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.
Laurie Jean Lyckholm, MD, is clinical professor of internal medicine hematology/oncology and blood and bone marrow transplantation, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City.
Caroline Lucas Glancey, MS, ACNP-BC, is hematology/oncology nurse practitioner, Virginia Commonwealth University Massey Cancer Center, Richmond.
Address correspondence to Laurie Jean Lyckholm MD, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, 200 Hawkins Dr, C21-NGH, Iowa City, IA 52242 (email@example.com).
In this article, we describe ethical, existential, and practical concerns encountered by prisoners with advanced cancer. The case that follows describes a prison inmate with locally extensive, invasive cancer. His team of providers in the prison and the oncology clinic team, 2 of whom are authors of this article, developed a collaborative, compassionate approach to his care that maintained public and personal safety while optimizing symptom management and respect for his goals of care.
Some details are changed to protect the confidentiality of the patient.
The authors have no conflicts of interest to disclose.