A commentary published in the AMA Journal of Ethics notes that physicians who treat patients in correctional institutions face unique bioethical challenges that can be particularly complex when the treating physician has knowledge that could affect an inmate’s legal proceedings.
David Beckmann, MD, MPH, from Massachusetts General Hospital and McLean Hospital in Boston, notes that issues of privacy and informed consent remain the same as with a patient in the nonprison population, but incarcerated patients are at increased risk for substance use disorder, mental health problems, and traumatic brain injury, all of which can affect their ability to give informed consent.
In 2002, 19% of incarcerated individuals met the criteria for substance use disorder; 15% met the criteria for mental health issues, including schizophrenia, bipolar disorder, or major depressive disorder; and approximately 50% met the criteria for both. Traumatic brain injury may affect 35.7% of the prison population.
The decision to share important clinical information with a patient’s legal defense team or with correctional personnel within the institution to prevent the patient from being victimized by other inmates must be carefully considered in light of the patient’s right to confidentiality and autonomy. Patient-centered care, the concept that clinicians should engage patients in shared-decision making, is especially important in settings in which patients are already marginalized, such as correctional settings.
To ensure that the best interests of the patient are served, clinicians treating those in correctional institutions should assess the decision-making capacity of their patients. When a patient is judged to be incapable of making an informed decision, substituted judgment may be used; that is, the clinician or family members may make a decision based on what they believe the patient would have wanted. If this is not possible, physicians should apply the best interest standard and become effective advocates for their patients.
Beckmann D. What are physicians’ responsibilities to patients whose health conditions can influence their legal proceedings? AMA J Ethics. 2017;19(9):877-884.