Dying for a change: a systematic review of compassionate release policies

• DOI: https://doi.org/10.1108/IJPH-11-2021-0110
• Published date: 28 June 2022
• Date: 28 June 2022
• Pages: 47-62
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Shivani Kaushik,Jen Currin-McCulloch

Dying for a change: a systematic review

of compassionate release policies

Shivani Kaushik and Jen Currin-McCulloch

Abstract

Purpose –The purpose of this study was to systematically review literature to investigate trends in

compassionate release policies, facility implementation, barriers at both the incarcerated individual and

institutional levels, as well as gaps in the literature. The absence of uniform and appropriate policies to

address suitable interventions at the end-of-life has aggravated the challenges and issues facing health-

care systems within a correctional facility. A response to address and alleviate these barriers is policies

related to compassionate release, a complex route that grants eligible inmates the opportunity to die in their

community. Despite the existence of compassionate release policies, only 4% of requests to the Federal

Bureau of Prisons are granted, with evidence demonstrating similarly low rates among numerous state

prison systems, signifying the underuse of these procedures as a vital approach to decarceration.

Design/methodology/approach –A systematic review wascompleted using preferred reporting items

for systematic reviews and meta-analyses guidelines. Centre for Agriculture and Biosciences

International Abstracts, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library,

Education Resources Information Center, Google Scholar, MEDLINE, PsycINFO, PubMed, Social

Services Abstracts and Social Work Abstracts were searched from inception to March 2021. Inclusion

criteria included: the compassionate release policy (or related policy) is implemented in the USA;

reportedqualitative and/or quantitative outcomes;and reported original data.

Findings –Twenty studiesformed the final data set. Data analysis revealed fourmain themes: language

barriers, complexitiesof eligibility criteria, over-relianceon prognostication and social stigma. Barriers to

inmates’ access to compassionaterelease policies include unclear or technicallanguage used in policy

documents. Eligibility criteria appear to vary across the country, including disease prognoses and the

ability to predict terminal declines in health, creating confusion amongst inmates, lawyers and review

boards. Stigmas surrounding the rights of incarcerated individuals frequently influence policymakers

who experience pressure to maintain a punitive stance to appease constituents, thus discouraging

policiesand interventions that promote the release of incarceratedindividuals.

Research limitations/implications –Further research is vital to strengthen the understanding of

compassionate release policies and related barriers associated with accessing various types of early

parole. To promote socialjustice for this marginalized population, end-of-life interventions in corrections

need to beconsistently evaluated with outcomesthat improve care for dying inmates.

Practical implications –Within correctional facilities, correctional health-careworkers should play an integral

role in influencing prison and medical staff attitudes toward dying inmates by providing an understanding of

how to effectively support this vulnerable population. Social workers should participatein research that focuses

on effective guidelines for correctionalfacilities to provide compassionate end-of-life care for inmates.

Social implications –Racial disparities in the US criminal justice system are prevalent and well

documented,as individuals of color are arrested far out of proportionto their share of all individuals in the

USA. This particular population is thus challenged with poor access to and quality of health care in

corrections. Correctional health-care workers can play an integral role in influencing policymakers, as

well as prison and medicalstaff attitudes toward dying inmates by providing an understandingof how to

effectivelysupport this vulnerable population.

Originality/value –Currently, there are no publishedresearch articles that provide a systematic review

of compassionaterelease policies in the USA.

Keywords Correctional health care, Health policy, Hospice, End-of-life care, Compassionate release,

Early parole

Paper type Literature review

Shivani Kaushik and

Jen Currin-McCulloch are

both based at the School of

Social Work, Colorado

State University, Fort

Collins, Colorado, USA.

Received 5 November 2021

Revised 5 March 2022

Accepted 6 June 2022

DOI 10.1108/IJPH-11-2021-0110 VOL. 19 NO. 1 2023, pp. 47-62, ©Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 47

Introduction

The unique needs of an aging prison population continue to demonstrate itself as an

imperative and significant topic of conversation between health care professionals and

correctional administrators (Rothman et al.,2017). The number of elderly incarcerated

individuals in the USA continues to grow, calling for multiple policy changes from health

care advocates and scholars, including increased training for correctional staff and the

revision of compassionate release policies to increase their utilization among state and

federal correctional systems (Wylie et al.,2018;Williams et al., 2012). Compassionate

release policies provide the opportunity for incarcerated individuals to die in their

community. Although nearly all states have some form of a compassionate release policy,

they are remarkably underused. Barriers continue to exist that complicate the utilization of

these policies, including prognosis requirements and applicants being required to have

served a specified portion of their sentence(Dubler, 1998;Price, 2018).

The lack of knowledge regarding optimal end-of-life care for seriously ill, incarcerated

patients has exacerbated the existing barriers already endured by aging incarcerated

populations (Rothman et al.,2017). Though substantial research and resources have

concentrated on dying with dignity for individuals who retain their civil liberties, these have

been greatly limited for incarcerated populations. Correctional settings, in general, lack

end-of-life care models and the justification for imprisonment often impedes the provision of

quality health care for incarcerated individuals (Hoffman and Dickinson, 2011). As prisons

exist as isolated systems, incorporating strict regulations and social functioning, it is

necessary to customize end-of-life care needs to satisfy this specific environment (Handtke

and Wangmo, 2014). Health and behavioral factors, in addition to low health literacy and

living in an isolated environment with significantly diminished independence, has created a

great challenges for the terminally ill accessing appropriate end-of-life care (Handtke and

Wangmo, 2014).

Correctional facilities encounter complex challenges with respect to the provision of

humane health care, with barriers associated with end-of-life care delivery continuing to

emerge for this aging population (Williams et al.,2015). A strategy that aims to address and

alleviate such barriers, however, are policies related to compassionate release, which may

include medical parole, medical release or geriatric parole, although these policies may

differ in regard to requirements. For terminally ill applicants who have a viable release plan

for housing and medical care,these policies comprises an imperative step toward reducing

mass incarceration rates, promoting dignity at the end-of-life for incarcerated populations

and advancing a public health approach for an aging and marginalized population. The

existence of these barriers consequently motivates healthcare providers and human rights

advocates to view this crisis as a human rights issue; one thatimpacts the rights and needs

of an elderly and terminally ill population (Maschiet al.,2016).

Background

The complexities of care, paired with an overcrowding, aging population and a lack of

resources, create vast challenges in providing end-of-life care within correctional settings

(Turner et al., 2011). With more than twomillion prisoners in the USA alone, this incarcerated

population is quickly shifting from younger to older adults (Institute for Crime and Justice

Policy Research, 2016). Incarcerated individuals are also enduring longer prison

sentences, therefore resulting in potentially lifelong internment (Maschi and Richter, 2017).

The Bureau of Justice Statistics reports that between 2001 and 2013, nine out of ten of

prisoner deaths were because of an illness-related cause. Incarcerated individuals are

medically and socially vulnerable and thus develop chronic illness and disability

approximately 10–15years earlier than nonincarcerated individuals (Williams et al.,2015).

The lack of uniform and appropriate policies to address suitable interventions at the end-of-

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