Embargoed news from Annals of Internal Medicine

May 31, 2011

Philadelphia, May 31, 2011 - In an article published today in Annals of Internal Medicine, the flagship journal of the American College of Physicians (ACP), authors suggest broader use of compassionate release in the nation's prison system. Under current guidelines, many prisoners who may be eligible for compassionate release die in prison while waiting for review. The authors propose changes that could fix compassionate release medical and procedural flaws, thus reducing in-prison deaths and inmate health care costs.

The nation's prison system is overcrowded and the inmate population is aging. Compassionate release allows some eligible, terminally ill prisoners to be freed early so they may die outside prison. Inmates are considered for compassionate release if they have a clinically diagnosed life-limiting illness and if it is legally justifiable to release them into society. According to Brie Williams, MD, Assistant Professor of Medicine, Division of Geriatrics at the University of California, San Francisco, who co-authored the article with R. Sean Morrison, MD, Rebecca Sudore, MD, and Robert Greifinger, MD, prognostication is an inexact science, marking one of the major flaws in the system.

"Death and functional trajectories can be unpredictable for many serious and debilitating illnesses such as cancer, dementia, persistent vegetative state, or end-stage organ disease, just to name a few," said Dr. Williams. "Current compassionate release guidelines are failing to identify prisoners who no longer pose a threat to society but who are suffering, placing huge financial burdens on state budgets, and contributing to the national crisis of prison overcrowding."

To address medical-related flaws in the system, the authors recommend the development of standardized guidelines by an independent advisory panel comprised of palliative medicine, geriatrics, and correctional health care experts. Under the new guidelines, prisoners should be assigned an advocate to help navigate the system and represent prisoners who are unable to represent themselves. In addition, there should be a fast-track option for prisoners with short life expectancies. And, finally, there should be a well-described and disseminated application procedure so that prisoners and their advocates understand their rights.

In addition, the authors call for national criteria to help categorize critically-ill patients into three groups: 1) prisoners with terminal illnesses and predictably poor prognoses; 2) prisoners with Alzheimer and related dementias; and 3) prisoners with serious, progressive, nonreversible illness with profound functional/cognitive impairments. For prisoners that fall into one of the three outlined categories, the authors recommend palliative care to ease symptom burden while the inmates await a decision on compassionate release. For those that are not approved, palliative care should continue, as it could improve health care in the prison system while lowering costs.

"As experts in the fields of prognosis, geriatrics, cognitive and functional decline, and palliative medicine, physicians can provide the medical foundation to help criminal justice professionals make informed decisions about compassionate release," said Dr. Williams.

American College of Physicians

Related Palliative Care Articles from Brightsurf:

Palliative care needed across China for everyone who needs it -- study
Palliative care should extend across China and pay more attention to managing non-malignant disease -- integrated within the country's healthcare system and available to everyone who needs it, according to a new study.

New palliative care model shown to reduce costs without compromising on quality of care
Findings from a large-scale clinical trial testing a new palliative care model have shown to be lower cost, viewed positively by patients and their carers while showing no difference in patient-reported outcomes when compared with standard care.

Palliative Care in emergency departments during COVID-19 pandemic
The clinical characteristics and outcomes of patients who received intervention by a COVID-19 palliative care response team are examined in this case series.

Palliative care for patients with cancer in COVID-19 era
The considerations and challenges affecting the palliative care specialty and delivery of palliative care in the COVID-19 era, as well as potential solutions, are discussed in this Viewpoint.

To face coronavirus disease 2019, surgeons must embrace palliative care
This Viewpoint describes the relevance of a palliative care approach to surgery during the coronavirus disease 2019 pandemic.

Call for palliative care to be adapted for severely ill Covid-19 patients
Emergency-style palliative care needs to implemented to meet the needs of Covid-19 patients who wouldn't benefit from a ventilator say researchers.

A COVID-19 palliative care pandemic plan: An essential tool
Palliative care physicians have created a coronavirus disease 2019 (COVID-19) palliative care plan as an essential tool to provide care and help manage scare resources during the pandemic.

MAiD is not driven by socioeconomic vulnerability or poor access to palliative care
A new study of people who received medical assistance in dying (MAiD) in Ontario found that about three-quarters were cared for by palliative care practitioners at the time of their request for MAiD, and MAiD recipients were younger, wealthier and more likely to be married than the general population at time of death.

Palliative vs. standard care for Parkinson's disease
This randomized clinical trial that included 210 patients with Parkinson's disease and related disorders and 175 caregivers examined whether outpatient palliative care was associated with better patient or caregiver outcomes compared with standard care.

Palliative care in hospitals linked to decrease in use of ICU; treatment intensity
A new study shows that implementing hospital-based palliative care services in New York State reduces treatment intensity at the end of life for hospitalized patients.

Read More: Palliative Care News and Palliative Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.