Providing palliative care in prisons: Perspectives of prison clinicians, hospital clinicians and correctional officers

An article written by Isabelle Schaefer, PhD Candidate

Care of the dying has become a prominent social and political concern as the global prison population ages. While much of the work has focused on palliative care in the home, hospital, or residential aged care facilities less is known about providing palliative care in more restrictive settings such as prisons. So what is it like providing palliative care for people in prison?

People in prison usually receive primary palliative care from generalist correctional healthcare clinicians and are transferred to an external hospital for specialist palliative care when their needs can no longer be safely managed in-house. People in prison with palliative care needs will also be monitored by correctional officers who oversee their security measures both within the prison as well as in the hospital. 

A recent systematic review [1] of the perspectives of prison- and hospital-based clinicians and correctional officers described complexities of managing palliative care for people in prison, as summarised below.

A prison lens on a palliative approach
Clinicians in prison and hospital both described how security considerations were omnipresent and shaped care provision, which made it difficult for them to maintain the usual ethical and professional care standards for these patients, which was distressing.

'Everything is harder. You want to do things for the patients. Sometimes even simple things, but you just can't.... It's hard to get used to' (Correctional clinician, US) [2, p233]

They also described how the prison environment and its associated rules makes it challenging to facilitate patients’ care preferences. Hospital clinicians in one Australian state described the losses people in prison transferred from regional minimum/medium security facility to a high security metropolitan centre to access specialist palliative care experienced:

'…they lose their room [cell] and lose their job, so they’re effectively discharged from the [lower security] prison, even if it’s just an outpatient appointment. That’s a big deal.' (Hospital clinician, Australia) [3, p987]

Correctional officers also spoke of the personal impact managing palliative patients, feeling that they were not trained to cope with managing people in prison at the end of life.

'The look they [dying patients] give you is just something you don't forget, like you just can't help them… Before here, I've never just watched someone die…' (Correctional officer, US). [2, p233]

Societal attitudes towards palliative care for people in prison also meant that correctional officers and clinicians had fewer opportunities for social coping strategies, as the public could be '… very judgemental …' (Correctional clinician, UK) [4, p63] 

Coping with complexities
Moral and ethical questions of caring for people in prison at the end of life were also prominent. Clinicians described not wanting to know about patients’ offenses so they could focus on providing the best possible care because ‘…They’re people at the end of the day…’ (Correctional clinician, UK) [4 p63] 

Differing priorities of stakeholders could also cause tension, as prison- and hospital-based clinicians were focused on care provision while officers prioritised security protocols. Despite this, officers could choose to temporarily set aside protocols for compassionate reasons, such as allowing a patient who had died on a commode to be moved even though the room had become a crime scene upon the person’s death. [5] Legal and policy ambiguities also meant that routine palliative care processes such as advance care planning could be limited in prison.

Conclusion
Stakeholders facilitating palliative care for people in prison face numerous physical, social, and procedural barriers. Increasing discipline-specific palliative care education and fostering a collaborative, multidisciplinary care approach that includes correctional officers are critical actions needed to better support stakeholders and promote and support high- quality, accessible palliative care in prison.
 

Authors

Isabelle Schaefer

PhD Candidate, National Palliative Care in Prisons Project

University of Technology Sydney, on behalf of authorship team

Reference

1. Schaefer I, Panozzo S, DiGiacomo M, Heneka N, Phillips JL. Perceptions and experiences of clinicians and correctional officers facilitating palliative care for people in prison: A systematic review and meta-synthesis. Pall Med. 2024:02692163241262614.

2. Steely Smith M, Cooley B, ten Bensel T. “We are all humans and deserve a decent way to go”: Examining professional’s experiences with providing end-of-life care in correctional institutions. Criminal Justice Review. 2022;47(2):225-242.

3. Panozzo S, Bryan T, Collins A, Marco D, Lethborg C, Philip JA. Complexities and constraints in end-of-life care for hospitalized prisoner patients. J Pain Symptom Manage. 2020. Nov;60(5):984-991.e1.

4. Turner M, Peacock M. Palliative care in UK prisons: Practical and emotional challenges for staff and fellow prisoners. Journal of Correctional Health Care. 2017;23(1):56-65.

5. Robinson C. The anticipation of an investigation: The effects of expecting investigations after a death from natural causes in prison custody. Criminology & Criminal Justice. 2023:17488958211028721