End-of-life Care in the Prison Environment (Supplement #19) by Barry R Ashpole

Older people and prison: Proposals for an approach

CONSEJO GENERAL DE LA ABOGACÍA ESPAÑOLA (The General Council of Spanish Lawyers) | Online – 9 May 2025 – According to data published by the Ministry of the Interior … the prison population is aging. Often, the needs of older inmates cannot be met in the prison environment … as is the case with other groups such as inmates with disabilities or mental illness. The prison environment is not adapted to fulfill its purpose of reintegration, social rehabilitation, protection of fundamental rights, [and] adequate healthcare… Prisons are not provided with the means for the … treatment of the elderly, espe- cially those who, due to their age and health, physical or mental life circumstances, suffer from patholo- gies to which prisons cannot provide an answer – mobility problems, cognitive impairment, dementia … and even inmates with intellectual disabilities or mental illness. Rehabilitation programs in these cases … become complicated or unattainable. Full text: https://bit.ly/44CGYb4

Prison Health Services:

Decades of indifference and failures in accountability in the provision of medical care in federal prisons

NEVADA LAW JOURNAL, 2025;25(3):755-796 (U.S.) The Bureau of Prison’s (BOP) is the nation’s larg- est prison system, and it wields enormous power over the lives of the hundreds of thousands of people in its custody. It also has a duty, proscribed by the Constitution, to provide each of those people with ad- equate medical care. Yet, for decades, oversight bodies have made clear that the BOP is failing to meet its constitutional obligations to those in its custody. Despite report after report highlighting the BOP’s sys- temic deficiencies, no institution has stepped up to hold the BOP accountable for its misdeeds, and this lack of accountability has led to preventable harms, suffering, and the death of incarcerated people. Frederick Bardell provides a tragic example of the individualized impacts of the BOP’s lack of accounta- bility. In 2022, a federal judge held the BOP in civil contempt after the BOP failed to treat Bardell for co- lon cancer, ultimately leading to his untimely death. Download full text at: https://bit.ly/4kFcj1i

Related:

‘Watchdog faults Bureau of Prisons for failing to screen inmates for colorectal cancer,’ Reuters (U.S.) | Online – 20 May 2025 – The U.S. Bureau of Prisons is failing to routinely screen older inmates for colorec- tal cancer, and has in some cases failed to follow up with proper medical care after inmates tested positive in cancer screening… Less than two-thirds of average risk inmates between ages 45 and 74 received a colo- rectal cancer screening as of April 2024.1 The review also found that about 10% of a sampling of 327 in- mates had no documented medical follow-up after receiving a positive result in colorectal cancer screening. Full text: https://bit.ly/3H1cC8h

1. ‘Evaluation of the Federal Bureau of Prisons’ Colorectal Cancer Screening Practices for Inmates and Its Clinical Follow-up on Screenings,’ U.S. Department of Justice (Office of the Inspector General), May 2025. Download report at: https://bit.ly/436jKsz

‘Policies for waiving medical copays in prisons are not enough to undo the harm caused by charg- ing incarcerated people for healthcare access,’ Prison Policy Initiative (U.S.) | Online – 15 May 2025 – In most states, people incarcerated in prisons must pay medical “copays,” essentially fees to access health- care, including physician visits, medications, and other health services. While these fees may seem reason- able at two or five dollars, research shows they actually act as barriers to healthcare for incarcerated people who typically earn less than a dollar an hour, if they are paid at all. Prison administrators claim these fees deter the “overuse and abuse” of limited healthcare resources… Full text: https://bit.ly/45drCK9

‘Health-focused arguments for eliminating overcrowding in prisons, jails, and other detention facilities,’ American Journal of Public Health (U.S.) | Online – 14 May 2025 – Living incarcerated in a prison, jail or detention facility is certainly not intended to be easy, but living in such facilities when they are overcrowd- ed is truly horrific. Adler and Chen report on their analysis of the relationship between the extent of prison overcrowding – prisons with incarcerated populations larger than the designed occupancy – and five healthcare and health outcomes.1 The negative health implications of overcrowding are applicable far be- yond California’s [30 state] prisons… First page view: https://bit.ly/4dkvgE6

1. ‘Healthcare, mortality, and declining occupancy rates in California prisons, 2013-2023,’ American Journal of Public Health, 2025;115(6):936–944. Abstract: https://bit.ly/4dsGNl6

‘“No meaningful treatment”: Doctor says San Diego County jails are the worst he’s ever seen,’ San Diego Union-Tribune (U.S.) | Online – 9 May 2025 – When people who rely on psychiatric medication are booked into a San Diego County jail they are forbidden to bring their prescriptions with them, leaving them to decompensate as they go days or weeks without treatment. In San Diego jails, decisions that affect mentally ill people are regularly made by command staff rather than healthcare professionals – a practice that can jeopardize the well-being of people behind bars. These and other findings are the conclusions of Dr. Pablo Stewart, a correctional healthcare expert… Full text: https://bit.ly/4dsnUP1

Coroner calls for action on culturally safe care for Aboriginal prisoners

(Australia) | Online – 26 May 2025 – The National Justice Project has welcomed a Coroner’s recommendations for the provision of culturally safe care to Aboriginal prisoners in Western Australia following an inquest into the death in custody of 41- year-old Martu woman Dannielle Lowe. The inquest findings detail missed opportunities for treatment and care as well as evidence that the care she received was not culturally safe. In or- der to provide culturally safe care to Aboriginal prisoners in Western Australia, the Department of Justice should redouble its efforts to recruit Aboriginal staff at its prisons, including medical officers, nurses, psy- chologists, social workers, and prisoner support officers. Culturally safe care for Aboriginal prisoners in Western Australia may also be achieved by establishing partnerships with Aboriginal community con- trolled health organisations and medical services, to provide access to visits from Aboriginal health prac- titioners, and by developing an Aboriginal Elders visiting program. Full text: https://bit.ly/3Fr2q8G

Related:

‘Victoria’s prison healthcare system should match community healthcare,’ The Bulletin (Australia) | Online – 9 May 2025 – In Victoria, if a person in prison is Aboriginal and/or Torres Strait Islander, they do not get access to culturally competent care through Aboriginal community-controlled health organisations. In Victoria, prison healthcare is provided by for-profit private companies contracted by the state government. Imprisoned peoples’ physical health and/or social and emotional well-being is at the mercy of prison officers and prison healthcare providers. International law requires prisoners should enjoy the same standards of healthcare that are available in the community. Full text: https://bit.ly/3RT6VeT

Global Prison Trends 2025: Healthcare

| Online – 22 May 2025 – The state of prison healthcare remains dire in many parts of the world, with people in prison still facing much greater health challenges than the rest of the community. A grave indicator is that mortality rates among prison popula- tions are up to 50% higher than those in the general population, largely due to inade- quate healthcare, overcrowding and poor living conditions. These factors, combined with non-communicable and communicable diseases, levels of violence and suicide, significantly contribute to fatalities within detention facilities. Budgetary constraints, along with challenges in recruiting and retaining qualified healthcare staff, are common barriers to ade- quate prison healthcare… Where prison populations are ageing, there are often struggles to adequately meet their healthcare needs. Research highlights the inadequate care provided to older persons in prison, particularly in relation to end-of-life care. Full text (scroll down to pp.24-25): https://bit.ly/43tuAYM

Moldova prison staff better equipped to address health needs of prisoners

| Online – 20 May 2025 – Medical and non-medical staff from all (59) penitentiary in- stitutions … were trained on areas of critical importance for healthcare delivery in prison environments, such as medical examination upon admission to prison, includ- ing the management of individual medical files, and medical ethics within the prison system. The training sessions … addressed key topics such as screening for mental health issues, drug use, and infectious diseases that increase vulnerability, risk of discrimination and ill-treatment of these inmates. Additional subjects included ensuring equal access to healthcare, patient consent and confidentiality, equivalence of care with community health services, pro- fessional independence, the treatment of inmates with special needs, and the management of ethically challenging situations. The sessions raised the awareness of penitentiary personnel about the importance of interprofessional cooperation… Full text: https://bit.ly/4k3zDWD

Health rights of inmates of correctional institutions in Nigeria during endemic periods: Challenges and responses

AFRICAN JOURNAL OF LAW & HUMAN RIGHTS, 2025;9(1):41-47. The health rights of inmates in cor- rectional institutions are a fundamental aspect of human rights that often face significant challenges, par- ticularly during periods of endemic disease outbreaks. Inmates are among the most vulnerable popula- tions due to overcrowding, poor sanitation, inadequate healthcare infrastructure, and limited access to medical services. This paper examines the legal framework governing the health rights of inmates … in- cluding relevant constitutional provisions, international human rights instruments, and case law. It high- lights the systemic barriers that hinder implementation of these rights, such as insufficient funding, stigma associated with certain diseases, and a lack of trained medical personnel within correctional facilities. The analysis explores the government’s policy responses… The paper proposes policy reforms to enhance healthcare access and promote the welfare of incarcerated individuals. Full text: https://bit.ly/4jFq3Jq

End-of-Life Care in Prisons

Research in Progress

Attitudes towards end-of-life care options for people in prison

Online – 14 May 2025 – This University of Adelaide research project is about capturing knowledge of and attitudes towards end-of-life care (EoLC) for people in prison in Australia. The aim is to better understand how the community feels about these services being provided to incarcerated individuals. Researchers will examine public attitudes towards providing palliative care, voluntary assisted dying, and/or compas- sionate release for people in prison. The research “may result in a better understanding of community sentiments towards people in prison at end of life in Australia and guide policy changes.” The data will be used for a PhD thesis, where it will be analysed to explore peoples’ perceptions about EoLC in prisons, and whether or not there are insights that can be used to inform policy and practice. It may also add to the overall international literature on this topic by providing an Australian perspective, which to date is not featured. Access details at: https://bit.ly/3YJlqFQ

Related:

‘Continuing the conversation: Practical strategies to enable acceptable and feasible health research in prisons,’ Archives of Public Health (Canada) | Online – 28 May 2025 – There are substantial challenges in conducting health research within prison systems, which may preclude research or compromise research quality, and could be associated with potential harms for participants and missed opportunities for benefits. Barriers … relate to funding, logistics, including access to people in prison, minimal knowledge of prison re- search conduct and prison systems…, communication to establish partnerships, ethical challenges and eth- ics review board processes and requirements, and laws and regulations. Full text: https://bit.ly/3SK240

Challenges and ethical considerations of palliative care in Indian prisons

JOURNAL OF PAIN & SYMPTOM MANAGEMENT (India) | Online – 12 May 2025 – Palliative care in Indian prisons faces challenges due to overcrowding, inadequate medical infrastructure, and societal ne- glect of incarcerated individuals. Chronic illnesses are common, yet regular follow-ups are lacking… Psy- chological issues … further complicate care. Although medical parole exists, bureaucratic inefficiencies often lead to delayed or denied release. In contrast, few developed nations with prison hospice models integrate interdisciplinary teams and inmate caregivers, offering structured approaches to compassionate care despite facing challenges… Ethical principles like autonomy, beneficence, nonmaleficence and jus- tice are often compromised in Indian prisons, demanding policy reforms. Expanding hospice facilities, training prison staff in compassionate care, and improving the use of compassionate release mechanisms can ensure humane end-of-life care for incarcerated individuals. Abstract: https://bit.ly/3EQuu5c

Illinois plan calls for annual report on hospice, palliative care for prisoners

WAND TV NEWS (U.S.) | Online – 8 May 2025 – The Illinois House of Restorative Justice & Public Safety Committee recently passed a bill requiring the Illinois Department of Corrections to report on the hospice care that is available for prisoners. Over 1,000 Illinois prisoners are 65 or older, and a growing number of those people are in need of end-of-life care (EoLC) and also support services. The Department does not have a formal hospice program, as EoLC is provided on a prison-by-prison basis. This has led to incon- sistent care for prisoners diagnosed with terminal illnesses… What is provided in various facilities is not consistently provided among all of the facilities. The reason for this data collection is really to have an understanding of what is provided and who does it, how we do it… The bill calls on the Department of Corrections to provide the report with demographic data of prisoners receiving hospice and palliative care by 1 December of each year. Full text: https://bit.ly/4jMYL3N

My first death: Dying well in prison settings

(U.K.) | Online – 7 May 2025 – Everyone deserves a dignified death, but in custody settings not all prisoners get the chance to die well. A recent online talk brought together nursing, healthcare and prison staff to discuss death in relation to patients in custody. They shared the first patient death they experienced. By bringing out the human stories behind the prison walls we see the patient behind each prisoner. Much of the discussion focused on the National Health Service England’s ‘Dying Well in Custody Charter’ (see sidebar) The custodial environment is different to other settings in which clinical care takes place, and providing the best possible end-of-life care in prison is complex and challenging. The charter enables those involved in caring for indi- viduals to manage this event with compassion, inclusivity and en- sures that there is dignity in the death irrespective of their place of death. Download the charter at: https://bit.ly/4evqeEQ

The charter mirrors the ambitions for palliative and end-of-life care and provides a framework for establishments to act, help and support all staff who are involved in the care of an individual preparing to die… This framework provides a set of standards … which place the individual at the centre of the care being planned and delivered. The ambitions and standards in the dying well in custody charter ensure that care is coordinated across the establishment and supports all staff being able to achieve a level of competence and confidence in delivering professional care to these individuals with dignity and calm.

| Online – 12 April 2025 – An aging prison population pos- es myriad challenges for pe- nal institutions and prison health systems. While chron- ic health conditions are not exclusively the terrain of older adults, they become more prevalent and more costly for penal systems as people age. And while prison death, significantly, has causes beyond illness and disease, “natural causes” account for the great majority of deaths in prison. Relatively few prisons, however, have dedicated geriatricians or palliative care (PC) staff, let alone a hospice or hospice services. Accordingly, along with calls for reduced incarceration of older adults and more community support systems to receive them upon release from prison, geriatric and PC has emerged internationally as a central topic in public health and penal reform, particularly in higher-income nations. The topical focus on PC in prison … encompasses care provided to general prison populations as well as services provided in specialized care facilities such as critical care units or prison hospices. Full text: https://bit.ly/3Y9O1E7

Recognized barriers to end-of- life care in prisons include:

● Poor communication between medical staff and patients,

● Failures to diagnose illness or harmful delays in diagnosis,

● Lack of continuity of care, and
● Dehumanizing practices and interactions with staff.

Implementing voluntary assisted dying in New South Wales correctional settings

MEDICAL JOURNAL OF AUSTRALIA | Online – 26 May 2025 – New South Wales (NSW) was the last Australian state to pass vol- untary assisted dying (VAD) legislation, effective on 28 November 2023.The Justice Health & Forensic Mental Health Network (JHNSW) is responsible for the healthcare of people in contact with the criminal justice system in NSW [and] was tasked with imple- menting a VAD pathway for prisoners. A steering committee was formed with the Corrective Services NSW, the local health district, the CSNSW Inmate Consumer Referent Group, the Mental Health Review Tribunal, the JHNSW Clinical Ethics Committee, the Vic- tims Support Scheme and the Aboriginal Health & Medical Re- search Council of NSW to create dignified and culturally safe path- ways for prisoners to access VAD. The ethical and legal challenges of integrating VAD into the NSW correctional settings are highlight- ed, with a hypothetical patient journey demonstrating the pathway. Full text: https://bit.ly/3FD6QcG

Patient autonomy is a corner-stone principle of VAD. Informed and free decision making can be limited in a correctional setting, with institutionalised inequalities and power dynamics that can create coercive relationships between prisoners, CSNSW and NSW Health staff. The psycho-social disadvantages of prisoners can render them unable to protect their own interests and can undermine their autonomy.

‘Life without parole and euthanasia: The future unintended consequences of current sentencing policies,’ Punishment & Society, 2025;27(2)191-214 (U.S.). It is possible that jurisdictions in the U.S. will authorize euthanasia for prisoners in states where medically assisted death is permissible for non-incarcerated citizens. It is important for criminal justice scholars to prepare for the controversies that will follow. The U.S. incarcerates nearly 56,000 people who are serving life without the possibility of parole… It is argued that life without parole sentences are unethical and unconstitutional, just as euthanasia policies are argued on simi- lar grounds. Abstract (w. references): https://bit.ly/3G3DeVL

N.B. See International Association for Hospice & Palliative Care literature search on assisted dying practices at: https://bit.ly/3ZLkhOo

Grief & Bereavement

From the archives: An interesting read you might have missed

The grief experience of prison inmate hospice volunteer caregivers

JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE, 2014;10(1):80-94 (U.S.). Inmate volunteers at the Louisiana State Penitentiary (LSP) Hospice Program managed unrelenting loss with strategies beyond the parameters typically prescribed in healthcare. Though strongly identifying themselves in a profession- al role, volunteers appeared to accept deeper levels of relationship than typically endorsed in community hospice practice. The fluidity of boundaries was striking in the context of prison, where rigid sys- tems of personal boundaries are socially reinforced. One possible implication of the volunteers’ method of accepting deep relation- ships with dying persons while continually processing grief and re- maining open to new relationships with certain loss for professional hospice caregivers, is the use of personal spiritual care and ac- ceptance of peer support that is a signature feature of the LSP Hospice at Angola. Download full text at: https://bit.ly/4m9QuJ6

Social workers practicing in prison hospices are uniquely equipped to counsel healthy grief and self-care in inmate volunteers. In the setting of prison hospice with inmate volunteer caregivers, social workers could facilitate formal peer support and contribute to an atmosphere that endorses this effective peer-to-peer model of grief care.