Ethical Issues in Caring for Prison Inmates With Advanced Cancer

Prison life is difficult, and when a prisoner develops a serious illness, the difficulty is significantly compounded. The health care providers involved in the prisoners' care also face tremendous challenges in providing the best care possible while observing prison rules and the need for public safety, often in desperately underfunded, underresourced circumstances. This article includes a discussion of the ethical issues, especially justice issues, encountered in provision of care for prisoners that should, but often does not, approximate that of nonprisoner care. The history of the prison hospice movement is described. The case of a prisoner with extensive cancer and multiple symptoms is presented to highlight the ethical, existential, and practical issues encountered especially by the nurses, as well as other team members providing care for prisoners with advanced cancer. Then follows a discussion of the collaborative, compassionate approach to his care that maintained public and personal safety while optimizing symptom management and respect for his goals of care. Finally, suggestions for improving care of inmates with serious illness are provided.