Clinicians have an ethical obligation to provide high-quality care to incarcerated and justice-involved patients, which means being knowledgeable and empathic about the challenges these patients face. This month, we explore patient, student, and clinician perspectives on correctional health care.
This month, AMA Journal of Ethics theme editor Marguerite Reid Schneider, a fourth-year medical student at University of Cincinnati College of Medicine, interviewed Srijan Sen, MD, PhD, about how mental health care and medical culture can be changed to benefit medical trainees.
Prison patients are never alone and never without supervision and rules, and the medical staff is always negotiating its power with the adminsitration. The patient-doctor relationship can become distorted in this setting.
Those in prison are less healthy than the general population, are far more likely to have engaged in high-risk behaviors that can result in organ damage, disease and disability, and age more rapidly than nonincarcerated individuals do.
There are “push” factors such as poor working conditions, substandard facilities, unsafe conditions, and low income that discourage health professionals trained in Indian medical schools from staying in country.
Undocumented patients in the United States with end-stage renal disease receive “compassionate” dialysis. Such patients oscillate between being marginally well and “ill enough” to receive dialysis while clinicians wrestle with complicity in a system that both offers and withholds life-saving therapy.
AMA J Ethics. 2018;20(8):E778-779. doi:
10.1001/amajethics.2018.778.
Abraar Karan, MD, Daniel DeUgarte, MD, and Michele Barry, MD
Responsibility for physician “brain drain” can be attributed to the resource-poor countries that lose talent, the wealthy recruiting countries, and individuals.
AMA J Ethics. 2016;18(7):665-675. doi:
10.1001/journalofethics.2016.18.7.ecas1-1607.
Giving undocumented immigrants and those with DACA status (DREAMers) access to health care and medical education enables them to contribute to these systems.
AMA J Ethics. 2017;19(3):221-233. doi:
10.1001/journalofethics.2017.19.3.peer1-1703.