Prisoners are the only people in the United States who are constitutionally guaranteed a right to health care, but serious problems persist. How should Catholics and Catholic health providers respond?
Shaun Slusarski explored this question in a Feb. 4 CHA webinar titled, "The Ethics of Health Care in Prisons."
Slusarski, a doctoral candidate in theological ethics at Boston College, is working on a dissertation on the ethics of prison health care with a focus on using restorative justice principles to distribute care.
Slusarski began by exploring the Biblical references to acting with mercy toward the most vulnerable in society, including the imprisoned. He referred to a United States Conference of Catholic Bishops statement that "human dignity is not something we earn by our good behavior" and "none of us is the sum total of the worst act we have ever committed."
While the USCCB's Ethical and Religious Directives for Catholic Health Care Services doesn't specifically mention incarcerated patients, it points to serving and advocating for those at the margins of society, he said.
"Catholic health care should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society," Slusarski said. "Obviously, sick people are marginalized, and incarcerated people are quite literally marginalized."
Challenges to care
Though incarcerated people have a right to health care, for there to be an Eighth Amendment violation they need to prove the medical need neglected is serious and that prison officials knew about it and willfully denied care, Slusarski said. Meanwhile, preventative care isn't the norm, delays are common, follow-up care is inconsistent, and staffing issues are pervasive in prison health care, he said.
The crowded conditions of prison and poor nutrition also negatively influence health, Slusarski said. "One study suggests that that a person's life expectancy decreases by two years for every one year in prison, and indeed, incarceration is considered to be a social determinant of health," he added.
Co-pays for health care services in prison are relatively high compared to prisoner wages, with some amounting to more than a week's wage, he said.
He pointed to the case of Ronald Leftwich, who wrote about his experiences in a Massachusetts prison as he waited for eye surgery for glaucoma. It took 11 months to get the surgery in one eye, and he had aftercare issues. The prison refused to provide shades for his room, which were necessary for his recovery. Then there were delays in getting surgery on the other eye.
An ethical response
It's important to provide humanizing care to prisoners, Slusarski said. "Incarceration is a dehumanizing phenomenon," he said. "It's always important to remember that these are human beings, even if they've in some cases committed serious crimes."
It can be tempting for a health care worker to look up a patient's criminal record, though that should be avoided unless it's medically necessary, he said. And while health providers should be safe, there's no data to suggest that they would be less so treating a prisoner, he said.
He cautioned that knowing a person's crime could result in biased treatment. For example, based on the knowledge, a nurse might make less of an effort to visit or may delay or deny comfort measures like requests for ice chips.
"It's important to remember that in the Catholic tradition, civil punishment belongs to the state alone," he said.
Slusarski said shackling should be scrutinized. He noted a rising activism among clinicians against their mandated use. "Clinicians ought to advocate for the removal of shackles when they are unnecessary and when they impinge on patient health," he said.
In general, Catholic hospitals should eschew punitive treatment whenever possible, he said.
In many cases, prisoners are barred from having outside visitors while hospitalized, so the experience may be all the more isolating, he pointed out. "Ensuring that a chaplain visits these patients becomes all the more necessary," he said.
Prison hospice programs have grown as the prison population has aged, and those programs have their own challenges, he said. One such challenge is that opioids are not permitted in prisons, making it difficult to provide comfort care.
In many cases, prisoners can become trained to provide end-of-life care, he said. "This can be such a humanizing process for both the dying prisoner and for the prisoner caring for them," he said. "It can give a great sense of meaning."