Ethical Dilemmas in Correctional Nursing

I recently had the opportunity to be interviewed for the KindEthics Radio Program. We had an interesting discussion about ethical dilemmas unique to nurses (and doctors) working in corrections.

Basis of Ethical Care

Two basic principles of ethical care are beneficence (acting only for the benefit of the patient) and nonmalfeasance (do no harm to the patient). In the course of working in a security environment, an ethical dilemma can arise when the  goals of custody administration seem to conflict with these principles. A code of ethics specific to correctional healthcare was created by the American Correctional Health Services Association (ACHSA). Lets look at just a few examples of ethical dilemmas that may be encountered.

Body Cavity Searches

 Healthcare staff may be asked to perform searches of rectal or genital areas for contraband items such as drugs or weapons. This action would not be of benefit to the patient and has no health purpose. Professionals may have concerns that these searches done by custody might injure or harm the patient. However, there is general agreement that body cavity searches should not be performed by healthcare staff that have a patient-provider relationship with the inmate.

Collecting Forensic Information

 Along the same lines, requests can be made to assist with collecting forensic evidence to be used against the inmate, such as blood tests, DNA analysis or psychological evaluations. Providing such services would constitute a conflict of interest for the care providers working in the facility. Resources outside the facility medical unit should be accessed to provide these services.

 Executions

 Fortunately most states executing the death penalty have moved to the use of outside providers for monitoring and initiating lethal injection. All authorities agree that participation in executions is inappropriate for healthcare staff with a patient-provider relationship to the inmate population.

Hunger Strikes

 Ethical conflict can develop regarding treatment choices during hunger strikes. Most certainly, monitoring the health status of a striking inmate would be beneficent and nonmalfesent care. The dilemma begins if healthcare staff are asked to force feed (tube feed) the starving inmate. Practitioners are mixed on a response to this request. Although there is no clear consensus, the ACHSA has adopted a position statement advocating force feeding in some situations. The Federal Bureau of Prisons has a program statement on hunger strikes indicating force-feeding is a medical decision based on emergent life threatening criteria.

Inmate Discipline

 Involvement in inmate discipline can also result in an ethical dilemma. For the most part, healthcare staff should not be involved in disciplinary action or disciplinary committees determining actions in the facility in which they work. However, involvement becomes necessary when a staff member has witnessed or is the receiver of wrongful action. It is appropriate to provide factual objective testimony in order to maintain security in the facility and the safety of other inmates and staff members.

Patient Confidentiality

Healthcare providers often get queries from custody staff about the health condition of particular inmates usually related to infectious diseases or mental health. Information can also be spread through knowledge of the type of services provided to specific inmates or special needs issues (bottom bunk, food privileges, etc). In these situations it is important to carefully share needed information which will minimally jeopardize patient confidentiality. The specific need can be shared (bottom bunk) without sharing the diagnosis (epilepsy).

What other ethical dilemmas might be experienced in correctional practice?