Department of Family and Community Medicine, 8785University of California, San Francisco, CA, USA.
Division of Geriatrics, 8785University of California, San Francisco, CA, USA.
Am J Hosp Palliat Care. 2021 Jun;38(6):731-733. doi: 10.1177/1049909121994313. Epub 2021 Feb 10.
The COVID-19 pandemic is devastating the health of hundreds of thousands of people who live and work in U.S. jails and prisons. Due to dozens of large outbreaks in correctional facilities, tens of thousands of seriously ill incarcerated people are receiving medical care in the community hospital setting. Yet community clinicians often have little knowledge of the basic rights and ethical principles governing care of seriously ill incarcerated patients. Such patients are legally entitled to make their own medical decisions just like non-incarcerated patients, and retain rights to appoint surrogate decision makers and make advance care plans. Wardens, correctional officers, and prison health care professionals should not make medical decisions for incarcerated patients and should not be asked to do so. Dying incarcerated patients should be offered goodbye visits with their loved ones, and patients from federal prisons are legally entitled to them. Community health care professionals may need to advocate for this medically vulnerable hospitalized patient population to receive ethically appropriate, humane care when under their care in community hospitals. If ethical care is being obstructed, community health care professionals should contact the prison's warden and medical director to explain their concerns and ask questions. If necessary, community clinicians should involve a hospital's ethics committee, leadership, and legal counsel. Correctional medicine experts and legal advocates for incarcerated people can also help community clinicians safeguard the rights of incarcerated patients.
新冠疫情正在摧毁成千上万居住和工作在美国监狱中的人们的健康。由于惩教设施中爆发了数十起大规模疫情，数以万计的重病在押人员正在社区医院接受治疗。然而，社区临床医生通常对管理重病在押患者护理的基本权利和道德原则知之甚少。这些患者在法律上有权像非在押患者一样做出自己的医疗决定，并保留指定替代决策人和制定预先护理计划的权利。典狱长、狱警和监狱医疗保健专业人员不应为在押患者做出医疗决定，也不应被要求这样做。垂死的在押病人应获准与亲人告别，联邦监狱的病人在法律上有权获得这种待遇。社区卫生保健专业人员可能需要为这些在社区医院接受治疗的处于医疗弱势地位的住院病人争取获得符合伦理道德、人道的护理。如果受到阻碍，社区卫生保健专业人员应与监狱典狱长和医疗主任联系，说明他们的关切并提出问题。如有必要，社区临床医生应让医院的伦理委员会、领导层和法律顾问参与进来。惩教医学专家和被监禁者的法律倡导者也可以帮助社区临床医生维护在押患者的权利。
