The conference was based on the premise that even the worst offenders are worthy of society’s concern and human compassion. The Supreme Court has already ruled that prisoners must receive adequate health care services, and that "deliberate indifference to the serious medical needs of prisoners" is a violation of the 8th Amendment’s protection against cruel and unusual punishment.
Several former convicts, who were among invited speakers and audience members, served as poignant reminders of notions of human dignity and the need for humane care, even under the worst circumstances. However, it became clear throughout the presentations that unsympathetic public attitudes are a real obstacle to corrections health care reform. Several speakers noted that they have faced sentiments ranging from a lack of concern or disregard to the plight of ill inmates, to beliefs that inmates have earned their suffering and have forgone any right to appropriate medical care.
Despite what public opinion might be, the practical reality remains. The numbers of older and terminally ill inmates are projected to continue increasing, creating problems that cannot long be contained by iron bars and barbed wire. And whether the funding comes from the Department of Justice or the Department of Health and Human Services, the public will foot the bill for caring for dying prisoners.
A presentation by the Hospice of Louisiana State Penitentiary at Angola set the emotional tenor for the conference. Prison staff, including the hospice, security, and a warden, accompanied by a family member of the first prisoner to die in the prisons hospice, told a compelling story about their work.
This program, which began in January 1998, has proven to be successful. Inmates serve as hospice volunteers, and many are involved in caring for dying friends. In a video about the Angola experience, one inmate describes how his experience caring for a dying friend, and watching the family grieve, allowed him to appreciate for the first time the suffering caused by his crimes.
The experiences of many conference participants reveal the difficulties prison hospices face, but also suggest opportunities. Barriers include difficulty developing programs in an unsympathetic society, managing medications for pain and symptom relief in prison formularies, and multiple security concerns. However, one conference participant reported that a prison hospice has been able to achieve a remarkable 80-day average length of stay (as compared with Medicare hospice stays, which range from a few hours to a few weeks). Involving inmates in the hospice program and training them to serve as assistants or companions for their dying peers offers a unique occasion for rehabilitation. Angola and other prison hospice programs reported the positive effect of giving prisoners permission and the opportunity to care for other prisoners.
If audience members were not already convinced that prisoners are deserving of humane treatment and good palliative care, Sister Helen Prejean provided a compelling keynote speech. The author of Dead Man Walking, Sister Helen has long been an advocate of work to redeem and value inmates. We all live in a prison, she claimed, bounded by walls of fear and a lack of information. Prison renders individuals vulnerable and prevents growth, but hospice provides a little light.
Although it might be difficult to conjure sympathy for a convicted murderer or rapist who is dying in prison, it is certainly easy to feel compassion and empathy for prisoners’ families. Barbara Verri, a member of the Board of Directors for the National Prison Hospice Association, described the Kafkaesque nightmare in which she found herself when trying to be with her dying son, a prisoner. Mark Anthony Nolan died in 1996 at the Federal Medical Center for Prisoners in Springfield, MO.
Nolan was dying of AIDS; his mother was allowed to visit him for one hour each morning and evening. What would have been Verri’s final visit with her son was canceled because no security guards were available to monitor her visit; her son, who was 27, died that night.
Despite the strides many organizations have made in improving care for dying prisoners, other families will continue to face the tragedy Barbara Verri described. Many groups noted the ever-present problem of funding. Eddie Ellis of the Community Justice Center, Inc., suggested moving fiscal responsibility for prison health care from the Department of Corrections to the Department of Health and Human Services and the establishment of utilization review committees. Others extolled the value of compassionate release programs for infirm prisoners who are unable or unlikely to offend again and the need for improved corrections training programs and increased accountability. With the limited success of prison hospice and compassionate release programs, change is likely to be a slow process.
For more information, visit the Center on Crime, Communities & Culture website at www.soros.org/crime/index.html or contact the National Prison Hospice Association, P.O. Box 3769, Boulder, CO 80307, 303.543.8913 (phone) or www.npha.org.
Felicia Cohen is a senior scientist at the George Washington University Center to Improve Care of the Dying.
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