Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

Circle of Life Award Recipient

The Louisiana State Penitentiary Hospice Program is an interdisciplinary team program designed to provide palliative care to inmates housed at the state correctional facility at Angola. The program includes professional staff traditionally found in a hospice team in the "free world," including physicians, nurses, social workers, chaplains, as well as bereavement, dietary, and ancillary personnel. It is unusual in that it also includes the extensive participation of specially trained inmate volunteers, who provide dying prisoners with emotional support, companionship and assistance with activities of daily living. Some inmates provide administrative support to the program, in such areas as computer graphics, peer education, design of educational materials, and interpretation for the deaf and for the Spanish-speaking. The presence of a hospice inside a maximum security prison in a state which has the death penalty is remarkable in itself.¹ What is especially innovative about the Louisiana hospice program, however, is the way in which it fosters teamwork and rare common cause between members of the inmate population and the people who maintain their world inside the prison walls.

A prison's primary goal is safety of the community, inmates, and prison employees through removing criminals from the "free world" and maintaining the security of the institution. By design, prisons are not places that encourage comfort and care, but rather discipline, structure, and sometimes rehabilitation. The relationship between those charged with maintaining security in prisons and those who are imprisoned has long been characterized by mutual suspicion and distrust. Prisoners' distrust extends to medical personnel, who are perceived as an arm of the security system. In an environment in which the primary function of the facility is at odds with personal choice, comfort, and family unity, the Louisiana State Penitentiary Hospice Program offers inmates, medical care providers, and security personnel a rare opportunity to work together in a "neutral zone," with a common goal of providing humane care to the dying.

The inmates who volunteer for the hospice program have a personal investment in its success. In Louisiana, a sentence of life in prison means life without the possibility of parole. Thus, 85 percent of the 5,108 men who live in the Louisiana State Penitentiary are expected to die there. Because of the length of their incarceration (sometimes 10, 20 or 30 years), many inmates have lost all outside contact with their families. The prison at Angola is their home, their community, and other inmates have become their family. Therefore, many inmates see their participation in the hospice program as a way to prepare for how they themselves will die or as a way of giving back something to others, a way of repaying their debts and redeeming lost lives.

By necessity, prison inmates are separated from society and family members. This means that at times of crisis due to grave personal illness, when they need the support of others most, they are often isolated. The Angola prison hospice's focus on palliation of symptoms, including emotional, social, and spiritual needs of dying patients, has led to efforts to reunite families that have been out of touch for years, as well as to help patients maintain friendships with other inmates. As a consequence, the Angola prison hospice has the most liberal inmate visitation policy of any in the country. Because current parole and compassionate release laws in Louisiana mean that few terminally ill inmates will be released solely because they are dying, the hospice program tries to bring "home" to them, through providing special items, music, pictures and visits, and within the constraints of prison security, whatever patients identify as "life-affirming" experiences.

The hospice program has had an impact not only on dying prisoners and their family members outside the prison walls. It has touched other inmates who come in contact with the program, including volunteers, and the patients' inmate "family" and friends. By respecting the dignity of the inmate, regardless of his crimes, and by offering humane care to both inmates and their families, the Louisiana State Penitentiary Hospice Program has the ongoing support and participation of the inmate population and many of the security staff.

References:

1. Maull FW. Issues in prison hospice: Toward a model for the delivery of hospice care in a correctional setting. The Hospice Journal. 1998:13(4):57-82. [Return to Description]

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