A review and content analysis of U.S. Department of Corrections end-of-life decision making policies

• DOI: https://doi.org/10.1108/IJPH-06-2021-0060
• Published date: 27 December 2021
• Date: 27 December 2021
• Pages: 165-175
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Victoria Helmly,Marisol Garica,Brie Williams,Benjamin A. Howell

A review and content analysis of U.S.

Department of Corrections end-of-life

decision making policies

Victoria Helmly, Marisol Garica, Brie Williams and Benjamin A. Howell

Abstract

Purpose –With a rapidly growing population of older adults with chronic illness in US prisons, the

number of people who die while incarcerated is increasing. Support for patients’ medical decision-

making is a cornerstone of quality care for people at the end of life (EOL). This study aims to identify,

describe, and analyze existing policies regarding EOL decision-making in U.S. Departments of

Corrections.

Design/methodology/approach –This study performed an iterative content analysis on all available

EOL decision-makingpolicies in US state departmentsof corrections and the FederalBureau of Prisons.

Findings –This study collected and reviewed available policies from 37 of 51 prison systems (73%).

Some areas of commonality included the importance of establishing health-care proxies and how to

transfer EOL decision documents, although policies differed in terms of which patients can complete

advancecare planning documents, and who canserve as their surrogate decision-makers.

Practical implications –Many prison systems have an opportunity to enhance their patient medical

decision-making policiesto bring them in line with community standard quality of care. In addition, this

study was unable to locate policies regarding patient decision-making at the EOL inone quarter of US

prison systems, suggesting there may be quality-of-care challenges around formalized approaches to

documentingpatient medical wishes in some of thoseprison systems.

Originality/value –To the best of the authors’ knowledge, this is the first content analysis of EOL

decision-makingpolicies in US prison systems.

Keywords Advance care planning, End of life, Palliative care, Hospice care, Correctional health care,

Advance directives, Do not resuscitate, Living wills, Health-care directives

Paper type Research paper

Introduction

The US prison population is aging rapidly, eclipsing the rate of increase of the

population of non-incarcerated older Americans. Older adults make up the fastest

growing age demographic in prison populat ions, comprising 3% of the prison

population in 1993 but 10% of the prison population in 2013 (Carson and Sabol, 2016).

Although prison deaths occur among people of all ages, older adults account for most

deaths in prison because of their increased burden of chronic and/or serious life-

limiting illnesses (Carson and Cowhig, 2020). As a result, there is a growing need for

specialized geriatric and of end-of-life (EOL) care in prisons, including clear delineation

of the decisions people, who are incarcerated, can make when facing serious, life-

limiting illness.

Medical decisions commonly made at the EOL (“end-of-life decision-making”) may include

identifying a health care power of attorney and deciding in advance to accept or decline

curative medical interventions or advanced life support (“do not resuscitate orders”).

Victoria Helmly is based at

the Andrew Young School

of Policy Studies, Georgia

State University, Atlanta,

Georgia, USA.

Marisol Garica is based at

the Trinity College,

Hartford, Connecticut,

USA. Brie Williams is based

at the Department of

Medicine, Division of

Geriatrics, University of

California San Francisco,

San Francisco, California,

USA. Benjamin A. Howell is

based at the SEICHE

Center for Health and

Justice, Yale School of

Medicine, New Haven,

Connecticut, USA.

Received 30 June 2021

Revised 11 October 2021

Accepted 30 November 2021

The authors would like to

acknowledge the contribution

of Dr. Jennifer G. Clarke who

provided motivation for initiation

of this research study.

Dr Howell was supported via

funding from National Institute

of Drug Abuse grant

5K12DA033312. The efforts of

Dr Williams was supported by

the National Institute on Aging

of the National Institutes of

Health under The Aging

Research in Criminal Justice

Health (ARCH) Network

(R24AG065175).

DOI 10.1108/IJPH-06-2021-0060 VOL. 18 NO. 2 2022, pp. 165-175, ©Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 165