Expanding End-of-Life Options for Incarcerated Individuals

Abstract

The aging prison population in the United States presents urgent challenges for providing appropriate end-of-life (EOL) care. Currently, there are two primary approaches to deliver this in a compassionate manner: medical release programs (MRPs) and prison-based end-of-life care programs (EOLCPs). Using New York State as a case study, we argue expanded MRPs represent the most ethical path forward, while acknowledging the continuing need for prison-based EOLCPs. Our analysis reveals significant barriers to accessing medical release, including lack of knowledge about the application processes, procedural inefficiencies, overreliance on prognostication, and social stigma. While prison-based programs offer some benefits, studies indicate they frequently fall short of community standards for EOL care, particularly regarding family involvement, pain management, and environment, including a shortage of beds and equipment. We argue for expanding MRPs based on three key considerations: (1) documented preferences of incarcerated individuals against dying in prison, (2) low recidivism rates among medically released individuals, (3) concerning variations in prison-based EOLCP implementation and oversight that likely leads to inconsistent care. While maintaining prison-based EOLCPs remains necessary for incarcerated people ineligible for medical release or those who prefer to remain in facility care, expanding MRPs may better protect patient autonomy and dignity. We recommend three policy changes: (1) training and requiring correctional staff to identify potential eligible individuals for medical release, (2) training community medical professionals on state medical release policies to facilitate applications during community care episodes, and (3) establishing independent physician panels for medical evaluations to expedite evaluations and reduce potential bias.