1. Ethics and End-of-Life Care for the Incarcerated Becky Ellis

3. Objectives  Understand the scope and seriousness of the aging prison population.  Identify ethical concerns in providing end-of-life care for the prison population.  Identify your personal feelings and biases in providing compassionate end-of-life care to the incarcerated.  Identify at least 3 methods of providing for the end- of-life needs of this population.

4. Why Should We Care?  As citizens, we may be asked to vote in community referendums on how best to meet the needs of this “forgotten incarcerated population”.  As professional nurses working in community hospitals, we may be caring for these aging and dying prisoners in our health care institutions.

5.  Before we can begin to provide nursing care to this population, we must understand our own feelings and biases toward this at risk prison population.

6. Scope of the Problem  From 1999 to January 2001 the over 50 inmate population has increased from 41,586 to 113,358, a 172.6% increase (US Department of Justice, 2004). The over 40 age group is the fastest growing segment of the prison population

7. Why is this Happening?  More offenders are sentenced in this age group than any other.  Mandatory sentences, longer sentences compound the problem.  More restrictive release policies

8. Scope of the Problem US Dept of Justice Correctional Health Care 2004

9. Prison Elderly Defined  In the prison population, over 50 years of age is considered elderly.  The aging process is accelerated an average of 11.5 years for those prisoners over 50 as a result of years of poor health care, substance abuse, and stress.

10.  The number of inmates dying of natural causes has increased by 123%.  The most common natural causes: Hepatitis B HIV Cancers  Liver  Lung  Esophageal

11. The Cost of End-of-Life Care  Aging and dying prisoners are costly to states Average cost is approximately $60,000 to $70,000 per year per elderly inmate (U.S. Department of Justice, 2004).  From 1997 to 2000 health care spending in the US prison systems increased 27.1%. $2,747,843,808 to $3,493,047,306 (U.S. Department of Justice, 2004).

12. Palliative Care  An inmate meets the requirements of end-of- life care once an illness is considered fatal and the prisoner has 6 months to live.

13. Ways the Dying are Managed  Transfer inmates under guard to community hospices in the surrounding towns.  In-prison hospice facilities staffed by inmates as care givers.  Compassionate release into the community to families or community hospices.  If an inmate is compassionately released and his condition improves, does he return to prison? Many states have no provisions for their return to prison.

14.  Below is a link to an interview conducted by National Public Radio with Wilbert Rideau an inmate at the Louisiana State Penitentiary currently serving a life sentence. Dying in Prison

15.  Scott Smith, a staff writer for the California web based publication Recordnet.com, discusses the problem of aging inmates in California’s prisons. The Price of Punishment

16.  This a link to a video made of the Hospice at Vacaville Prison, Vacaville, California. There are interesting interviews with inmates, those dying and those inmates caring for the dying. Prison Hospice

17. Is Compassionate Release an Option?  The purpose of compassionate release is to allow inmates some time with relatives before they die, either in private homes, or in community hospices  The San Francisco Chronicle published an Editorial in December 2005 addressing Compassionate Release in California Prisons Imprisoned to the Bitter End

18. Opponent’s Opinions  They showed no compassion to their victims why should we now show them compassion?  They are being punished for their crimes, suffering is just part of their punishment.

19. Proponent's Opinions  Even though they committed crimes against society and may have not shown their victims compassion, they are still human and deserve to die with dignity with their suffering alleviated.  Being locked away from society is their punishment, not added suffering at the end of their life.

20. What the US Courts Have Said  Estelle v. Gamble, 1976 – affirmed society’s responsibility to provide a community level of care for aging and dying prisoners.  The American Correctional Association’s 1996 Task Force on Health Care in Corrections – Correctional institutions must proved culturally sensitive health care which is age and gender- specific and must be consistent with contemporary health standards of the surrounding community

21. Ethical Questions  Are they deserving of compassionate care?  How do we best meet their end-of-life needs while maintaining a safe environment within our prisons or community hospitals?  Is society at risk if we compassionately release them to our communities for end-of- life care?

22. Assignment  Read required articles listed under Course Documents on Blackboard  Review PowerPoint and related links  Participate in Discussions on Blackboard

23. Evaluation  All responses are to be posted on the discussion board under “Ethics and End-of-Life Care for the Incarcerated” by Monday 10 April. Identify your feelings and biases concerning end-of-life care for the incarcerated. Could you provide compassionate care to a convicted murder or child rapist that is dying? How would you approach the delivery of nursing care to him/her? In your opinion what is the best method of caring for this population? Why?

24. References  U.S. Department of Justice (2004), Correctional Health Care: Addressing the Needs of Elderly Chronically Ill, and Terminally Ill Inmates. February 2004.