsource medical services to private companies that get paid more when they spend less [4].

In prison, There are real horror stories. People with cancer are denied biopsies, inmates are forced to give birth in solitary, and psychiatric patients can be locked in isolation for months. But the everyday realities are just as disturbing: delayed diagnoses, skipped medications, and untreated infections. Persistent staff vacancies—nurse positions alone have a 37% vacancy rate—make it significantly harder for prisons to meet even basic healthcare needs, often resulting in delays that stretch far beyond what would be acceptable in any other setting [5]. In some cases, incarcerated people report waiting extended periods for care that would be considered urgent outside prison walls [5]. 

Of course, there are arguments on the other side. Resources are limited. Some say prisoners shouldn’t get “free” healthcare while working-class Americans struggle to afford insulin. However, there’s also a public health perspective people forget. Prisons aren’t closed systems. People cycle in and out. If diseases spread inside—think tuberculosis, hepatitis C, or even COVID—they don’t stay there. In fact, during the early waves of the pandemic, prison outbreaks were directly tied to spikes in surrounding communities [6, 8]. Neglecting prison healthcare could be short-sighted as it leads to widespread consequences—both at the individual and community level.

And what about re-entry? If someone leaves prison without treatment for their addiction, their bipolar disorder, or their chronic pain, they’re at higher risk for recidivism. Or worse. Studies have shown that the first two weeks post-release are some of the most dangerous for overdose and suicide [7, 9]. If we care about rehabilitation—and not just retribution—then medical care must be part of the conversation.

So what do we do with all of this? This is a tough question that should be addressed in policy within the coming years. The way we treat people in prisons reflects who we are outside of them. Are we okay with a two-tiered system that draws its ethical line at the prison gates? Or can we imagine a version of justice that embodies compassion, even behind bars?

Healthcare in prisons is messy, underfunded, and often invisible. But that doesn’t mean it should stay that way. The goal shouldn’t be perfection, it should be dignity. And maybe we start by acknowledging that everyone deserves a fighting chance at health, no matter what side of the bars they’re on.

Reviewed by Matthew Sun

References

[1] Widra, E., & Herring, T. (2021, September). States of incarceration: The global context 2021. Prison Policy Initiative. https://www.prisonpolicy.org/global/2021.html?gad_source=1&gclid=CjwKCAjwnPS-BhBxEiwAZjMF0ucBeW1XMbZgWuPVOY-Jybvpqf5e7ZKTm9MRGqUOOZBLTG1cOS-COxoCUAgQAvD_BwE

[2] Maruschak, L. M., Bronson, J., & Alper, M. (2021, June 2). Medical problems reported by prisoners: Survey of prison inmates, 2016. Bureau of Justice Statistics. https://bjs.ojp.gov/library/publications/medical-problems-reported-prisoners-survey-prison-inmates-2016#:~:text=About%2051%25%20of%20state%20and,currently%20having%20a%20chronic%20condition.[3] Mental health treatment while incarcerated. National Alliance on Mental Illness. (n.d.). https://www.nami.org/advocacy/policy-priorities/improving-health/mental-health-treatment-while-incarcerated/

[4] Szep, J., Parker, N., So, L., Eisler, P., & Smith, G. (2020, October 26). Special report: U.S. jails are outsourcing medical care — and the death toll is rising. Reuters. https://www.reuters.com/article/usa-jails-privatization-special-report-idINKBN27B1D7/

[5] Crumpler, R. (2025, March 11). NC prisons struggle to meet health care demands amid rising costs, staff shortages. North Carolina Health News. https://www.northcarolinahealthnews.org/2025/03/11/nc-prisons-face-growing-health-care-costs/ 

[6] Rubin, A. (2020, April 27). Prisons were once designed to prevent disease outbreaks. Honolulu Civil Beat. https://www.civilbeat.org/2020/04/prisons-were-once-designed-to-prevent-disease-outbreaks/

[7] Crumpler, R. (2024, March 21). Formerly incarcerated at higher risk of suicide - even years after prison release, study finds. North Carolina Health News. https://www.northcarolinahealthnews.org/2024/03/21/formerly-incarcerated-at-higher-risk-of-suicide-even-years-after-prison-release-study-finds/?utm_ 

[8] Shoot, B. (2024, December 16). How prisons become “corridors of contagion” during a pandemic. Prism. https://prismreports.org/2024/12/16/how-prisons-become-corridors-of-contagion-during-a-pandemic/ 

[9] Merrall, E. L., Kariminia, A., Binswanger, I. A., Hobbs, M. S., Farrell, M., Marsden, J., Hutchinson, S. J., & Bird, S. M. (2010). Meta-analysis of drug-related deaths soon after release from prison. Addiction (Abingdon, England), 105(9), 1545–1554. https://doi.org/10.1111/j.1360-0443.2010.02990.x