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Ethical Dilemmas Concerning Healthcare in Prisons


Healthcare in the correctional facilities is a major issue that creates controversy in the United States as well as other countries around the globe. The human rights groups and the rest of the civil society continue to wage a scathing attack on the prison authorities as well as the respective governments of the various states. Ethical dilemmas derail the prison authorities as well as the medical practitioners in the promotion of the prisoners' welfare. Among the major issues that promote the dilemmas are the perception of inmates as outcasts and the prison authorities' bid to squander money allocated to correctional facilities. The private prison officials also aim at maximizing profits at the expense of prisoners' welfare.

The researcher seeks to conduct a desktop study to unearth the dilemmas in correctional health care as well as their remedies. The issues captured are dual loyalty, prisoners' right to health and hygiene promotion as well as access to doctors and medication, doctors' honesty as well as the state laws that compel medical practitioners to violate the principles of their profession. Among the recommendations are awareness and training for physicians, a clear definition of roles, and supervision by competent authorities.

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Keywords: Ethical dilemmas, correctional healthcare, and recommendations


Between 2011 and 2012, half of the federal, as well as state prisoners, reported having an experience of chronic illnesses such as hypertension, cancer, stroke, diabetes, heart attack, arthritis, asthma, and liver cirrhosis among other ailments (Berzofsky, Maruschak, & Unangst, 2015). The same report indicated that 21% of the group had also suffered from infectious diseases such as tuberculosis, hepatitis B, and C as well as sexually transmitted diseases. 1% of the people also had an HIV positive status (Berzofsky et al., 2015).

The above data shows the seriousness of the health problem in correctional facilities. Despite the right to health guaranteed by the Eighth Amendment, prisoners continue to suffer from deficiencies in health care. In some cases, the convicts live in deplorable conditions that are harmful to their health. Additionally, there is a lack of adequate health care or the provision of poor quality services that worsens the illnesses in jails. This research seeks to explore the ethical dilemmas in the correctional healthcare as well as give recommendations for the identified problems aimed at alleviating the severity of the issue in the federal, state, and local prisons. The work also covers a theoretical framework that relates the problems to the various ethical theories.

Theoretical Framework

Deontological Theory

The theorists judge the morality of action regarding the adherence to the rules or the norms of society or professionalism (Kelly, 2006). Scientists also refer to the theory of the "obligation", "law", or "duty"-based ethics because the rules bind individuals to their duty. The method, therefore, requires all professionals to abide by the rules or norms that govern the manner in which they should execute their duties. Deontology talks about the general duties that apply to everyone and the specific tasks that a person has towards a particular group by the relationship and responsibility (Kelly, 2006).

Regarding the theory, medical professionals should, therefore, adhere to their professional ethics, and this means treating the inmate patients in a manner that does not violate the rules. Likewise, the prison managers should also follow suit by ensuring that they only treat prisoners in a way that promotes reformation but not dehumanization.


The theory states that the consequences of an individual's conduct form the basis for judgment of the action as either right or wrong (Portmore, 2011) and thus the end justifies the means. The approach, therefore, means that if the consequences of an action are good, then the action is also good, and if they are bad, the action is not desirable. In this regard, the prison administration must ensure that it treats inmates in a manner that promotes desirable results/health improvement. The medical practitioners should also treat the detainees in a manner that promotes their health as the desired result.

The Dilemmas in Correctional Health Care

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Dual Loyalty

The subject represents a dilemma experienced by medical professionals in the course of their duty. The issue is a conflict in the profession regarding the functions and obligations towards the detainees and the third part interests of the bosses of convicts or the prison authorities. The correctional doctors and nurses have the responsibility of acting as private caretakers of inmates, and thus they should treat them with full consideration of the medical principles. The latter include respect for their autonomy, beneficence, justice, non-maleficence, veracity, and fidelity (Pont, Stover, & Wolff, 2012).

The healthcare practitioners must, therefore, play the role of health officers and thus they should check on the food, hygiene, sanitation, light, ventilation, clothing, as well as physical exercise to ensure that they meet the required standards. The officers must also act as advisors to the prison authorities regarding their health duties towards the inmates. The medical practitioners must, therefore, conduct their functions according to the principles of the medical profession, but not other interests (Pont et al., 2012).

However, according to Pont et al. (2012), despite all the stated requirements, the health workers tend to violate these principles repeatedly through engagement and participation in undesirable practices such as force-feeding of striking prisoners, taking part in death penalties as well as torturing. The prison administration may also press the doctors not to provide quality health care for various reasons. The healthcare practitioners may also succumb to the pressure to falsify records and thus issue a certificate of fitness to incarceration for a person whose health condition does not warrant incarceration. Regarding the above information, dual loyalty, therefore, remains a serious dilemma in correctional healthcare.

Hygiene and Health Promotion

Proper health care in prisons does not end at the treatment of sick prisoners, but it also includes the promotion of measures to preempt or reduce illnesses. However, the management of prisons, especially the privately owned, has a dilemma regarding the profitability of their business and the prisoners’ rights. According to Lehtmets & Pont (2014), the prison authorities must provide the right quality and quantity of food, prepared in the correct manner. The management must also check on the hygiene that is the cleanliness of the clothing, beddings, cells as well as the general compound. The prisoners must have access to running water sanitary installations such as toilets, proper room conditions such as lighting, ventilation, and heating.

Additionally, managers should also provide adequate clothing and avoid solitary confinement (Lehtmets & Pont, 2014). However, despite all these requirements, there are cases of improper feeding, clothing, and overcrowding among other issues that compromise the prisoners’ safety and health. The profit motive and selfish interests by the management, therefore, conflict with the inmates' rights, and thus immediate actions are necessary.

Access to Doctor and Medication

Prisoners have a right to medication that is commensurate to their health conditions (Lehtmets & Pont, 2014). The prison authorities must use the allocated funds to provide free quality healthcare to those prisoners who have no insurance covers or money to cater for their health. The availability of the doctor is also essential, and the inmates must access him/her whenever required. The management must ensure that there is an equivalence between the services offered by their institutions and those provided in the civilian hospitals. The patients must access specialized treatment if they need to be in hospitals outside the prison premises.

However, prison authorities, as well as the doctors, have a dilemma as to whether prisoners deserve mercy and compassion. Regarding this aspect, according to Wilper et al. (2009), 13.9%, 20.1%, and 68.4% of federal, state, and local prisoners respectively who had persistent medical conditions before incarceration had no access to the examination. Moreover, 7,232, 80,971, and 58,991 prisoners from the federal, state, and local facilities respectively who were on medication before the incarceration had their treatment cut short by their sentences (Wilper et al., 2009). The figures above, therefore, depict the denial of medical access after prisoners face their sentences.

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Compatibility of Prisoners

According to Wilper et al. (2009), medical examination before incarceration is crucial for establishing the health conditions of the prisoners as a way of determining their compatibility. There are health conditions such as mental illness, and overdependence on drugs that may trigger acute health circumstances in the case of withdrawal, and these issues may necessitate treatment before incarceration.

However, the public prison management, on the one hand, may disregard this point due to its contempt for prisoner's rights. Their private counterparts, on the other hand, have the intention of filling their institutions to capacity for purposes of profit maximization (Wilper et al., 2009). Additionally, the prison authorities may compromise the doctor to falsify the results and issue a certificate of fitness. The above issues, therefore, contribute to the problem of poor health in prisons and may also lead to severe cases or even death.

The Undesirable Government Laws

Beyond the United States, the dilemma in correctional health care also exists in many other countries that have laws that compel medical officers in the criminal justice system to participate in activities that are beyond their health mandate (Wilper et al., 2009). The laws, therefore, put the medical personnel at crossroads as they have to violate their professional conduct for the state laws. Such countries include Austria, Germany, and Azerbaijan among others that have penal legislation that obliges the medical workers to participate in the approval of punishments, or medical supervision for security measures (Wilper et al., 2009). The laws also compel doctors to conduct medical searches and examinations for forensic purposes. Such issues are problematic to the medical personnel as they make them violate their code of ethics.


Regarding dual loyalty, there is the need to create awareness of the principles of the medical field as a way of sensitizing doctors to remember their role. The next step would be the adoption of training programs on human rights, medical ethics as well as laws and this would be a step towards educating the medical personnel on better ways of handling patients. The involvement and engagement of professional bodies to check and monitor the conduct of the doctors are also necessary (Pont et al., 2012). Lastly, there must be a separation of roles as well as relevant training to make sure that healthcare professionals clearly understand that their work is to serve patients and not the prison management.

Regarding the hygiene and health promotion issues, the government should be competent and create independent authorities with the role of supervising the feeding, sanitation, clothing, and housing of inmates to ensure that they receive humane treatment. The bodies should make impromptu visits to the correctional facilities to assess their conditions. The other move should be taking the management of the undesirable prisons to the responsibility, and this should involve personal responsibility and prosecution. The government should also consider releasing petty offenders as well as non-violent drug offenders to decongest the prison cells as a way of improving the housing situation in the correctional facilities.

Concerning the access to doctors and medication, the government should ensure that the jail authorities collect the medical history of inmates before admitting them. The other move should be conducting a screening of all patients before incarceration providing proper treatment of the sick and the routine screening of prisoners to establish emerging illnesses. After all these, the government must also ensure that the prisons keep and maintain proper convicts’ medical records to show how they access treatment.

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Regarding the compatibility and fitness of prisoners, the government at all levels should take stern action on the rogue doctors who falsify documents and should hold them accountable for the misconduct. Moreover, the federal in collaboration with the state government can also contract private hospitals as well as public ones to conduct tests on people before their conviction.

Regarding the improper laws that compel the medical practitioners to participate in issues beyond their professional scope, the respective governments should embark on a clear role definition to ensure that the laws do not make people violate their professional conduct. The international community should also rise and condemn the legislation as a way of restoring sanity.


In conclusion, the prevalence of chronic illnesses is evident in the federal, state as well as local correctional facilities. Hypertension, cancer, stroke, diabetes, heart attack, arthritis, asthma, and liver cirrhosis are some of the major diseases. The cases are alarming, and thus there is the need for urgent measures to solve the ethical dilemmas that make delivery of quality health care in prisons difficult.

Despite the rights to medication guaranteed by the Eighth Amendment, prisoners continue suffering from deplorable health conditions as well as inadequate care. The deontological theory calls for adherence to the rules and norms while consequentialism calls for actions the results of which are desirable. Some of the ethical dilemmas include dual loyalty, prisoners’ right to health and hygiene promotion as well as access to doctor and medication, doctors’ honesty as well as the state laws that compel medical practitioners to violate the principles of their profession.

Among the recommendations are awareness and training for physicians, clear definition of roles, supervision by competent authorities, taking legal action against errant doctors and prison administrators, lobbying loyalty, prisoners’ right to health and hygiene promotion as well as access to doctor and medication, doctors’ honesty as well as the state laws that compel medical practitioners to violate the principles of their profession. In addition, proper screening of people before incarceration as well as the proper maintenance of medical records can also play a role in addressing the plight of prisoners.

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