Beyond Bars: Evaluating End-of-Life Care and Surrogate Decision-Making for Hospitalized Incarcerated Persons

Area of Science:

• Medical Law
• Public Health
• Palliative Care

Background:

• Incarcerated persons (IPs) have a constitutional right to healthcare, including palliative care (PC).
• Access to PC and surrogate designation for incapacitated IPs face unique challenges within correctional systems.
• Correctional policies can impede timely communication and end-of-life (EOL) care for IPs.

Purpose of the Study:

• To highlight barriers IPs face in accessing palliative care and designating surrogates.
• To examine the impact of correctional policies on EOL care for hospitalized IPs.
• To identify needs for improved institutional policies and inter-system collaboration.

Main Methods:

• Case study analysis of two hospitalized incarcerated individuals with life-limiting illnesses.
• Review of barriers in surrogate identification and engagement.
• Examination of communication delays and visitation restrictions.

Main Results:

• Delays in surrogate communication and restricted EOL visitation significantly impacted PC delivery.
• Misinformation and procedural ambiguity among staff hindered timely and appropriate care.
• Existing legal frameworks, like the Tennessee Health Care Decisions Act, were not always effectively applied.

Conclusions:

• Improved institutional policies and staff training are essential for IPs' EOL care.
• Clearer surrogate identification protocols are needed.
• Enhanced collaboration between healthcare and correctional systems is vital to uphold the rights and dignity of IPs.