Dying for a Change: A Systematic Review of Compassionate Release Policies

Background:

The absence of uniform and appropriate policies to address suitable interventions at the end-of-life has aggravated the challenges and issues facing health care systems within a correctional facility. With an increasingly aging prison population, correctional facilities encounter multifaceted challenges with respect to the provision of humane health care. A response to address and alleviate these barriers are policies related to compassionate release, a complex route that grants eligible inmates the opportunity to die in their community. Despite the existence of compassionate release policies, only 4% of requests to the Federal Bureau of Prisons are granted, with evidence demonstrating similarly low rates among numerous state prison systems, signifying the underuse of these procedures as a vital approach to decarceration.

Methods:

The purpose of this study was to systematically review literature to investigate trends in compassionate release policies, facility implementation, barriers at both the incarcerated individual and institutional levels, as well as gaps in the literature. A systematic review was completed using PRISMA guidelines. CAB Abstracts, CINAHL, Cochrane Library, ERIC, Google Scholar, MEDLINE, PsycINFO, PubMed, Social Services Abstracts, and Social Work Abstracts were searched from inception to March 2021. Inclusion criteria included: 1) the compassionate release policy (or related policy) is implemented in the United States; 2) reported qualitative and/or quantitative outcomes; and 3) reported original data.

Results:

Twenty-five studies formed the final data set. Data analysis revealed four main themes: language barriers, complexities of eligibility criteria, overreliance on prognostication, and social stigma. Barriers to inmates’ access to compassionate release policies include unclear or technical language utilized in policy documents. Eligibility criteria appear to vary across the country, including disease prognoses and the ability to predict terminal declines in health, creating confusion amongst inmates, lawyers, and review boards. Stigmas surrounding the rights of incarcerated individuals frequently influence policymakers who experience pressure to maintain a punitive stance to appease constituents, thus discouraging policies and interventions that promote the release of incarcerated individuals.

Conclusions and implications:

Racial disparities in the US criminal justice system are prevalent and well-documented, as individuals of color are arrested far out of proportion to their share of all individuals in the US. This particular population is thus challenged with poor access to and quality of health care in corrections. To promote social justice for this marginalized population, end-of-life interventions in corrections need to be consistently evaluated with outcomes that improve care for dying inmates. Social workers can play an integral role in influencing policymakers, as well as prison and medical staff attitudes toward dying inmates by providing an understanding of how to effectively support this vulnerable population. Within correctional facilities, social workers should play an integral role in influencing prison and medical staff attitudes toward dying inmates by providing an understanding of how to effectively support this vulnerable population. Social workers should participate in research which focuses on effective guidelines for correctional facilities to provide compassionate end-of-life care for inmates.