Rocks and hard places: a clinical ethics panel in a prison health context

Area of Science:

• Bioethics
• Public Health
• Health Services Management

Background:

• Clinical Ethics Support Services (CESS) are increasingly common in Australian healthcare.
• Prison health services face unique and complex ethical challenges.
• Limited literature exists on CESS implementation within correctional facilities.

Purpose of the Study:

• To describe the implementation of a CESS within an Australian prison health service.
• To establish a Clinical Ethics Advisory Panel (CEAP) to address ethical challenges in this setting.

Main Methods:

• Conducted a literature review to inform CESS implementation.
• Obtained expert advice from a clinical bioethicist.
• Established a CEAP with clinical and non-clinical representatives.
• Reviewed referrals to assess objective achievement.

Main Results:

• The CEAP received seven referrals over 24 months, primarily concerning clinical operational issues (86%).
• All referrals were initiated by senior medical management.
• The panel comprised both clinical and non-clinical members.

Conclusions:

• The CEAP played a beneficial role in supporting ethical decision-making for prison health staff.
• CESS can offer crucial support to frontline staff and management in correctional healthcare.
• Further evaluation of CESS in prison settings is warranted.