Beyond bars: Evaluating end-of-life care and surrogate decision-making for hospitalized incarcerated persons

Beyond bars: Evaluating end-of-life care and surrogate decision-making for hospitalized incarcerated persons
Journal of Palliative Medicine; by Zack Watson, Julie Brown, Abhinav Vyas, Stacey Tillman, Sumi Misra, Rajiv Agarwal, Cheryl Gatto, Allison McCarthy, Mohana Karlekar; 9/25
Incarcerated persons (IPs) retain the constitutional right to health care, yet they face unique challenges in accessing palliative care (PC) and designating surrogates, especially when incapacitated. We present two cases of hospitalized IPs with life-limiting illnesses who experienced significant barriers in identifying and engaging surrogates. Both cases underscore the effect of delays in communication with surrogates and restricted end-of-life (EOL) visitation due to correctional policies. These delays limited the delivery of optimal interdisciplinary PC and bereavement support. Despite clear legal guidance under the Tennessee Health Care Decisions Act, misinformation and procedural ambiguity among medical and correctional staff impeded timely and appropriate care.