Palliative Care Experts Argue for Wider Use of Compassionate Release in U.S. Prisons
New York, NY (May 31, 2011) — An article published today in Annals of Internal Medicine, suggests the broader use of compassionate release in US prisons. The authors propose changes that could fix compassionate release medical and procedural flaws, thus reducing in-prison deaths and inmate health care costs.
Inmates are considered for compassionate release if they have a clinically diagnosed life-limiting illness, and if it is legally justifiable to release them into society. Current guidelines, however, have clinical flaws and do not adequately identify eligible prisoners in time for release. Many prisoners who may be eligible die in prison as they wait for a definitive diagnosis and review thus placing huge financial burdens on state budgets and contributing to the national crisis of prison overcrowding.
“An aging prison population, overcrowding, and healthcare costs are causing prison expenditures to soar. Inmates who are eligible for compassionate release are very ill and no longer pose a threat to society. Yet, they contribute to the crisis of overcrowding and immense prison costs,” said R. Sean Morrison, MD, Director of the National Palliative Care Research Center and co-author of the article.
Death is unpredictable for many illnesses such as cancer, dementia, persistent vegetative state or end-stage organ disease, to name a few, say the authors. Reliance on prognostication can create a “Catch-22.”
To address medical-related flaws in the system, the authors, Brie Williams, MD, R. Sean Morrison, MD, Rebecca Sudore, MD, and Robert Greifinger, MD, offer novel proposals to reducing in-prison deaths and inmate health care costs:
- Development of standardized guidelines by an independent advisory panel comprised of palliative medicine, geriatrics, and correctional health care experts
- Under the new guidelines, prisoners should be assigned an advocate to help navigate the system and represent prisoners who are unable to represent themselves
- A fast-track option for prisoners with short life expectancies
- A well-described and disseminated application procedure so that prisoners and their advocates understand their rights
In addition, the authors call for national criteria to help categorize critically-ill patients into three groups: 1) prisoners with terminal illnesses and predictably poor prognoses; 2) prisoners with Alzheimer and related dementias; and 3) prisoners with serious, progressive, nonreversible illness with profound functional/cognitive impairments.
For prisoners who fall into one of the three outlined categories, the authors recommend palliative care to ease symptoms while inmates await a decision on compassionate release. Palliative care is specialized medical care focused on pain and symptom management, communication and coordination of care. For those prisoners who are not approved, palliative care should continue.
About the Center to Advance Palliative Care
The Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center are affiliated with Mount Sinai School of Medicine and are dedicated to increasing quality palliative care services for people facing serious illness.
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