It is always good news to hear of a new book available in our specialty. That is why I am delighted to tell you about Humane Health Care for Prisoner: Ethical and Legal Challenges by Ken Faiver. Ken is uniquely qualified to write this book as he has extensive background as a religious leader, civil rights activist, and correctional health care manager in Michigan.
You do not have to be in the correctional specialty for very long to discover that working in the criminal justice system involves struggling with ethical and legal issues. Where do you turn for guidance and direction when you need answers? This 350 plus page text is an excellent option. The nine chapter are thorough and well-annotated for further research in any particular area. Here my brief ‘take’ on each chapter including my favorite sections.
Ethics in the Context of Correctional Health Care
This first chapter provides an overview of professional ethics in general with specific application to correctional practice. An added bonus is a brief history of correctional health care that provides some context for the presentation of issues that follow. Favorite section: A full discussion of the ethical dilemma of body cavity searches with application of accreditation standards and recommendation by the World Medical Association.
Areas of Significant Ethical Role Conflict
This chapter gets to the heart of specific ethical conflicts correctional nurses may encounter. Many of these situations, such as witnessing the use of force or participating in executions regularly appear in ethical issue listings. Other topics, such as use of mace, writing tickets, and performing shakedowns, provide less available information for practitioners struggling with these issues in their settings. Favorite section: Writing tickets for inmate misbehavior is presented from an ethical context with examples based on staff safety.
Other Challenging Topics in Ethics
Chapter 3 focuses on broad ethical issues encountered in correctional practice such as biomedical research, isolation and segregation, and chemical castration of sex offenders. This chapter is less practical in nature for front-line correctional nurses but provides an excellent background for the sociological debate on these topics. Favorite section: The important discussion of how to encourage appropriate research with our vulnerable patient population. The history of research abuse in correctional settings led to much-needed reforms that are well described in this chapter. Unfortunately, the horror of past research practices as all but ended any research with correctional populations; even research that might benefit our patients.
Legal Issues in Correctional Health Care
Chapter 4 initiates the beginning of the legal section of the text. This chapter reviews the key legal decisions that moved correctional health care into the modern era, including a very thorough presentation of the elements of Estelle v. Gamble. Favorite section: I must admit, I had trouble picking a favorite section in this chapter. It is a wealth of information, especially for correctional nurses involved in legal cases and expert witness work. In the end, I selected the Persons with Disabilities section as I am less familiar with legal claims and court cases in this area. After reading this section, I have a better understanding of the application of the Americans with Disabilities Act (ADA) to correctional settings.
How Much Health Care is Appropriate and Necessary?
It is impressive to find such an extensive discussion of this complex issue in a correctional text. Kudos to Dr. Faiver for collecting this information in one place. It is a struggle, in this era of social politics, to determine what medical treatment fits the definition of appropriate and necessary. Favorite section: While I almost chose the section providing an excellent model for approving medical treatment – The Spectrum of Care Model – I settled on the section listing factors that should not influence a decision to treat. This list is a reminder of our unconscious biases such as sexual orientation, patient behavior, self-harm, or celebrity status. We all need to be mindful of possible ethical hindrances in our perspective and worldview.
Conceptualizing Mental Illness as a Chronic Condition
No correctional health care text is complete without a presentation of mental health. In this case, Chapter 6 is a comprehensive description of the causes and outcomes of the mental health crisis in the criminal justice system. It is particularly helpful for medical practitioners like me who have little background in mental health care and context. Favorite section: While this entire chapter was a help to me, I especially liked the section on the history of deinstitutionalization that resulted in our current situation. While I was aware of this history before, I now have an annotated fact source for future reference.
A Patient or a Prisoner
I am glad this short chapter is included in the text as often this issue is given only a brief comment. I think, though, that consideration of patient or prisoner is really an ethical, rather than legal, issue. Possibly, this chapter would be better placed in the earlier ethical section of the book. Favorite section: A Lesson from the Captain has several good analogies for why healthcare staff should regard clients as patients rather than prisoners while still being continually aware of the environment. We must ‘never, ever, forget that [we] are working in a prison and that the security rules and policies exist for legitimate reasons”.
Organizing Correctional Health Care
These last two chapters diverge from the clear division of ethical and legal content but still stay true to the main theme of humane health care for prisoners. This chapter describes the various organizational models for correctional health care delivery and includes a discussion of medical autonomy and various healthcare leadership roles. Favorite section: The section on Risk of Excessive Fragmentation can really apply to all correctional health care models. The disconnect among various health care providers both inside and outside the facility is a major cause of clinical error.
Corrections and Health Care Working Together
This final chapter addresses the important issue of correctional and health disciplines collaborating and coordinating roles. It is a helpful presentation of the similarities and differences between the disciplines. Favorite section: The Interdependence section lists how health care staff are dependent on custody and then how custody staff are dependent on health care. This is a helpful listing that both disciplines should regularly review.
There is a lot to like about this book and just a few shortcomings to consider. Of positive note is the well-researched presentation of every area of ethical and legal concern in our specialty. You would be hard-pressed to find a topic not covered. The extensive index and detailed table of contents make searching for a specific topic (e.g. rhabdomyolysis or vicarious liability) quite easy. The content covers both NCCHC and ACA accreditation standards and the standards are indexed. On the downside, this text is not an easy read, although the author writes well, and the print is small. Although direct quotations can be helpful, the frequency of direct quotation in this text can be distracting. The comprehensive nature makes it more of a reference text than summer beach reading. The price ($73) is a bit high unless you are a student, then you are used to high-priced books (!). If that amount is beyond your budget, you may wish to suggest it for the medical unit library. It would be a valuable addition.
What are your thoughts on the ethical and legal challenges of correctional health care? Share your ideas in the comments section of this post.
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