What are prisoners' rights to refuse treatment with public health ramifications?

[jschmitz47]

Hello -

 

I am about to start rotations and will have two in prisons. Looking forward to it. But something came up in my mind about prisoner's rights of refusal of Dx and Tx. As a for instance, suppose a prisoner has pneumonia and refuses Tx either because of religion or just because he's an a**h*** who would just as soon infect other people.

 

1. Does this actually come up?

2. What is the legal status? Can a court order and/or administrative order compel treatment?

3. Thoughts on the ethics of the situation.

 

Thanks -

 

John

[marilynpac]

I would imagine that prisoners have the same rights when it comes to their bodies about healthcare as anyone else. The only thing that could be done is isolation. Hopefully the prison has the means to do that. The best thing you could do is to ask your preceptor about it or whoever is in charge(warden?) of the prison. There are court ordered tx for people who can't protect themselves...children, mentally ill, but as for a person that doesn't fall into this catagory they have many of the same rights as any other citizens, they are just incarcerated. Quite a few yrs ago they had a prisoner on death row receive a liver transplant. There was public outcry, but the administrative head of the prison healthcare system(my former program director, MWU), stated just b/c a prisoner is incarcerated doesn't mean that they don't have the same rights to healthcare as anyone else in the general public. I would imagine that would go both ways.

[SocialMedicine]

Fascinating question. I focus on the ethics of Infectious Disease treatment and prevention. Mostly HIV and not in the setting of prison or jail. Would have preferred the question did not resort to profanity. Patients with active Tuberculosis have been mandated to treatment in prison and civilian settings. The mandated treatment has invovled various forms of coercion such as directly oberved therapy and inpatient mandates. And we all are familiar with the famous New York story of typhoid mary where a woman shedding typhoid was confined until she completed treatment. I am not familiar with any case where a prisoner who has a highly infectious disease (such as active TB or typhoid) did not elect to have medical intervention. I am also not certain what each state allows for prisoner health officials and wardens to assume control of in these situations. ...... maybe you should be writing a paper on this? I would be suprised if someone who was a risk to the public health would be allowed to exist in the community setting ... they would probably be sent to the prison infirmary for confinement. Do you have an interest in prisoner public health? The history of HIV in prisons is fascinating and terrible.

[marilynpac]

So are you saying it's federal law that they have to have tx for active TB and HIV? It doesn't vary from state to state? So even if the incarcerated person is in a state prison vs federal, federal law takes precedent over states/individual rights? I'm surprised the ACLU didn't jump on this...

[d2305]

TB yes, HIV no.

[marilynpac]

So when you get an HIV that's very contagious you can only isolate if tx is refused??....

[SocialMedicine]

HIV does not spread through air and close contact like TB. It invovles a greater intimacy such as sex, needle sharing, blood contact. An individual can control spread of HIV with behavior control. In theory prisons do not allow any of the HIV risk behavior (sex, rec drug use, blood contact with other prisoners). I would MUCH rather share a prison cell with an advanced AIDS patient w/ very high viral load than an individual with any severity of active pulmonary TB.

[SocialMedicine]

I think the ACLU would act more riotous for isolation of someone with HIV at any stage versus someone with TB being coerced into therapy. Sadly, a few prisoners in the US STILL separate persons with HIV and without.

[jschmitz47]

I stand appropriately scolded for use of profanity. Trying to work on this and will continue to work on it.

 

John