Humane Health Care For Prisoners: Ethical And Legal Challenges

Cover
......Page 1
Half Title
......Page 2
Title Page
......Page 4
Copyright
......Page 5
Contents......Page 6
Preface......Page 12
Acknowledgments......Page 16
Explanatory Notes......Page 20
Introduction......Page 24
Common Mission......Page 30
A Brief Historical Perspective......Page 31
Definition of Ethics......Page 35
Ethics and the Law......Page 36
Dignity of the Human Person......Page 37
Professional Codes of Ethics......Page 39
Meaning of a Professional Code of Ethics......Page 40
Privacy, Patient Autonomy, Confidentiality, Acceptability......Page 43
Informed Consent and Enforced Treatment......Page 47
A Caring Approach......Page 51
Transgender Issues......Page 56
General Principles......Page 59
DNA Testing......Page 61
Body Cavity Searches......Page 62
Strip Searches......Page 65
Evaluation of Competence......Page 68
Concept of Predicted Dangerousness and Medical Parole Issues......Page 69
Directly Observed Therapy......Page 70
Crushing Medications......Page 71
Treating or Diagnosing under Less-than-Satisfactory Conditions......Page 72
Patient Assessment through a Closed Door......Page 73
Drawing Blood through the Bars or through a Food Slot......Page 74
Unnecessary Risk to Safety of Health Care Staff......Page 75
Defective or Inadequate Equipment......Page 76
Methods of Preventing HIV Transmission......Page 77
Food Loaf......Page 78
Hunger Strikes......Page 79
Conclusion......Page 82
Ethical Role Conflict Situations
......Page 84
Medical Clearance for Punishment
......Page 85
Use of Mace
......Page 87
Writing Tickets
......Page 88
Use of Medication for Behavior Control
......Page 89
Witnessing the Use of Force
......Page 90
Participation in Executions
......Page 91
Position of the American Pharmaceutical Association......Page 97
Treatment to Render a Person Competent for Trial......Page 99
Determination of Competence to Be Executed......Page 101
Treatment to Render a Person Competent for Execution......Page 103
Involvement with Acts of Torture
......Page 104
Reporting Abuses by Staff
......Page 108
A Note of Caution—Erosion and Burnout
......Page 110
Conclusion
......Page 113
Ethical Reasoning......Page 116
Working in the Context of a Blemished History......Page 117
First Steps toward
Regulation of Biomedical Research in U.S. Prisons......Page 119
Institute of Medicine Recommendations and Some
Critical Responses......Page 127
Encouraging Appropriate Research......Page 130
How Do We Bring It All Together?
......Page 131
Housing the Mentally Ill in Isolation or Supermax Settings......Page 133
A Vicious Cycle......Page 136
Extreme Segregation, Isolation, and Supermax Settings......Page 138
Is It Legal?......Page 144
Is Physician Participation Ethical?......Page 146
Retrospective Clues for a Current Ethical Imperative......Page 149
Conclusion......Page 150
What the Courts Have Done......Page 152
Hands-off
Policy......Page 153
A Break in the Hands-off
Era......Page 154
Holt v. Sarver......Page 156
Estelle v. Gamble
......Page 157
Tort Liability
......Page 159
Deliberate Indifference......Page 160
Qualified Immunity......Page 162
Farmer v. Brennan......Page 163
Civil Rights of Institutionalized Persons Act......Page 164
Pulling in the Reins......Page 165
Prison Litigation Reform Act of 1996......Page 166
Urgent Need for Reform of the PLRA......Page 169
Persons with Disabilities......Page 172
Adequate Documentation......Page 177
Special Problems
of Juveniles......Page 178
Some Important Legal
Cases......Page 179
Cases Concerning Adults......Page 180
Cases Concerning Juveniles......Page 185
A Checklist of Risk-Prone Areas......Page 188
Don’t
Fight the Courts......Page 191
Impact of the Courts......Page 192
A New Challenge—The
Impact of Mass Incarceration......Page 196
Conclusion: Looking Towardthe Future......Page 198
A Complex Issue......Page 202
Practitioner Guidelines......Page 205
Universal Principles......Page 207
Conceptual Framework for Decision Analysis......Page 209
International Implications......Page 211
A Spectrum of Care Model......Page 212
From Whose Perspective?
......Page 216
Factors That Should Not Influence a Decision to Treat
......Page 218
Self-Harm or Contributory Behavior......Page 219
Preexisting Conditions......Page 220
Dimensions of Necessity......Page 221
Cost Factors
......Page 223
Description of Factors to Be Considered in the Decision to Treat 
......Page 224
Probability of a Successful Outcome with Few Adverse Side Effects
......Page 225
Expected Remaining Duration of Incarceration......Page 226
Cost of the Intervention......Page 227
Treatment Delays......Page 228
Conclusion......Page 229
Mental
Illness Should Be Treated, Not Punished......Page 232
Society’s Failure—Deinstitutionalization......Page 234
Scope of the Problem—Prevalence......Page 238
Jail and Prison Environments Are Countertherapeutic......Page 241
Mental Illness: A Chronic Condition That Waxes and Wanes
......Page 244
Closed Head Injury......Page 247
Special Units for Housing Mentally Ill Patients......Page 248
Typical Characteristics of Mentally Ill Patients by Level of Care......Page 249
Practical Consequences of Failing to Recognize the Chronic Nature
of Mental Illness......Page 250
Conclusion: An Ethical Imperative......Page 253
7. A Patient or a Prisoner?
......Page 256
Why Call Them “Patients\"?......Page 257
Is It a Health Care Unit?
......Page 263
Where the Lines Get Crossed......Page 264
Patient Advocacy......Page 265
A Lesson from the Captain......Page 266
Conclusion......Page 267
Common Mission with Differences......Page 270
Responsible Health Authority......Page 271
Medical Autonomy......Page 272
Rationale for Designating a Responsible Health Authority......Page 274
Role of Responsible Health Authority......Page 275
Role of the Medical Director......Page 276
No Central Health Authority......Page 277
Outside Public Health Authority......Page 280
Need for Patient Advocacy......Page 281
Risk of Excessive Fragmentation......Page 282
Line Authority from a Central Office of Health Care......Page 283
Conclusion......Page 285
Corrections and Health Care......Page 288
Purpose......Page 289
Means Employed......Page 291
Coercive Measures......Page 292
Primary Client Served......Page 293
Style of Staff Training......Page 294
System of Beliefs......Page 295
How Health Care Depends on Custody and Institutional Services
......Page 297
How Custody Depends on Health Care......Page 298
Strategies......Page 299
Dialogue and Respectful Deliberation......Page 301
Health Aspects of Officer Training......Page 303
Security and Institutional Aspects of Health Care Staff Training......Page 306
Some Tough Questions......Page 308
Rhabdomyolysis......Page 309
Emergency Vodka......Page 310
Ensuring Safety and Security within Clinic Areas......Page 311
Security Housing Units and Other Forms of Severe Isolation......Page 312
Privacy of Clinic Encounters......Page 313
Health Classification......Page 314
Transporting Prisoners......Page 315
Security Constraints That Impair Cost-Effective
Health Care......Page 316
Conclusion—Speaking Out Loyally......Page 317
Epilogue......Page 320
Notes......Page 322
Bibliography......Page 346
Index......Page 364
Index of Legal Cases......Page 390
About the Author......Page 394