Shackled: the challenge of caring for an incarcerated patient

Hospice care for inmates is widely recognized as an important way of providing efficient, cost-effective palliative care to a growing number of dying inmates. The case presented here is of a 34-year-old inmate who was admitted to a tertiary-care hospital for diagnostic tests and treatment of non-small cell lung cancer. While he was in the hospital, his clinical status rapidly deteriorated and it was clear that palliative care was most appropriate. Prison restrictions prevented the health care team from sharing the patient's clinical status with his family. He was forbidden many interventions that would have improved his comfort, such as watching television. The problems illustrated by this case occur many times in United States tertiary-care hospitals, and it is hoped that by describing it, more compassionate care for inmate patients, regardless of location, can be provided.