Overcoming Barriers to Advance Care Planning for Incarcerated Individuals

Abstract: Incarcerated individuals have little control over their lives in carceral facilities. Incarceration restricts autonomy and also disrupts social and familial relationships. Incarcerated individuals are also medically vulnerable, experiencing assault and injury, and poorly managed chronic and acute illness at rates that are significantly higher than they are for the general population. Advance care planning, whether it is appointing a health care proxy/surrogate, or creating a living will that specifies values and preferences with respect to medical treatment, is thus particularly valuable for incarcerated individuals, and an opportunity to exercise and safeguard their autonomy. Yet, advance care planning and documents are rarely created by incarcerated individuals.

This session will present data from a study of the medical records of incarcerated patients at a university hospital system with a Level 1 trauma center that receives both inpatient and outpatient incarcerees from several state correctional facilities. The study examined ten years of medical records and found that fewer than one percent of incarcerees had advance care documents. Two of the presenters are clinical ethics consultants: a philosopher/bioethicist and an attorney/bioethicist, and a third presenter is a MD candidate who worked as a research assistant on the study. We’ll present two case studies demonstrating the need for advance planning, one focused on a patient who experienced a cerebrovascular accident and one focused on a patient who presented with preeclampsia complications. The presentation will consider the barriers to advance care planning, and focus audience discussion on strategies for increasing uptake among the incarcerated population.

Keywords: incarceral healthcare, advance care planning