Humane Health Care for Prisoners: Ethical and Legal Challenges

by Kenneth L. Faiver

Overview

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.

Product Details

ISBN-13:	9781440855511
Publisher:	ABC-CLIO, Incorporated
Publication date:	05/05/2017
Sold by:	Barnes & Noble
Format:	eBook
Pages:	364
File size:	2 MB

About the Author

Kenneth L. Faiver has 42 years of active involvement in the field of correctional health care. He is a certified correctional health professional (American Academy of Correctional Health Professionals).

Table of Contents

Preface xi

Acknowledgments xv

Explanatory Notes xix

Introduction xxiii

1 Ethics in the Context of Correctional Health 1

Common Mission 1

Recognizing Differences 2

A Brief Historical Perspective 2

Ethics 6

Definition of Ethics 6

Ethics and the Law 7

Dignity of the Human Person 8

Professional Codes of Ethics 10

Meaning of a Professional Code of Ethics 11

Important Ethical Issues in Corrections 14

Beneficence, Medical Neutrality, Medical Autonomy 14

Privacy, Patient Autonomy, Confidentiality, Acceptability 14

Informed Consent and Enforced Treatment 18

Informed Refusal 22

A Caring Approach 22

Some Practical Ethical Issues in Corrections 27

Transgender Issues 27

Forensic Use of Medically Obtained Information 30

General Principles 30

DNA Testing 32

Body Cavity Searches 33

Strip Searches 36

Evaluation of Competence 39

Concept of Predicted Dangerousness and Medical Parole Issues 40

Medical Restraint 41

Directly Observed Therapy 41

Crushing Medications 42

Organ Transplants 43

Treating or Diagnosing under Less-than-Satisfactory Conditions 43

Patient Assessment through a Closed Door 44

Drawing Blood through the Bars or through a Food Slot 45

Undue Noise 46

Unnecessary Risk to Safety of Health Care Staff 46

No Sink or Running Water 47

Defective or Inadequate Equipment 47

Methods of Preventing HIV Transmission 48

Food Loaf 49

Hunger Strikes 50

Conclusion 53

2 Areas of Significant Ethical Role Conflict 55

Ethical Role Conflict Situations 55

Medical Clearance for Punishment 56

Use of Mace 58

Writing Tickets 59

Use of Medication for Behavior Control 60

Shakedowns Performed by Health Professional Staff 61

Witnessing the Use of Force 61

Participation in Executions 62

Position of the American Pharmaceutical Association 68

Treatment to Render a Person Competent for Trial 70

Determination of Competence to Be Executed 72

Treatment to Render a Person Competent for Execution 74

Involvement with Acts of Torture 75

Reporting Abuses by Staff 79

A Note of Caution-Erosion and Burnout 81

Conclusion 84

3 Other Challenging Topics in Ethics 87

Ethical Reasoning 87

Biomedical Research and Experimentation 88

Working in the Context of a Blemished History 88

First Steps toward Regulation of Biomedical Research in U.S. Prisons 90

Institute of Medicine Recommendations and Some Critical Responses 98

Encouraging Appropriate Research 101

How Do We Bring It All Together? 102

Housing the Mentally Ill in Isolation or Supermax Settings 104

A Vicious Cycle 107

Extreme Segregation, Isolation, and Supermax Settings 109

Chemical Castration by Court Order 115

Is It Legal? 115

Is Physician Participation Ethical? 117

Retrospective Clues for a Current Ethical Imperative 120

Conclusion 121

4 Legal Issues in Correctional Health Care 123

What the Courts Have Done 123

Hands-off Policy 124

A Break in the Hands-off Era 125

Holt v. Sarver 127

Newman v. Alabama 128

Estelle v. Gamble 128

Tort Liability 130

Deliberate Indifference 131

Qualified Immunity 133

Farmer v. Brennan 134

Civil Rights of Institutionalized Persons Act 135

Bivens v. Six Unknown Agents of the Federal Bureau of Narcotics 136

Pulling in the Reins 136

Prison Litigation Reform Act of 1996 137

Urgent Need for Reform of the PLRA 140

Miscellaneous Legal Issues 143

Adequacy of Funding 143

Persons with Disabilities 143

Adequate Documentation 148

Health Insurance Portability and Accountability Act 149

Special Problems of Juveniles 149

Some Important Legal Cases 150

Cases Concerning Adults 151

Cases Concerning Juveniles 156

Strategies to Avoid Litigation 159

A Checklist of Risk-Prone Areas 159

Don't Fight the Courts 162

Impact of the Courts 163

A New Challenge-The Impact of Mass Incarceration 167

Conclusion: Looking Toward the Future 169

5 How Much Health Care Is Appropriate and Necessary? 173

A Complex Issue 173

Practitioner Guidelines 176

Universal Principles 178

Conceptual Framework for Decision Analysis 180

International Implications 182

A Spectrum of Care Model 183

From Whose Perspective? 187

Factors That Should Not Influence a Decision to Treat 189

Gender, Race, Ethnicity, or Sexual Orientation 190

Nature of Crime or Behavior in Prison 190

Self-Harm or Contributory Behavior 190

Celebrity Status, Notoriety, Social Class, or Profession 191

Preexisting Conditions 191

Factors That May Influence the Decision to Intervene 192

Dimensions of Necessity 192

Cost Factors 194

Description of Factors to Be Considered in the Decision to Treat 195

Improvement in Health, Improvement in Function, or Relief of Pain 196

Probability of a Successful Outcome with Few Adverse Side Effects 196

Urgency 197

Availability of an Acceptable Alternative 197

Patient's Desire for Treatment 197

Expected Remaining Duration of Incarceration 197

Chronicity of Care 198

Cost of the Intervention 198

Avoid Confounding the Variables 199

History of Compliance with Treatment 199

Comorbidity 199

Treatment Delays 199

Age and General Health of Patient 200

Quality of Life 200

Conclusion 200

6 Conceptualizing Mental Illness as a Chronic Condition 203

Mental Illness Should Be Treated, Not Punished 203

Society's Failure-Deinstitutionalization 205

The Consequences 209

Scope of the Problem-Prevalence 209

Jail and Prison Environments Are Countertherapeutic 212

Mental Illness: A Chronic Condition That Waxes and Wanes 215

Acute Stress Disorder versus PTSD 218

Closed Head Injury 218

Special Units for Housing Mentally Ill Patients 219

Typical Characteristics of Mentally Ill Patients by Level of Care 220

Practical Consequences of Failing to Recognize the Chronic Nature of Mental Illness 221

Conclusion: An Ethical Imperative 224

7 A Patient or a Prisoner? 227

Why Call Them "Patients"? 228

Is It a Health Care Unit? 234

Where the Lines Get Crossed 235

Patient Advocacy 236

A Lesson from the Captain 237

Conclusion 238

8 Organizing Correctional Health Care 241

Common Mission with Differences 241

Responsible Health Authority 242

Medical Autonomy 243

Rationale for Designating a Responsible Health Authority 245

Role of Responsible Health Authority 246

Role of the Medical Director 247

Organizational Models 248

No Central Health Authority 248

Outside Public Health Authority 251

Need for Patient Advocacy 252

Risk of Excessive Fragmentation 253

Coordination by a Central Health Care Authority 254

Line Authority from a Central Office of Health Care 254

Conclusion 256

9 Corrections and Health Care Working Together 259

Corrections and Health Care 259

Recognizing Differences 260

Purpose 260

Means Employed 262

Coercive Measures 263

Punitive Sanctions 264

Primary Client Served 264

Style of Staff Training 265

System of Beliefs 266

Interdependence 268

How Health Care Depends on Custody and Institutional Services 268

How Custody Depends on Health Care 269

Working Together 270

Strategies 270

Dialogue and Respectful Deliberation 272

Cooperating in Training 274

Health Aspects of Officer Training 274

Security and Institutional Aspects of Health Care Staff Training 277

Some Tough Questions 279

Two Examples of Productive Cooperation 280

Rhabdomyolysis 280

Emergency Vodka 281

Selected Problems for Cooperative Resolution 282

Ensuring Safety and Security within Clinic Areas 282

What Should We Call "Them"? 283

Security Housing Units and Other Forms of Severe Isolation 283

Physician On-Call Arrangement 284

On-Site Specialty Care 284

Privacy of Clinic Encounters 284

Health Classification 285

Transporting Prisoners 286

Security Constraints That Impair Cost-Effective Health Care 287

Rehabilitation-Start with Respect for Dignity and Self-Worth 288

Conclusion-Speaking Out Loyally 288

Epilogue 291

Notes 293

Bibliography 317

Index 335

Index of Legal Cases 361

About the Author 365

What People are Saying About This

Dianne Rechtine

"This book belongs on the shelf in every correctional medicine physician’s library. Faiver has comprehensively researched and reviewed the history of correctional medicine and has offered many thoughts on the impact of the history to present-day practice."

Rev. John P. Foglio

"Faiver's passion to promote due respect for the dignity of each man, woman, and child in custody is realized in this excellent book's effort to facilitate and inform ongoing dialogue and communication between health care professionals and correctional authorities about health-related ethical principles and their practical application."

Lorry Schoenly

"Ken Faiver has written an informative book that provides much-needed information for health care professionals in the criminal justice system. Possibly more than any other specialty, we are in need of practical advice about the ethical and legal challenges we face daily. This book should be in the library of every serious correctional health professional."

Jayne R. Russell

"Anyone involved in jails and prisons today has a responsibility to examine and evaluate policies and practices. Faiver helps us to understand how correctional health care has evolved and the complex issues that remain. Today’s challenges test our morals as a society and our sense of fairness. They present tough decisions with limited choices. We have the largest correctional system in the free world and as humane and respected leaders we need to get this right."

Dean Rieger

"From the pen of one of the founders of modern correctional health care, this work is a broad-ranging discussion of the ethical and legal challenges that have shaped our field during the past few decades, mixed with a plea for recognition of the inherent humanity of our imprisoned citizens. Kenneth Faiver’s well-researched and footnoted book will be an instant classic; an inspiring read and a useful reference for those trying to understand how to provide safe and effective health care within our jails and prisons. This material will be accessible and useful to corrections professionals whether they are new to corrections or have years of experience."

Editorial Reviews

There is a lot to like about this book. . . . You would be hard-pressed to find a topic not covered. The extensive index and detailed table of contents make searching for a specific topic (e.g. rhabdomyolysis or vicarious liability) quite easy. The content covers both NCCHC and ACA accreditation standards and the standards are indexed. . . . It would be a valuable addition.” —Correctional Nurse

“There is something in this book for all who work in corrections, including administration, operations, medical/mental health staff, institutional services, and agency leadership. Although the book begins with a discussion of general ethical principles, the author quickly begins to discuss how these principles are involved in practical issues of interest to all in corrections: inmate searches, use of restraints, organ transplants, hunger strikes, informed consent, disciplinary sanctions, use of force, capital punishment, transgender inmates, and medical research involving prisoners. The writing is clear and to the point but not lacking in style. The book is well-annotated and indexed, including a helpful index of all court cases cited. Humane Health Care for Prisoners is a welcome addition to the field and should be a valuable resource for many years to come.” —Jourbanal of Correctional Health Care

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