Surrogate Decision Making for Incarcerated Patients

Scarlet, Sara; DeMartino, Erin S.; Siegler, Mark

doi:10.1001/jamainternmed.2019.1386

Cited by 13 publications

(18 citation statements)

References 7 publications

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“…[6][7][8][9] Close proximity and incidents of sexual assault in carceral settings also increases risk and occurrence of communicable diseases, including Tuberculosis, Hepatitis B, Hepatitis C, and human immunodeficiency virus. 4,5,8,10 This population also experiences higher rates of interpersonal violence from physical assault. 11 Modvig found 25% of prisoners report experiencing violence (excluding sexual assault) each year, which is eighteen times higher than rates of assault in the general adult male population.…”

Section: Medical Needs Of Incarcerated Patientsmentioning

confidence: 99%

Medical decision-making when the patient is a prisoner

Larsen

Drabiak

2022

Clinical Ethics

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Although prisons provide on-site primary care, the corrections system relies on external hospitals to provide a variety of healthcare services. Compared to the general population, incarcerated patients experience higher rates of chronic medical conditions, mental illness, substance abuse, cancer, traumatic brain injury, assault, and communicable disease. Certain specialties of clinicians are likely to encounter patients who are incarcerated, which makes it important for clinicians to understand how medical decision-making may differ when the patient is a prisoner. The corrections system retains custody of inmates and is responsible for their welfare, including facilitating necessary medical care. However, this does not permit corrections personnel or a warden to automatically assume the role of the patient's medical decision-maker. Except for narrow exceptions, prisoners do not lose their rights to medical decision-making. In some instances, corrections staff or the prison warden have improperly asserted authority to act as the patient's medical decision-maker, such as when the patient lacks decision-making capacity. This violates ethical principles of bodily integrity, respect, and fairness. This paper provides an overview of medical decision-making for incarcerated patients, how surrogate decision-maker hierarchies apply to incarcerated patients without decision-making capacity, and special considerations for this subset of patients.

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Section: Medical Needs Of Incarcerated Patientsmentioning

confidence: 99%

Medical decision-making when the patient is a prisoner

Larsen

Drabiak

2022

Clinical Ethics

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“…Prison officials should not obstruct families from getting the information they need to make medical decisions in line with an incapacitated patient’s values. Although some states require that information shared with next of kin go through prison staff, 13 given the complexity of medical information and decisions, surrogate decision makers ideally should be able to ask questions directly of the patient’s treating physician just as with any other patient who lacks decision-making capacity.…”

Section: Surrogate Decision Makers For Incarcerated Patients Deserve Timely Communicationmentioning

confidence: 99%

Providing Ethical and Humane Care to Hospitalized, Incarcerated Patients With COVID-19

Rorvig

Williams

2021

Am J Hosp Palliat Care

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The COVID-19 pandemic is devastating the health of hundreds of thousands of people who live and work in U.S. jails and prisons. Due to dozens of large outbreaks in correctional facilities, tens of thousands of seriously ill incarcerated people are receiving medical care in the community hospital setting. Yet community clinicians often have little knowledge of the basic rights and ethical principles governing care of seriously ill incarcerated patients. Such patients are legally entitled to make their own medical decisions just like non-incarcerated patients, and retain rights to appoint surrogate decision makers and make advance care plans. Wardens, correctional officers, and prison health care professionals should not make medical decisions for incarcerated patients and should not be asked to do so. Dying incarcerated patients should be offered goodbye visits with their loved ones, and patients from federal prisons are legally entitled to them. Community health care professionals may need to advocate for this medically vulnerable hospitalized patient population to receive ethically appropriate, humane care when under their care in community hospitals. If ethical care is being obstructed, community health care professionals should contact the prison’s warden and medical director to explain their concerns and ask questions. If necessary, community clinicians should involve a hospital’s ethics committee, leadership, and legal counsel. Correctional medicine experts and legal advocates for incarcerated people can also help community clinicians safeguard the rights of incarcerated patients.

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“…In our experience, this belief is common, albeit incorrect. In fact, throughout the United States, incarcerated patients maintain the right to autonomy in medical decision-making [5].…”

Section: Incarceration and Autonomymentioning

confidence: 99%

“…For unrepresented patients who cannot choose a surrogate, designation of a surrogate should proceed according to the state surrogacy ladder, a hierarchical list governing all North Carolina patients and designating who may serve as decision-makers. In North Carolina, family, then friends, and even a patient's physician are potential surrogates [5,7]. North Carolina state statute does not incorporate correctional staff in this hierarchy [5].…”

Section: Incarceration and Autonomymentioning

confidence: 99%

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Delivering Hospital-based Medical Care to Incarcerated Patients in North Carolina State Prisons

Scarlet¹,

Dreesen²

2019

North Carolina Medical Journal

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Many incarcerated patients will require in-hospital care outside prison facilities. Often, this care is provided by clinicians unfamiliar with the correctional context. In this article, we reflect on our experiences caring for incarcerated inpatients in non-carceral settings in North Carolina and highlight sources of misunderstanding and potential conflicts that arise in the care of these patients. A 27-year-old incarcerated man is stabbed in the neck at a rural prison. He is seen by the surgeon on call in the local emergency room. Air is bubbling from the wound. The surgeon recommends an immediate operation and asks the patient for his consent. The patient's nurse tells the surgeon that the patient can't consent for himself because "prisoners are wards of the state." The surgeon, however, has obtained consent from prisoners in the past. She proceeds to obtain consent, but the nurse refuses to witness the required documentation. The surgeon asks the patient who he would like notified about his injury. He provides his mother's contact information. The anesthesiologist arrives and obtains the patient's consent for anesthesia. The correctional officers enter the operating room with the patient and shackle him to the OR table. After the surgery is completed (repair of a large tracheal injury with tracheostomy), the patient moves to the ICU and is shackled to the bed. The nurse expresses concern over his ability to turn the shackled patient from side to side in order to avoid pressure injury. The surgeon calls the patient's mother who asks if she can visit. The surgeon walks to the bedside and asks the corrections officers about visitation. The officers are angry that the surgeon has called the mother. They tell her she needs to get permission before communicating with families. The warden denies permission for visitation. On postoperative day three, the patient is transferred to an inpatient unit in the state prison hospital for tracheostomy care until the tube can be safely removed. The surgeon wishes he could stay under her care, but the care manager, who seems quite knowledgeable, tells her that transfer is "better for everyone." When the patient does not return for follow-up, the surgeon wishes she knew more about the resources in the prison hospital. *This hypothetical case is based on multiple experiences in many North Carolina settings and does not reflect the care of a single individual.

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Surrogate Decision Making for Incarcerated Patients

Cited by 13 publications

References 7 publications

Medical decision-making when the patient is a prisoner

Medical decision-making when the patient is a prisoner

Providing Ethical and Humane Care to Hospitalized, Incarcerated Patients With COVID-19

Delivering Hospital-based Medical Care to Incarcerated Patients in North Carolina State Prisons

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