Humane Health Care for Prisoners : Ethical and Legal Challenges

Cover ......Page 1 Half Title ......Page 2 Title Page ......Page 4 Copyright ......Page 5 Contents......Page 6 Preface......Page 12 Acknowledgments......Page 16 Explanatory Notes......Page 20 Introduction......Page 24 Common Mission......Page 30 A Brief Historical Perspective......Page 31 Definition of Ethics......Page 35 Ethics and the Law......Page 36 Dignity of the Human Person......Page 37 Professional Codes of Ethics......Page 39 Meaning of a Professional Code of Ethics......Page 40 Privacy, Patient Autonomy, Confidentiality, Acceptability......Page 43 Informed Consent and Enforced Treatment......Page 47 A Caring Approach......Page 51 Transgender Issues......Page 56 General Principles......Page 59 DNA Testing......Page 61 Body Cavity Searches......Page 62 Strip Searches......Page 65 Evaluation of Competence......Page 68 Concept of Predicted Dangerousness and Medical Parole Issues......Page 69 Directly Observed Therapy......Page 70 Crushing Medications......Page 71 Treating or Diagnosing under Less-than-Satisfactory Conditions......Page 72 Patient Assessment through a Closed Door......Page 73 Drawing Blood through the Bars or through a Food Slot......Page 74 Unnecessary Risk to Safety of Health Care Staff......Page 75 Defective or Inadequate Equipment......Page 76 Methods of Preventing HIV Transmission......Page 77 Food Loaf......Page 78 Hunger Strikes......Page 79 Conclusion......Page 82 Ethical Role Conflict Situations ......Page 84 Medical Clearance for Punishment ......Page 85 Use of Mace ......Page 87 Writing Tickets ......Page 88 Use of Medication for Behavior Control ......Page 89 Witnessing the Use of Force ......Page 90 Participation in Executions ......Page 91 Position of the American Pharmaceutical Association......Page 97 Treatment to Render a Person Competent for Trial......Page 99 Determination of Competence to Be Executed......Page 101 Treatment to Render a Person Competent for Execution......Page 103 Involvement with Acts of Torture ......Page 104 Reporting Abuses by Staff ......Page 108 A Note of Caution—Erosion and Burnout ......Page 110 Conclusion ......Page 113 Ethical Reasoning......Page 116 Working in the Context of a Blemished History......Page 117 First Steps toward Regulation of Biomedical Research in U.S. Prisons......Page 119 Institute of Medicine Recommendations and Some Critical Responses......Page 127 Encouraging Appropriate Research......Page 130 How Do We Bring It All Together? ......Page 131 Housing the Mentally Ill in Isolation or Supermax Settings......Page 133 A Vicious Cycle......Page 136 Extreme Segregation, Isolation, and Supermax Settings......Page 138 Is It Legal?......Page 144 Is Physician Participation Ethical?......Page 146 Retrospective Clues for a Current Ethical Imperative......Page 149 Conclusion......Page 150 What the Courts Have Done......Page 152 Hands-off Policy......Page 153 A Break in the Hands-off Era......Page 154 Holt v. Sarver......Page 156 Estelle v. Gamble ......Page 157 Tort Liability ......Page 159 Deliberate Indifference......Page 160 Qualified Immunity......Page 162 Farmer v. Brennan......Page 163 Civil Rights of Institutionalized Persons Act......Page 164 Pulling in the Reins......Page 165 Prison Litigation Reform Act of 1996......Page 166 Urgent Need for Reform of the PLRA......Page 169 Persons with Disabilities......Page 172 Adequate Documentation......Page 177 Special Problems of Juveniles......Page 178 Some Important Legal Cases......Page 179 Cases Concerning Adults......Page 180 Cases Concerning Juveniles......Page 185 A Checklist of Risk-Prone Areas......Page 188 Don’t Fight the Courts......Page 191 Impact of the Courts......Page 192 A New Challenge—The Impact of Mass Incarceration......Page 196 Conclusion: Looking Towardthe Future......Page 198 A Complex Issue......Page 202 Practitioner Guidelines......Page 205 Universal Principles......Page 207 Conceptual Framework for Decision Analysis......Page 209 International Implications......Page 211 A Spectrum of Care Model......Page 212 From Whose Perspective? ......Page 216 Factors That Should Not Influence a Decision to Treat ......Page 218 Self-Harm or Contributory Behavior......Page 219 Preexisting Conditions......Page 220 Dimensions of Necessity......Page 221 Cost Factors ......Page 223 Description of Factors to Be Considered in the Decision to Treat ......Page 224 Probability of a Successful Outcome with Few Adverse Side Effects ......Page 225 Expected Remaining Duration of Incarceration......Page 226 Cost of the Intervention......Page 227 Treatment Delays......Page 228 Conclusion......Page 229 Mental Illness Should Be Treated, Not Punished......Page 232 Society’s Failure—Deinstitutionalization......Page 234 Scope of the Problem—Prevalence......Page 238 Jail and Prison Environments Are Countertherapeutic......Page 241 Mental Illness: A Chronic Condition That Waxes and Wanes ......Page 244 Closed Head Injury......Page 247 Special Units for Housing Mentally Ill Patients......Page 248 Typical Characteristics of Mentally Ill Patients by Level of Care......Page 249 Practical Consequences of Failing to Recognize the Chronic Nature of Mental Illness......Page 250 Conclusion: An Ethical Imperative......Page 253 7. A Patient or a Prisoner? ......Page 256 Why Call Them “Patients"?......Page 257 Is It a Health Care Unit? ......Page 263 Where the Lines Get Crossed......Page 264 Patient Advocacy......Page 265 A Lesson from the Captain......Page 266 Conclusion......Page 267 Common Mission with Differences......Page 270 Responsible Health Authority......Page 271 Medical Autonomy......Page 272 Rationale for Designating a Responsible Health Authority......Page 274 Role of Responsible Health Authority......Page 275 Role of the Medical Director......Page 276 No Central Health Authority......Page 277 Outside Public Health Authority......Page 280 Need for Patient Advocacy......Page 281 Risk of Excessive Fragmentation......Page 282 Line Authority from a Central Office of Health Care......Page 283 Conclusion......Page 285 Corrections and Health Care......Page 288 Purpose......Page 289 Means Employed......Page 291 Coercive Measures......Page 292 Primary Client Served......Page 293 Style of Staff Training......Page 294 System of Beliefs......Page 295 How Health Care Depends on Custody and Institutional Services ......Page 297 How Custody Depends on Health Care......Page 298 Strategies......Page 299 Dialogue and Respectful Deliberation......Page 301 Health Aspects of Officer Training......Page 303 Security and Institutional Aspects of Health Care Staff Training......Page 306 Some Tough Questions......Page 308 Rhabdomyolysis......Page 309 Emergency Vodka......Page 310 Ensuring Safety and Security within Clinic Areas......Page 311 Security Housing Units and Other Forms of Severe Isolation......Page 312 Privacy of Clinic Encounters......Page 313 Health Classification......Page 314 Transporting Prisoners......Page 315 Security Constraints That Impair Cost-Effective Health Care......Page 316 Conclusion—Speaking Out Loyally......Page 317 Epilogue......Page 320 Notes......Page 322 Bibliography......Page 346 Index......Page 364 Index of Legal Cases......Page 390 About the Author......Page 394 A useful research resource and handy reference, this book discusses the many important ethical and legal issues that arise in the delivery of health care to prisoners at correctional facilities. It references national standards of professional practice as well as the advice of recognized experts. The mission of corrections is the care and custody of prisoners with a view to public safety within a place dedicated to punishment, while the mission of the medical and mental health professionals in a corrections facility is to care for the health and well-being of the prisoners. Both have a duty to provide care, but their differing roles and objectives give rise to ethical role conflict and disagreement regarding appropriate care strategies. Humane Health Care for Prisoners considers important ethical and legal issues that arise in the delivery of health care to prisoners, covering topics such as privacy, confidentiality, informed consent, extended isolation and solitary confinement, use of mace, strip searches and body cavity searches, and medical experimentation on prisoners as human subjects. It also considers participation by health care professionals in capital punishment, coerced substance abuse treatment, how much health care to provide, organizational structure and hierarchy, cooperation between correctional and health care staff, and the importance of recognizing mental illness as a chronic condition. This book is informative for professionals working in corrections facilities, such as physicians, psychiatrists, psychologists, nurses, wardens, jail administrators, sheriffs, and corrections officials, as well as legislators and decision makers, attorneys involved in correctional healthcare lawsuits, students of criminal justice, and those seeking to work in the field of correctional health care or in corrections. Additionally, students and professors of medical ethics will find this book helpful in illustrating real-life topics for research and discussion. * Clearly lays out the ethical issues in role conflicts or difficult policy questions in correctional health care management * Makes the argument that while correctional and medical care professionals have their own goals, policies, and practices in the correctional environment, a willingness to accommodate the key principles and needs of the other party benefits both disciplines * Investigates the central theme of what is right and what is wrong, by using ethical principles, court decisions, and accepted national standards as a guide * Provides an index designed to facilitate the book's use as a quick and ready reference