Compassion beyond hospital curtains and prison bars
“Let’s open these curtains and let some light in here. Is that better, Mr. Roy?”
I first met Mr. Roy during my cardiothoracic surgery rotation at Ben Taub Hospital. Each morning, his name appeared on my patient list. He had been in the Surgical Intensive Care Unit (SICU) for weeks, relying on a left ventricular assist device after major surgery left him in cardiogenic shock. Standing at the door of his room, I felt the weight of his critical condition. Yet, even before his complications, what caught everyone’s attention was the bright orange jumpsuit he wore and the guard stationed beside his bed.
For Mr. Roy, the SICU wasn’t a place of healing; instead, the sterile curtains and lack of natural light mirrored the prison he had come from. His indifference to my suggestion made me wonder: was this the most comfortable place he could be? And how often do hospitals start to resemble prisons for patients like Mr. Roy?
After returning from the American Society for Bioethics and Humanities (ASBH) conference in St. Louis, where I attended a panel on “compassionate release,” I felt compelled to explore Texas’ policy on this matter. The history of compassionate release in the United States dates back to the Sentencing Reform Act of 1984, which established the ability for federal judges to reduce a prisoner’s sentence under “extraordinary and compelling” circumstances. Compassionate release aims to address barriers to end-of-life care in correctional facilities, allowing terminally ill prisoners to spend their final days outside prison walls.
However, the reality is starkly different. While programs like Medically Recommended Intensive Supervision and Emergency Medical Reprieve exist, their approval rates are alarmingly low. Many applicants are denied compassionate release, and some pass away before their applications are even processed.
These patients are often deprived of the dignity and comfort afforded to others at the end of life. As healthcare providers, we become complicit if we ignore this issue. For individuals like Mr. Roy, death in a hospital – or a prison – is rarely the dignified process many hope for.
Even when compassionate release is granted, families face overwhelming challenges: finding a facility that will accept the patient, navigating health insurance complexities, and striving to make the patient’s last days meaningful. Losing a loved one to incarceration is traumatic for families but losing them without the opportunity to say goodbye – without guards or handcuffs – inflicts a second, deeply painful loss.
With the aging prison population now the fastest-growing demographic in corrections, this issue is only worsening. Prisons are transforming into makeshift nursing homes, entirely unfit for the task. We are approaching a crisis as correctional facilities remain unprepared and untrained to provide the end-of-life care these individuals need.
As a medical student nearing the end of my core rotations, going to ASBH taught me something essential about patient care: our roles extend beyond treating illnesses; they encompass advocating for humane policies that reflect comfort and compassion, regardless of the circumstances that brought our patients to us.
Perhaps true compassion means more than just pulling back the curtains to let in the light; it means challenging the shadows cast by systems in both life and death – an act that someone like Mr. Roy would surely not be indifferent to.
*All names and identifying details in this story have been changed to protect patient confidentiality in accordance with HIPAA regulations.
By Lama M. Abdurrahman, a third-year medical student at Baylor College of Medicine and recipient of the Laurence McCullough Travel Award.
