Advanced Care Plans while in Jail

For the elderly, or those with chronic or complex medical conditions, Advanced Care Planning (ACP) is a very important process to undertake. Unfortunately though, it is likely that the incarcerated are often not offered these services. Or it is possible that they are not participating in ACP. As the average age of inmates continues to rise, ACP, end-of-life and/or palliative care are becoming increasingly relevant.

Advance Care Planning

ACP is a a process where a person’s desires about their end-of-life care are made known. Specifically, sharing details about what they would like done should they become seriously ill, incapacitated, or unable to communicate. This does not always have be written or formalized in a document, but often can occur via an Advanced Directive which is discussed below.

Many people don’t consider ACP until their are in their later years. For the incarcerated population though–this should be occurring as early as their 50s. This is because of the increased burden and onset of chronic diseases or disabilities experienced by the incarcerated, which puts them at risk for earlier death or complications.

Inmates always have the right to accept or refuse healthcare services, as well as a right to participate in ACP, have an advanced directive and/or appoint a representative or proxy to participate in their care. And they should be given a right to make that choice before becoming incapacitated.

Challenges with ACP in Jail

One issue with ACP in general is a lack of knowledge by staff, to include healthcare providers. Some research indicates that 85% of correctional healthcare staff are familiar with ACP. However, only 42% of correctional staff were truly able to define an ACP correctly. Another challenge is that while all adults are required to be informed and given instructions on advanced directives, the federal law requiring this does not include the incarcerated.

When inmates were surveyed about their perspectives on ACP, common themes indicated that many perceived barriers to implementing or facilitating ACP. Additionally, just the complexity of knowing who would initiate and continue the conversation about ACP was confusing, and they noted a lack of education on their half as well.

Advanced Directive

For ACP, an advanced directive is one of the most common approaches for expressing an inmates medical wishes. This helps identify what type of care an inmate wants should they become unable to communicate or incapacitated. Usually an advanced directive is completed by preparing a living will and having a durable power of attorney for health care. Many states also have a specific form that can be filled out in addition to, or with these documents.

Living Will: This is the specific legal document that will be prepared and outline your decisions on what should be done in an emergency or when you cannot communicate. In this document you can specify what treatments to avoid, and state conditions surrounding your care choices.
Power of Attorney: This is a legal document that specifies who exactly can make health care decisions for you when you are unable to do so for yourself.
Health Proxy: A health proxy is the individual who will make decisions surrounding your health should you become incapacitated. This is sometimes known as a surrogate, agent, or representative.
- The person identified as having a durable power of attorney for health care, can also be your proxy–but someone can also be your proxy, even without a power of attorney.
- The important part is to make sure that they are very familiar with your desires, values and wishes surrounding your healthcare.

Standing Medical Orders

Another option can be documents agreed upon with your doctor–often pertaining to end-of-life situations, or when a patient is seriously ill. Here are a few common examples, but it is important to note that many of these depend on the laws in your state, and a doctor certifying your choice to decline certain medical actions.

Do Not Resuscitate (DNR): Indicates that if your heart and breathing stop, no CPR or other life-supporting measures should be attempted.
- This can also include an out-of-hospital DNR order which is meant to ensure emergency personnel are also aware of your wishes
Do Not Intubate (DNI): This informs medical staff that even if it becomes medically necessary to keep you alive, your wish is that you are not intubated.
Physician or Medical Orders for Life-Sustaining Treatment (POLST or MOLST): These are prepared documents with specific information and guidance concerning your care. These can exist in addition to an advanced directive, but are usually more specific and implemented during end-of-life treatment.

Why have an ACP?

A common misconception is that ACP is only for the elderly, or those on hospice. But in reality, they can be useful for people in a variety of situations. Anything from a stroke, to a sudden accident, or perhaps a bad fight or head injury while in jail could put someone in a position where they are unable to communicate their healthcare wishes.

Another common reason for ACP is for those with dementia or Alzheimers. These conditions are eventually terminal, and as time goes on–their decision-making abilities will be lost as well. Having a conversation early about their healthcare wishes can be very important, and help them retain their dignity throughout the challenging process. An ACP doesn’t always have to be just for end-of-life care, and Alzheimers is a prime example. An individual may live with the disease for many years, but have strong opinions on how they wish for their care to be delivered.

ACP Consequences

While an advanced directive is a legal document, and legally recognized–it is not legally binding. This means that your healthcare team will do their best to follow your wishes, but due to the dynamic and complex nature of medical conditions, sometimes they may have to deviate. Any time they must deviate from your advanced directive, your proxy will be informed–and if there is a conflict that prevents them from following your advanced directive, your proxy can ensure your care is transferred elsewhere.

If you don’t have an ACP or other legal documents surrounding your care, typically a family member will be consulted for medical decisions should you be incapacitated. However, it is not uncommon for those in jail to become isolated from friends or family, so it could be challenging in some instances to find someone familiar enough with the inmates medical wishes to make sound decisions on their behalf.

If you lost a loved one due to him or her not receiving medical treatment while in jail, consider reaching out to our experienced attorneys to see if we can help.

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