Who Should Make Decisions for Unrepresented Patients Who Are Incarcerated?

The United States has a high incarceration rate. Incarceration is associated with increased risk for cancer, chronic illness, serious mental illness, and substance use disorder. People who are incarcerated are less likely to be offered or participate in advance care planning, less likely to document their treatment preferences, and might not have a surrogate if one is needed.

How Should a Health Care Professional Respond to an Incarcerated Patient's Request for a Particular Treatment?

Incarceration complicates the ethical provision of clinical care through reduction in access to treatment modalities and institutional cultures that value order over autonomy. Correctional care clinicians should expand their guiding principles to consider autonomy and health justice for their patients, which in turn should prompt development of processes and care plans that are patient-centered and account for the inherent restrictions of the setting.