The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 15: Special Populationssponsibility for financing health care, even if the person would be eligible for insurance such asMedicare on the outside. Therefore, it is in the interest of a prison to provide or manage theirinmates’ health care rather than refer inmates to outside health care institutions that will billthe prison26 picasfor care provided.Palliative Care in Correctional Institutions: Unique IssuesWhether a patient is in jail or prison, certain issues affecting palliative care stand out:• Patient autonomy.If patients are to provide true informed consent for palliative care, they mustalso be assured of continued access to curative care. Medical prognosiscombined with prisoner wishes and values will determine the relative balanceof curative and palliative interventions. Palliative care should be an adjunct tocurative care plans.• Confidentiality.Protecting an inmate’s medical confidentiality is difficult even when access tomedical records is restricted to medical staff. Correctional staff, as well asother inmates, who observe an inmate being taken for special appointments ortaking certain medications, can figure out his or her diagnosis. Also,corrections officers may be involved in discussions with medical staff aboutpatient care for security reasons. Correctional staff should receive specialtraining in safeguarding medical information. In some institutions, they arerequired to sign agreements regarding the protection of confidential medicalinformation.• Medical advocacy and negotiation.The clinician should be the advocate for the individual inmate in designingand pursuing a palliative care plan. However, the plan must be approved bycorrections staff, who may not be willing to support the plan.• Pain management.Providing access to appropriate analgesic medication is perhaps the mostproblematic area for clinicians providing palliative care within corrections.• Advance directives.The issue of advance directives is extremely delicate in penal situations, whereself-determination is by definition abridged. Care providers must be assuredthat a patient’s decisions are voluntary and uncoerced regarding access to andwithholding of life-sustaining treatment. Health care proxy appointments risksetting up conflicts of authority in a correctional institution unless the proxiesare family members or friends.• Compassionate release.Compassionate release is the release of a terminally ill inmate to thecommunity so that she or he can die in an appropriate setting, with appropriatecare. Although the process of review for compassionate release exists inmany institutions, it is often so time-consuming that most inmates die inprison before release is approved. 9324U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau