U.S. Department of Corrections Compassionate Release Policies: A Content Analysis and Call to Action

Background: Many persons with chronic and terminal illnesses are serving time, and dying, in U.S. prisons. Social workers view dying in prisons as a human rights crisis as it deprives incarcerated persons of their autonomy and requires comprehensive and costly healthcare services. To ameliorate these concerns, compassionate release (CR) is often touted as a humane alternative that allows incarcerated persons the ability to die in their own communities. Such policies were first adopted in the federal Bureau of Prisons and later by many state prison systems. However, little is known about the content of CR policies at the state department of corrections (DOC) level. The current study provides an overview of CR policies in the U.S., which vary widely across the CR process.

Methods: An iterative content analysis was used to capture primary elements of CR at the state DOC level. All 50 states’ legislative archives and DOC websites were searched using all variants of “compassionate release” to identify CR state statutes. If no policy was identified on the state legislative or DOC website, a DOC representative was contacted to confirm that no such policy existed (n=4). A priori coding based on previous research was initially utilized to extract major themes from statutes (Maschi et al., 2015). Minor themes were identified using an emergent coding approach, which allowed the authors to identify and refine themes derived from identified statutes.

Results: Our search revealed 46 states have CR statutes and/or policies. Medical release policies, which grant release due to medical problems and on the promise of good behavior, were most common (n=32; 70%). All 46 states with CR statutes required a diagnosis for a chronic or terminal health condition and 22 states (48%) also required a prognosis. Ten states (22%) used age as a factor in determining release. Seventeen states (37%) determined eligibility based on medical care and seven states (15%) considered the “excessive” costs of medical treatment. Relative risk criteria were common (67%; n=31) and involved assessment of danger to society or self. Placement decisions (e.g., hospice, hospital, assisted living facility, private residence) were noted in 19 policies (41%). Eight state policies (17%) explicitly indicated that correctional personnel should assist with applications for government assistance. In 11 state policies, improvement in health or prognosis predicated return to prison.

Conclusions and Implications: Several notable implications for social workers emerged based on the current study results. The following recommendations for statute revision and development are made: expand diagnostic criteria, remove prognosis requirements, and lower age requirements and incorporate age as an independent determinant of CR eligibility to address accelerated aging in prisons. Also, discharge planning should be noted explicitly in statutory language to assure well-being upon release. Health improvement should not be considered a violation of CR and CR practices should be monitored to evaluate their impact on inmates. As macro-level change makers, social workers are called to advocate for these recommendations to facilitate the timely and humane release and care for incarcerated persons with chronic and terminal illnesses and older adults.