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

Victoria Helmly (Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA)
Marisol Garica (Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA)
Brie Williams (Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA)
Benjamin A. Howell (SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut, USA)

International Journal of Prisoner Health

ISSN: 1744-9200

Article publication date: 27 December 2021

Issue publication date: 2 June 2022

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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-making policies in US state departments of corrections and the Federal Bureau 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 advance care planning documents, and who can serve as their surrogate decision-makers.

Practical implications

Many prison systems have an opportunity to enhance their patient medical decision-making policies to 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 in one quarter of US prison systems, suggesting there may be quality-of-care challenges around formalized approaches to documenting patient medical wishes in some of those prison systems.

Originality/value

To the best of the authors’ knowledge, this is the first content analysis of EOL decision-making policies in US prison systems.

Keywords

Acknowledgements

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).

Citation

Helmly, V., Garica, M., Williams, B. and Howell, B.A. (2022), "A review and content analysis of U.S. Department of Corrections end-of-life decision making policies", International Journal of Prisoner Health, Vol. 18 No. 2, pp. 165-175. https://doi.org/10.1108/IJPH-06-2021-0060

Publisher

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Emerald Publishing Limited

Copyright © 2021, Emerald Publishing Limited

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