Exploring Bioethics of Incarcerated Patient’s Access to Advanced Heart Therapy
TL/DR –
The Hastings Bioethics Forum recently covered a bioethics case in which a 32-year-old incarcerated Black man diagnosed with heart failure was deemed ineligible for a heart transplant but underwent a successful ventricular assist device procedure. The authors argue that this case exposes the broader issues of inequalities in health care access and quality for incarcerated individuals, and the systemic injustices of mass incarceration in the U.S. They suggest a radically different approach to bioethics and propose that the most ethical solution would be to remove the patient from prison, thereby allowing him access to the care he needs.
Bioethics Forum Examines Incarcerated Patient’s Right to Advanced Heart Therapy
A recent Clinical Ethics Case Studies series essay titled “Should an Incarcerated Patient Get an Advanced Heart Therapy?” took a closer look at the ethical considerations surrounding a 32-year-old Black man identified as W, who is serving a life sentence and has been diagnosed with heart failure. The heart failure team was divided on whether advanced therapies like a ventricular assist device or a heart transplant were appropriate, given his incarceration. After deliberation, he was considered ineligible for a transplant, but successfully underwent the procedure for the assist device.
The authors examined this case within the wider context of mass incarceration injustices and the ensuing constraints on healthcare access, quality of care, and social support. The circumstances surrounding this case underscore a need for more bioethical engagement with mass incarceration issues, as there continues to be a growing awareness of the impact of incarceration on healthcare.
The 2023 Hasting Center Report issue on mass incarceration echoed this sentiment. Gregory Kaebnick, in the editors’ introduction, insisted that the field of bioethics has a responsibility to guide medical professionals and institutions in dealing with mass incarceration, given the health implications.
The lead piece by Sean Valles highlighted the historical impact of mass incarceration on individual and community levels, while Jennifer James made a case for bioethics to seriously engage with abolition principles in healthcare.
Reassessing W’s case through an explicitly anti-carceral and abolitionist viewpoint sparks a dialogue on advocating for justice-based solutions to healthcare dilemmas. This involves radically reconsidering the societal structures contributing to more harm than good and not settling for compromised solutions.
As interdisciplinary, bioethicists can leverage their unique position to apply an abolition lens to injustices within healthcare, both structural and clinical. The authors propose mitigating the ethical challenges in W’s situation through compassionate release, given certain assumptions about his family and insurance support. They argue that the most ethical solution is to remove W from prison to provide him with appropriate care, considering it is likely that his incarceration caused or hastened his disease.
However, advocating for release often sparks counterarguments, suggesting that advocating for release circumvents the purpose of incarceration or extends beyond the realm of clinical bioethics. To address these, the authors point out that many incarcerated individuals are there for nonviolent offenses, over-sentencing is more likely among marginalized groups, and assumptions about the incarcerated individual’s crime can reinforce the unjust stigma of their social worth.
The authors argue that clinical ethicists can and should engage in broader advocacy towards dismantling the prison industrial complex and advocate for the compassionate release of all incarcerated people with serious health conditions. They envision a more imaginative future for bioethics that doesn’t constrain itself but instead forges a path toward new futures.
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