In an article published in Annals of Internal Medicine, the flagship journal of the American College of Physicians (ACP), authors suggest broader use of compassionate release in the nation's prison system. Under current guidelines, many prisoners who may be eligible for compassionate release die in prison while waiting for review. The authors propose changes that could fix compassionate release medical and procedural flaws, thus reducing in-prison deaths and inmate health care costs.
The nation's prison system is overcrowded and the inmate population is aging. Compassionate release allows some eligible, terminally ill prisoners to be freed early so they may die outside prison. Inmates are considered for compassionate release if they have a clinically diagnosed life-limiting illness and if it is legally justifiable to release them into society. According to Brie Williams, MD, Assistant Professor of Medicine, Division of Geriatrics at the University of California, San Francisco, who co-authored the article with R. Sean Morrison, MD, Rebecca Sudore, MD, and Robert Greifinger, MD, prognostication is an inexact science, marking one of the major flaws in the system.
"Death and functional trajectories can be unpredictable for many serious and debilitating illnesses such as cancer, dementia, persistent vegetative state, or end-stage organ disease, just to name a few," said Dr. Williams. "Current compassionate release guidelines are failing to identify prisoners who no longer pose a threat to society but who are suffering, placing huge financial burdens on state budgets, and contributing to the national crisis of prison overcrowding."
To address medical-related flaws in the system, the authors recommend the development of standardized guidelines by an independent advisory panel comprising palliative medicine, geriatrics, and correctional health care experts. Under the new guidelines, prisoners should be assigned an advocate to help navigate the system and represent prisoners who are unable to represent themselves. In addition, there should be a fast-track option for prisoners with short life expectancies. And, finally, there should be a well-described and disseminated application procedure so that prisoners and their advocates understand their rights.
In addition, the authors call for national criteria to help categorize critically-ill patients into three groups: 1) prisoners with terminal illnesses and predictably poor prognoses; 2) prisoners with Alzheimer and related dementias; and 3) prisoners with serious, progressive, nonreversible illness with profound functional/cognitive impairments. For prisoners that fall into one of the three outlined categories, the authors recommend palliative care to ease symptom burden while the inmates await a decision on compassionate release. For those that are not approved, palliative care should continue, as it could improve health care in the prison system while lowering costs.
"As experts in the fields of prognosis, geriatrics, cognitive and functional decline, and palliative medicine, physicians can provide the medical foundation to help criminal justice professionals make informed decisions about compassionate release," said Dr. Williams.
- Brie A. Williams, Rebecca L. Sudore, Robert Greifinger, R. Sean Morrison. Balancing Punishment and Compassion for Seriously Ill Prisoners. Annals of Internal Medicine, 2011;
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