Wednesday, October 21, 2009

NYT on Prison Hospice Inmate Volunteers

The New York Times continues its coverage of hospice and palliative care related issues with a compelling report (with associated audio slideshow) on a volunteer hospice service at Coxsackie Correctional Facility in upstate New York. The article discusses the aging of the prison population, but mainly focuses on the experiences of inmates who have volunteered to provide support for dying inmates at the facility. Some of the lessons the inmate volunteers learn are not unique and might be extrapolated to all who provide care for the dying:
  • Being in the presence of a dying person can be transformative. You likely will have moments that remind you how fragile life truly is and will learn to value it more than you did previously. Convicted murderer John Henson poignantly describes his personal version of this lesson.
“I was just thinking about why I’m in here and the person’s life that I took,” he said. “And sitting with this person for the first time and actually seeing death firsthand, being right there, my hand in his hand, watching him take his last breath, just caused me to say, ‘Wow, who the hell are you? Who were you to do this to somebody else?’”
  • Attention to suffering at the end of life is a human right that everyone deserves and empathy is a key component. Benny Lee is another inmate who describes his attitude toward the death of even friends as "callous" before his hospice volunteer experience. Now, through his experience he's been able to see the suffering that death can entail and seems to have a growing understanding of the salutary experience of empathy.

  • Premature reassurance of dying patients is non-beneficial (and usually, the reassurance is a response to the reassurer's emotions rather than the patient's). Wensley Roberts is yet another inmate volunteer who tells Allen Jacobs to "man up" as Jacobs faces death. Jacobs rebukes Roberts emotionally, asking Roberts if he wants to die in prison. When Roberts answers "no," Jacobs anger evolves into sadness as he states the nearly universal fear amongst prisoners of dying in prison.
In addition to talking to volunteers, staff at the prison were interviewed about the program. The deputy superintendent for health services talks about some resentment of the prison guards that "people in prison for horrendous crimes getting better medical care than their families," (referring to the volunteer program which includes around the clock companionship near the end of life). Really? Rather, I suspect that some of them don't agree with the claim about this stuff being a human right, and I'm dubious about any claim that the circumstances of care might be better for prisoners than non-prisoners just based on the presence of a volunteer program. However, I know from professional experience that some prison guards can exhibit tremendous compassion. (I work at a hospital that accepts the state's prisoners for hospitalization needs. The patients' guards in the hospital usually come from the patient's correctional facility and sometimes have valuable personal information about incapacitated prisoners, including what the prisoner's main concerns have been.)

The director of nursing, Kathleen Allan, also is indirectly quoted as saying:
...the inmate volunteers bond with the patients in a way that staff members cannot, taking on “the touchy-feely thing” that may be inappropriate between inmates and prison workers.
I could see the potential for "bonding" between inmates that may not be possible with prison staff, but am I being Pollyannish to expect that there might be room for some display of empathy (that "touchy feely thing") by prison staff, especially the medical staff? If the inmate is fighting you to get out of his handcuffs or verbally abusing you, that's one thing, but if he's laying in bed in tears because he can't see his long-lost daughter and he's expressing remorse for his crime, doesn't that call for a different response? Empathy does not cross the line in this case, but a person needs to know how to express it, and it will come to no surprise to any that I have no idea what role empathy is given in the day-to-day jobs of prison guards. Empathy can play a role in conflict deescalation, so would seem to be a vital skill for a guard to employ.

At one time, Coxsackie did have an outside hospice agency that provided care for inmates. Eventually, they switched to the inmate volunteer program, ditching the agency. One might mistakenly conclude from the article that the hospice agency merely provided the same services as the inmate volunteer program (only with non-prisoners), and the article implies that the change was only for the better AND it might have saved money. In not having an expert interdisciplinary team (hospice nurses, social workers, chaplains, their own volunteers, medical director oversight, etc) managing the patient something was lost, no matter how impressive the benefits of the inmate volunteer program have been.

Lastly, Allan does talk about some very real problems that are faced in caring for dying prisoners, including drug diversion (with some inmate volunteers involved) and victimization of the dying. You don't have to be a prisoner to be at risk for these issues, though.

To read more about prison hospices, see The National Prison Hospice Association website. Also, see a couple of past posts related to the prison population here and here.

Pallimed | Blogger Template adapted from Mash2 by Bloggermint