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NOBODY SHOULD DIE IN HANDCUFFS: A CASE FOR ENDING SHACKLING AT THE END OF LIFE
Journal of General Internal Medicine ; 37:S490-S491, 2022.
Article in English | EMBASE | ID: covidwho-1995632
ABSTRACT
CASE A 75-year-old incarcerated man presented to the ED with one week of chills, body aches, dry cough, and dyspnea. His past medical history was significant for hypertension, type II diabetes, and obesity. He had been incarcerated for 18 years and was looking forward to his release in five months. He was identified as African-American in his chart. On initial evaluation, his oxygen saturation was 87% on room air with otherwise normal vitals. His breathing was labored with crackles in the lung bases. His chest x-ray showed multifocal opacities. He tested positive for SARS-CoV- 19 and was admitted on high-flow nasal cannula. In the following week, his oxygen needs escalated and he was transferred to the Medical ICU. Multiple requests for medical clearance to contact family were declined by the correctional facility. On day 8, he was intubated, paralyzed, and proned. He remained shackled to his bed with two correctional officers posted outside his door. On day 14, he suffered a PEA arrest with return of spontaneous circulation following ACLS. Attempts to contact family are approved and his care plan is changed to comfort measures only. He was terminally extubated and passed away soon after. Throughout the hospitalization, including during his cardiac arrest, the patient remained shackled to his hospital bed by the left ankle. Two correctional officers were stationed outside his hospital room 24 hours per day. The medical team had been unable to contact the patient's next of kin until the day he arrested, at which time they opted to pursue comfort measures. Months later, a medical resident who had cared for him shared the following words during a reflective writing session “Nobody should die in handcuffs.” IMPACT/

DISCUSSION:

End-of-life care for incarcerated people is a pressing issue in the United States, where approximately 2.4 million individuals are held within the prison system. Due to an aging prison population, more incarcerated patients are dying than ever before. It is predicted that by 2030, the number of elderly prisoners is expected to reach 400,000 - an increase of 4,400% since 1981, according to a 2012 report from the ACLU. Most jurisdictions in the United States require shackling of the hands or feet when inmates are transported outside the prison setting. For patients with debilitating illness, shackling in the medical setting violates the principles of beneficence, non-maleficence, and autonomy essential to the practice of medicine. The COVID-19 pandemic has further underscored the ethical, legal, and moral dilemmas which clinicians face in preserving the dignity of the dying patient.

CONCLUSION:

Given the expected changes in demographics within the US correctional system, clinicians must advocate for compassionate policies such as the removal of shackles at the end of life. Potential avenues for change in practice can involve increased medical-legal dialogue and partnerships with correctional officers and other stakeholders within medical and correctional institutions.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Journal of General Internal Medicine Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Journal of General Internal Medicine Year: 2022 Document Type: Article