Dying in Prison

Today there are 1.9 million people incarcerated in the United States, with 1 out of 6 prisoners serving a life sentence (Sawyer and Wagner). While the sheer number of prisoners is concerning, so are the unethical practices, lack of resources, and dearth of rehabilitation
opportunities endemic to the prison system. Substantial research supports the positive impact of rehabilitation programs for those with addiction and mental illness on the mitigation of mass incarceration. Nonetheless, most programs neglect one inevitable reality. What happens to those who are terminally ill and dying in prison?

There is very little research on how to support those prisoners with bereavement services, end of life care, and funeral planning. Hospice, or end of life care, is a relatively new concept, with the first prison hospice programs created in 1993. These programs have yet to be widely implemented despite evidence that they foster a positive death experience for terminally ill prisoners and allow other prisoners to work as hospice volunteers, giving them a sense of purpose while serving out their sentences.

Not Enough Hospice

Existing prison hospice programs are addressing the issues of dying in prison on a limited basis, but there are still insufficient resources to care for dying inmates. Even existing legislation makes it challenging to implement prison hospice programs. While there are financial and legislative forces driving the lack of prison hospice programs, the core issue is that these inmates are part of a population that is deemed permanently criminal and forgotten and neglected until they die, and even afterwards. Given such a high percentage of the population incarcerated, The United States naturally sees a shocking number of people die in prison.

Each year, nearly 7,000 inmates die in U.S. prisons, many from suicide or terminal illness. Add in the countless number of individuals serving sentences with a chronic or long-term illness and in need of constant medical attention, and we have a serious problem deserving of significant attention.

In fact, the lack of services is illegal. “In 1976, the US Supreme Court ruling Estelle vs. Gamble found that deliberate indifference to health care for inmates constituted cruel and unusual punishment and was thus prohibited by the US Constitution.” Prisons have worked to
implement better health care for their patients. Still, efforts have been focused mainly on more superficial physical needs, rather than desperately needed mental health and addiction therapy.

“Doctors working within corrections often find themselves caught between the punitive aspect of the institutions’ mission and the best interests of their patients,” leaving medical staff with inadequate facilities and resources, and the patients with inadequate care (Allen, et al. 100). Though there has been a steady improvement of overall healthcare in prison, there is still a very long way to go before the level of care is sufficient.

More Prisons in U.S. than Russia

Beyond the lack of primary health care, prisoners face an even more significant deficiency in hospice and palliative care options. The
National Prison Hospice Association was founded in 1993 to provide appropriate levels of care in prisons, arguing that “establishing an effective hospice/palliative care program in prison begins with the candid and respectful exchange of views between corrections and hospice
professionals about how best to serve those who face death in prison,” maintaining respect for both institutions (“Prison Hospice Operational Guidelines” 1).

Sadly, the association has achieved limited success. More recently, the Humane Prison Hospice Project was established to promote the creation of prison hospice programs, though they have yet to get many more systems into place (Humane Prison Hospice Project).

Currently, “there are 4,575 prisons in operation in the U.S., more than four times the number of second-place Russia at 1,029” (Lennard). Yet only 75 U.S. prisons and jails in the country have any type of prison hospice program (Schoenly). The numbers shed light on both the sheer number of prisons and jails in the U.S. and the extreme scarcity of programs for prisoners and their grieving loved ones who face death and bereavement separated by the barrier of prison bars.

Solutions are Available

With limited U.S. prisons and jails implementing hospice programs, there are minimal services available to terminal inmates and their bereaved friends and families. The NPHA explains that the application of hospice programs, “while rare, has been successful and is an
exciting area for correctional health care” (“Prison Hospice Operational Guidelines” 4).

Not only does prison hospice supply terminally ill patients with sufficient end of life care, but it also gives those prisoners assisting them with a sense of purpose while serving their time. Though prisoner volunteers go through extensive training to be certified to care for the dying, outsiders still question their motivations. However, many volunteers are serving life sentences themselves and take their new position as a hospice volunteer with the utmost respect and appreciation. As one volunteer comments, “hospice gave us an avenue to take care of each other… you’re not helping them to live, you’re just making their passing easier” (Prison Terminal: The Last Days of Private
Jack Hall).

Inmates Helping Inmates Die

Though there is compelling evidence from personal anecdotes that prison hospice programs work, there are not enough programs to provide care for every dying inmate. Many terminal inmates are left improperly cared for as they approach the end of life, as even the best prison physicians often do not have training in thanatological practices. The NPHA explains that “one advantage to the institution is that the inmate volunteers carry back to the general inmate population the news that competent end-of-life care is being provided by correctional medical staff,” both promoting the program and generating goodwill within the prisoner community
(“Prison Hospice Operational Guidelines” 5).

Yet even with overwhelming evidence that prison hospice programs are a viable and valuable service for terminally ill prisoners, little progress has been made in widely implementing such programs.

While healthcare in United States prisons, and the United States as a whole, has been inadequate for centuries, legislators have only recently sought to address the issue, and it is unclear the fate of future efforts under the Trump administration.

While death in prison may seem like a distant issue to many, each American plays a role in mass incarceration and the prison system since prisons are funded through tax dollars. Our elected officials set prison budgets, and since the current funding is barely enough to provide sufficient living conditions, hospice programs are left out of existing budgets almost entirely.

I do not believe a singular action dictates your character. If the United States used prisons as rehabilitation facilities rather than cages, crime rates would decrease dramatically, and we would have a safer and more empathetic society. We claim to be a country based on ‘Christian
values,’ yet we neglect one of the most important of those values — forgiveness.

Work Cited

Parts of this blog were taken directly from research conducted at the University of Southern
California by Symon Braun Freck, 2019.
Allen, Scott A., et al. “ Physicians in US Prisons in the Era of Mass Incarceration.” Int J Prison
Health, vol. 6, no. 3, 1 Dec. 2010, pp. 100–106.
Duffin, Erin. “Incarceration Rates in OECD Countries 2019.” Statista, 20 May 2019,
www.statista.com/statistics/300986/incarceration-rates-in-oecd-countries/.
“H.R.1447 – 113th Congress (2013-2014): Death in Custody Reporting Act of 2013.”
Congress.gov, 18 Dec. 2014, www.congress.gov/bill/113th-congress/house-bill/1447.
“Humane Prison Hospice Project.” Humane Prison Hospice Project,
humaneprisonhospiceproject.org/#dignity.
Hyle, Ken. “Annual Determination of Average Cost of Incarceration.” Federal Register, 30 Apr.
2018, www.federalregister.gov/documents/2018/04/30/2018-09062/
annual-determination-of-average-cost-of-incarceration.
Lennard, Natasha. “US Has More Prisoners, Prisons than Any Other Country.” Salon,
Salon.com, 15 Oct. 2012, www.salon.com/2012/10/15/us_has_more_
prisoners_prisons_than_any_other_country/.
Oliphant, J. Baxter. “U.S. Support for Death Penalty Ticks up in 2018.” Pew Research Center,
Pew Research Center, 11 June 2018, www.pewresearch.org/fact-tank/2018/06/11/us -support- for-death-penalty-ticks-up-2018/.
“Prison Hospice Operational Guidelines.” National Prison Hospice Association, 1998,
view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fprisonhospice.
files.wordpress.com%2F2011%2F11%2Fprison-hospice-guidelines-revised3.doc.
Prison Terminal: The Last Days of Private Jack Hall. Dir. Edgar Barens. 2014. HBO, 2014.
Prime Video.
“Private Prisons vs. Public Prisons.” Criminal Justice Programs, 15 Nov. 2018,
www.criminaljusticeprograms.com/articles/private-prisons-vs-public-prisons/.
Sawyer, Wendy, and Peter Wagner. “Mass Incarceration: The Whole Pie 2024.” Mass
Incarceration: The Whole Pie 2024 | Prison Policy Initiative, 14 Mar. 2024,
https://www.prisonpolicy.org/reports/pie2024.html
Schoenly, Larry. “When Prison Is an End-of-Life Sentence: Hospice in Corrections.”
Correctional Nurse . Net, 4 May 2018, correctionalnurse.net/when-prison -is-an-end-of-life -sentence-hospice-in-corrections/

Read more from Symon on Open to Hope: https://www.opentohope.com/death-positivity-vs-fear-of-death/

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