The Ethical and Psychosocial Dimensions of Palliative Care in Prison : A Scoping Review

With prison populations expanding and aging, palliative care (PC) is an urgent concern. People in prison (PIP) face chronic illness, mental health conditions, and social vulnerabilities, creating ethical and psychosocial challenges to dignified end-of-life (EOL) care.

This scoping review mapped key ethical and psychosocial domains in the provision of PC in prisons.

PubMed, Web of Science, and ScienceDirect were searched using the strategy: Population-individuals in prison; Concept-ethical and/or psychosocial issues in PC; Context-PC provision in prisons across regions and healthcare models. Data were coded inductively, organized into ethical and psychosocial domains, and synthesized narratively.

Sixteen studies were included, mainly conceptual analyses (n=10), most from North America (n=11). Ethical domains included structural neglect of PIP with life-limiting illness, barriers to compassionate release, compromised autonomy, denial of death in prison culture, and inadequacies in care quality and access. Psychosocial domains encompassed stigma, mistrust, isolation, existential suffering, and fractured social bonds. PIP-led hospice models offered companionship but raised tensions around labour, confidentiality, and the normalization of death in custody.

Prison-based PC requires systemic reforms, staff training, family and advocacy involvement, and legal safeguards to ensure equitable, compassionate, and dignified EOL care.