Surrogate Decision-Making in Carceral Healthcare

The carceral healthcare system is reckoning with a rapidly aging patient population. This is significant because elderly patients are more likely to have medical conditions that render them unable to make their own decisions. Existing laws and ethical guidelines mandate relying on patient-designated and next-of-kin surrogates to make medical decisions for patients who lack decision-making capacity. Yet, providing healthcare to incarcerated patients who lack decisional capacity is especially challenging. As a result, practices vary, and correctional officials, such as wardens or guards, are frequently involved in making medical decisions for incarcerated patients who lack decision-making capacity. The present paper thus considers what qualities make for effective surrogate decision-makers and whether correctional officials tend to possess them. We conclude that correctional officials frequently lack these qualities before exploring other approaches to surrogate decision-making. We identify several approaches with greater potential to ensure that incarcerated individuals' treatment is consistent with their preferences and values.