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.
The clinician/healer must both address the disease and seek to know how the medical condition is being experienced by the patient—what impact it has on his or her life and spirit.
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.
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.
Oliver Schirokauer, PhD, MD, Thomas A. Tallman, DO, MMM, Leah Jeunnette, PhD, Despina Mavrakis, MBA, and Monica L. Gerrek, PhD
An educational initiative is described in which medical and bioethics students observe health care in an urban jail for two days and reflect on their learning.
AMA J Ethics. 2017;19(9):845-853. doi:
10.1001/journalofethics.2017.19.9.peer1-1709.