Presentations

Abstract

Introduction:

As the number of older incarcerated adults and those with progressive chronic illnesses increases, institutional correctional facilities and hospital systems must consider how to address care when people reach the end-stages of disease and end-of-life. Compassionate release is a process available in 49 states and the District of Columbia that allows prisoners facing imminent death, advancing age, or debilitating medical conditions to secure early release.

Case Information:

Mr. A is a 48-year-old male with a past medical history of end-stage heart failure. He was brought in from prison due to worsening dyspnea and was admitted to the hospital with acute kidney injury. Mr. A was in prison after conviction of a sexual assault of a minor. He rapidly deteriorated, requiring transfer to the Intensive Care Unit (ICU) due to worsening shock requiring vasopressors. Mr. A's status continued to worsen leading to multiorgan system failure. Since the healthcare team felt he was dying and was unlikely to survive hospitalization, the team initiated a request for compassionate release which was granted by the courts. Mr. A's focus of treatment was on comfort and vasopressors, and medications that were not related to providing comfort were discontinued. In the subsequent days, Mr. A's condition improved. The team felt he no longer required hospital care but instead could be discharged with home health for support. However, due to his previous conviction, he was unable to obtain service from any home health agency. Prior to his discharge, the health care team noted that Mr. A was able to ambulate and the concern was raised that he may have the potential to harm others as there were no further legal constraints due to his compassionate release. He was ultimately discharged home with family members. Mr. A died two months after his hospitalization. There were no reports of criminal activity during the period of Mr. A's release. The healthcare team experienced moral distress upon his discharge, questioning their responsibility to society. Another aspect of the case which merits exploration is the inability for the patient to receive home health services due to his prior conviction and incarceration, which may result in other challenges for receiving end-of-life care.

Discussion/Clinical Findings:

This case reminds us that healthcare systems need to consider compassionate end-of-life care for incarcerated patients and its implications on society, as well as address the emotional distress on providers. This case presents the ethical implications for compassionate release of patients who may pose a danger to society. Another aspect of the case is the inability for the patient to receive home health services due to his prior conviction and incarceration, which resulted in challenges for receiving end-of-life care.Conclusion:The increasing number of incarcerated older adults, as well as incarcerated adults with chronic or terminal illnesses, necessitates the need for continued discussions and policies in institutional correctional facilities, and within hospitals, that address care during the end-of-life. Hospitals should create procedures to address requests for compassionate release utilizing the expertise of the facility ethics committee, medico-legal counsel and the Department of Corrections. Compassionate release may be granted for incarcerated adults who are facing end-of- life; however, there are other factors that need to be considered that affect the patient, the community, and health care professionals.