Ethics panel discusses end-of-life care for prisoners

Ethics panel discusses end-of-life care for prisoners

An educational panel discussion at Christiana Care’s John H. Ammon Medical Education Center examined some of the complex ethical issues related to providing medical care for people who are in prison.

Do doctors or nurses treat prison inmates differently from “free” patients? Does their approach to care subtly change because of negative feelings toward the person or because imprisonment limits treatment options?

Such questions were at the heart of an educational panel discussion, “Ethical Issues in End-of-Life Care for Incarcerated Offenders,” at the John H. Ammon Medical Education Center. Donna Casey, RN, co-chair of the Christiana Care Health System Ethics Committee, moderated the discussion as part of Christiana Care’s “Ethics After Work” series.

“A lot of people struggle with ‘why are we taking care of, and passionate about, these patients when they’ve done wrong,’” said panelist Dale Rodgers, M.D., infirmary medical director at the Delaware Department of Corrections’ (DOC) James T. Vaughn Correctional Center (JVTCC) in Smyrna. “When I signed up to be a doctor, I didn’t sign up to discriminate. It’s not for me to punish them or judge them … I look at them as patients, not inmates,” she says.

But when a prisoner needs a specialist, providing access to care can get complicated, said another panelist, DOC divisional director Jim Welch.

Although inmates regularly are sent to area hospitals and specialists for specialty care, or treatment of certain chronic or terminal illnesses, logistical issues such as security concerns and staffing expenses play into deciding the feasibility of treatments that require frequent trips away from the facility, Welch said.

Having specialists visit correctional facilities, instead of sending inmates out to them for treatment, would reduce cost and increase accessibility to their services, Welch said. But he and the other panelists said it is “challenging” to persuade doctors to do this.

“Wouldn’t it be better [if] instead of patients coming to you in chains, you visited our facility with a nurse?” Welch asked.

One audience member questioned whether taxpayer-funded “top-notch” care for inmates is appropriate when many law-abiding citizens might not be able to afford such care for themselves. William Mazur, M.D., an infectious disease specialist who formerly served as the regional medical director for Delaware DOC medical vendor Correct Care Solutions, said, “If we don’t treat appropriately, then we would be sentencing them to a harsher punishment.”

Co-panelists at the Ethics After Work event, in addition to Dr. Rodgers and Director Welch, were Brenda Barshinger, retired regional vice president of Correct Care Solutions, and Paul Crawford, Esq., an attorney who handles many inmate civil-rights actions, including those surrounding medical care.