Abstract
The prison population is graying as more individuals are receiving longer sentences without opportunities for parole or release for health-related reasons. While research has expanded on end-of-life care in and out of prison settings, to date there has been little research conducted on how inmates experience dying behind bars. Through collecting data during observation of facilitated advance care planning sessions, this qualitative study revealed four main themes: (1) losing a piece of everything, (2) not sure what to feel, (3) where will I die, and (4) finding purpose in the midst of purposelessness. These themes characterize the central issues discussed by inmates as they considered death behind bars. As we seek to improve health care in prison settings, this study provides insight into how inmates view their dying process.
Introduction
The number of older adults is rising throughout the United States and globally (Administration on Aging, 2014; He, Goodkind, & Kowal, 2016). The growth of the aging population has led to many structural changes within communities, institutions, and subsequently policies to accommodate the growing demand for formal and informal services, as individuals face greater needs for health care and assistance. One of the settings that is undergoing significant change is prisons, as more inmates are aging in place behind bars (Loeb, Penrod, McGhan, Kitt-Lewis, & Hollenbeak, 2014). The growth in the number of older adults in prisons has required a greater focus on strategies for meeting the complex health care needs of this population, including the need for expanded end-of-life (EOL) care (Williams, Goodwin, Baillargeon, Ahalt, & Walter, 2012). The present study documents how male inmates experience dying in prison. The data from this study were collected during a larger study on advance care planning (ACP) among dying inmates; the ACP study can be found elsewhere (see Sanders, Stensland, Dohrmann, Robinson, & Juraco, 2014; Sanders, Stensland, & Juraco, 2017).
Literature Review
Prison populations are growing at a staggering rate. In 2008, the Pew Charitable Trusts Study reported that 1 of every 100 individuals in the United States was residing in a correctional facility, totaling approximately 2.5 million individuals behind bars. This growth is an increase of over 500% over the last 30 years (Sentencing Project, 2014). This mass incarceration has seen a graying of prison in the United States, as the number of inmates 65 years of age and older grew 94 times faster than the overall prison population between 2007 and 2010 (Human Rights Watch, 2012). Policies such as three strike laws, tougher sentencing rules, and growth in the number of life sentences, which account for approximately 10% of all inmates (Moore, 2009), have led to an increase of inmates aging in place in correctional settings. States such as Iowa, Illinois, South Dakota, Pennsylvania, Louisiana, and Maine are seeing the fastest growth in aging inmates, as they have policies on life sentencing that make early release or parole, even for medical reasons, difficult to achieve (Nellis & King, 2009).
The increase in older prisoners has generated attention to the health care needs of this population. Fifty years of age is widely considered “old age” in prison (Loeb & AbuDagga, 2006), with these inmates having more complex health care needs than members of their age cohort not incarcerated due to substance use history, poor medical care before incarceration, and other lifestyle choices. In comparison to their younger counterparts, older inmates have significantly greater rates of functional impairment that requires assistance with activities of daily living (Trotter & Baidawi, 2015) and display growing rates of cognitive impairment, specifically dementia (Maschi, Kwak, Ko, & Morrissey, 2012). Prisons throughout the United States are examining the provision of health care for aging prisoners, recognizing that not all prison officials or taxpayers are supportive of inmates receiving medical care that is comparable to what is available in the community, even though this is required by law (see Estelle v. Gamble, 1976). Prisons are provided with a flat, per diem rate for inmate medical care, which does not consider the increased health care costs that come with many age, chronic, and terminal health conditions, and eventual death (National Hospice and Palliative Care Organization [NHPCO], 2015).
An increased number of older inmates behind bars lead to a greater number of in-prison deaths. Research has found that 60% of inmates who die in prison are over the age of 65 (Carson & Anderson, 2016) with the majority of deaths, approximately 90%, being related to illness including cancer, liver disease, kidney disease, or cardiac issues (Carson & Anderson, 2016). For older adults specifically between 2001 and 2011, inmates aged 55 and older comprised 42% of inmate deaths (Noonan & Ginder, 2013). Aging and rising in-prison deaths have resulted in an increased level of attention to the provision of EOL care.
Historically, dying in prison was accompanied by pain and isolation, with prisoners noting the lack of many comforts provided to those dying in the community (Dubler & Heyman, 2006). However, starting in 1999 with the advent of the Guiding Responsive Action in Corrections at End-of-life (GRACE) Project (2000), EOL care in prisons became a larger focus with the growing emergence of prison hospice programs. The GRACE Project is a collaborative initiative between EOL and correctional organizations committed to promoting quality EOL care in the prison setting (see Ratcliff & Craig, 2004). The United States is home to approximately 75 prison hospice programs, with about 50% using a model in which inmates are trained as volunteers to provide care (NHPCO, 2015). The hospice movement has led to greater discussions about the need to work with inmates to identify and express their own EOL wishes, with a small but growing body of work examining the EOL wishes of incarcerated individuals (e.g., Handtke & Wangmo, 2014; Loeb et al., 2014; Phillips et al., 2011; Phillips, Allen, Salekin, & Cavanaugh, 2009).
The notion of a “good death” has received great attention in the empirical and theoretical literature over the past two decades. Though historical notions of dying well have long existed (euthanasia stems from the Greek words eu thanatos meaning “good death”; Kellehear, 2007), the hospice movement contributed to the emergence of the modern concept (Meier et al., 2016). In a 1997 Institute of Medicine report, a good death is one that is “free from avoidable distress and suffering for patient, family, and caregivers, in general accord with the patient’s and family’s wishes, and reasonably consistent with clinical, cultural, and ethical standards” (Field & Cassel, 1997, p. 24). Since this early attempt at a definition, the concept of a good death has been examined and critiqued by professionals in a wide array of disciplines including medicine, anthropology, sociology, psychology, and gerontology (Granda-Cameron & Houldin, 2012; Kaufman, 2000).
Great effort has been put forth to define and understand what is meant by a good death (e.g., Kehl, 2006; Meier et al., 2016; Steinhauser et al., 2000). While an absence of suffering and pain are commonly mentioned in the context of good death, contemporary constructions of this concept include many core attributes beyond quality pain control. For example, in a concept analysis review of literature specifically on good death, Kehl (2006) identified 12 of the most commonly discussed features: being in control, being comfortable, sense of closure, affirmation/value of the dying person recognized, trust in care providers, recognition of impending death, beliefs and values honored, burden minimized, relationships optimized, appropriateness of death, leaving a legacy, and family care (p. 277).
Despite this important work in understanding a good death, critical issues remain surrounding this concept. First and foremost, it remains a debate as to whether or not a prototypical good death actually exists or whether the perception of death is more dependent upon personal perspectives of the individual dying. Relatedly, contradictions between patients and their health care providers exist regarding factors that contribute to a good death (Meier et al., 2016). Furthermore, cross-cultural variation is one of the most critical issues to consider, as cultural norms, beliefs, and traditions surrounding death deeply impact the perception of the quality of death (Counts & Counts, 2004; van der Geest, 2004). A relatively new issue being examined is the equity of achieving a good death, as it has been recognized that certain populations, such as incarcerated individuals, may be disadvantaged (Burles, Peternelj-Taylor, & Holtslander, 2016).
With “good death” as the guiding theoretical concept, the purpose of the present study is to report on the inmate experience of approaching death in prison. While discussing their advance care plans with prison staff members, many reactions to terminal illness emerged, granting perspective into the unique experience of incarcerated men preparing to die.
Method
The present study is part of a larger project that focused on the implementation of a formal, structured ACP program in three state prisons in a Midwestern state; a detailed description of the procedures related to recruitment, sample, data collection, and data analysis is reported elsewhere (see Sanders et al., 2014; Sanders et al., 2017). Briefly, the purpose of this project was to understand how an ACP program could be implemented in a correctional setting, as well as to develop insight about inmates’ EOL wishes. Inmates from the medical units who met the following criteria were identified by prison medical staff and invited to participate in ACP session(s): cognitively intact, older, frail, or reasonably thought to die within the next 12 months. Data were collected with 20 inmates via observation of the one-on-one ACP sessions, during which the researcher took detailed field notes. As shown in Table 1, inmates ranged in age from 25 to 79; all were Caucasian, which was consistent with the demographics of the prison population in the state; and all had terminal health conditions, including end-stage renal failure, forms of cancer, heart disease and emphysema, complications due to accidents prior to and after prison entry, and advanced Parkinson’s disease. Observations of the ACP sessions were conducted as opposed to direct interviewing per department of corrections stipulations. During the observations, detailed notes, containing as many quotes as possible, were handwritten by the researchers to capture the interview content as well as the emotional experience for the inmates and interviewers. Researchers were not actually engaged in conversation with the inmates and were instead silently watching, thereby allowing the capacity to write down inmate quotations verbatim. All notes were typed, thematically analyzed, and coded for meaning units in the data. The authors met frequently to review the coding and achieve a consensus for the final thematic structure. The current study details the journey of dying male inmates that emerged during ACP discussions. While the focus of these discussions was not on the process of dying specifically, intimate emotional and psychological challenges and strengths emerged, providing a glimpse into this experience for inmates. This study received approval from both a university institutional review board and the state department of corrections.
Sample Characteristics.
Results
The process of completing one’s advance care plans opened the door for the dying inmates to delve into their experience of dying in prison and issues associated with a good death. As seen in the results, the inmates have many complex feelings and situations that impact the dying process. A total of four themes emerged about the men’s experience preparing to die, with the fourth theme having subthemes.
Losing a Piece of Everything
Grief and guilt resonated throughout the comments of the inmates as they discussed their health status, advance care plans, and EOL wishes. The expression of grief was complex, incorporating losses from childhood to the period before entering prison, and then events that occurred while behind bars. Much of the grief expressed by the inmates was unresolved and diminished, despite the obvious pain it caused them. The men did not believe they could open up about their grief. “In here, no one really cares about what we are going through.” The grief was associated with previous deaths, such as death of family members and friends, and non-death-related losses associated with being in prison, including the loss of being with children and significant others, loss of contact with people on the outside, loss of jobs and homes, loss of freedom, loss of safety and control, and loss of having a future. Additional grief was associated with the loss of a life, as many of the inmates felt that they in some way died the day they entered the correctional system as they “lost a piece of me.” Inmates shared how they have little to no contact with family, and despite sending them letters for years, never hearing back. One inmate shared that he received a letter 5 years ago from his family announcing that his father had died; however, it was sent without a return address. This individual stated, “Prior to my dad’s death, I believed that eventually everyone would come around and be there for me.” But after this event, he was “shocked and saddened” that his family was “unable to move forward” from his crime. Another inmate stated, “I am grieving life, my daughter who is dying of cancer that I cannot see, and then my decline in health. I can take no more.”
Some of the men were moved to the medical classification center due to declining health status and the need to be closer to a hospital for treatment options. Thus, these individuals expressed added grief, as they lost familiarity and support from friends who resided in other correctional institutions or their “home prison.” One inmate in particular left friends of more than 25 years when he moved to the medical classification center, while another left individuals he had known since entering the correctional system at age 19. The losses that stemmed from the move were so great that, as one inmate poignantly described, he would rather stop treatment and prepare for death if he could be guaranteed to return to his “home” institution and friends. Unfortunately, no one within the prison system could confirm if this was a viable option for him.
Guilt was intertwined with the grief of the inmates, with much of it originating from their past behavior leading to prison. The inmates discussed the impact of their incarceration on others, noting that they “hurt a lot of people” or “ruined lives” and struggled to determine how to remedy their actions. The guilt of the inmates was associated with how they viewed their dying process. One inmate stated that due to his crime he “deserves nothing special” and “should be thankful for anything he gets.” Another inmate cried as he discussed the pain his mother and sister experienced watching his dad die of kidney failure, noting that as the “man in the family” he was not there to provide support and assistance. This man’s guilt was complicated by the fact he was also dying of kidney failure and he would subject his mother and his sister to the pain of his death. Other inmates experienced guilt for never having the opportunity to demonstrate remorse to those they hurt and that they had “changed.” The inmates were accepting their own death knowing that they were not forgiven and had yet to demonstrate personal growth around actions of the past.
Not Sure What to Feel
Part of the experience of dying for the inmates was managing the range of emotions that were associated with the dying process. Some of these emotions were related to dying in general, such as the fear of the unknown and leaving behind what is familiar, but other emotions were more associated with the experience of dying in prison, including harbored feelings associated with life behind bars. The emotions expressed by the inmates included fear, sadness, depression, anxiety, anger, paranoia, and others associated with a lack of control regarding their health and overall sense of personhood. One inmate stated, “Who wouldn’t be sad when you have been locked up and when you finally see yourself being free [you die before being released]?” This particular inmate was scheduled for parole 3 years later and knew he would not live long enough to reach his release date. Similarly, another inmate struggled with how to manage his fear of the dying process as he had been taught that “men are strong and show no fear. My dad told me that when death knocks at the door grab it and go with it.” This inmate also shared that his fear is so great that he often cries but cries in private, so other inmates do not see him. Other inmates struggled with disclosing that they were dying, as they perceived it made them vulnerable to other inmates and also prison staff. The fear of being “vulnerable,” “weak,” or “a potential victim” kept the men emotionally and psychologically isolated.
Where Will I Die?
Another struggle faced by inmates was reconciling where they may die. Inmates, regardless of whether they had a life sentence or knew parole was on the horizon, clung to the glimmer of hope of possibly dying on the outside. For some inmates, this prevented them from completing advance care plans or considering any option besides full treatment, should they be unable to make their health care decisions, which hindered death preparation. Of the 13 inmates in this subtheme, 6 knew their parole date, even though for 5 of them, the release date was more than 2 years away. These inmates were committed to doing whatever was possible to make it to their parole date, even though for most it was not a feasible goal as they had less than a year to live. These inmates were proactive with their medical care and researched potential treatments that had not been provided to them. Additionally, they spent time trying to coordinate care on the outside with family members or friends, if they were involved, so in case an early parole occurred or they made it to their parole date, care options were available. The one individual who made it to his parole date had coordinated with a church to ensure he had housing and hospice care ready upon his release. This man changed his advance care plans from full treatment to comfort measures only upon release.
Inmates who realized that they would die behind bars were preparing for what this experience would be like. For some, this involved choosing hospice care and moving from the general population or medical units to the private hospice rooms, but for others it was a cognitive process, accepting what their final days would be like and how they wanted to spend them. One inmate lived by the philosophy of “when your time is up, walk away and be a winner even though everyone else sees you as a loser.” For this man, the sense of “holding your head high” as he died in prison was critical. Other inmates’ preparation for in-prison death involved personal forgiveness for one’s crimes. For example, one inmate met with the ACP facilitator, chaplain, and prison psychologist over a period of months working toward personal forgiveness and reconciliation. As he poignantly stated, “How can I die when I have yet to prove I am a good man.” With his death imminently approaching, this inmate was able to share that he was finally able to forgive himself and receive forgiveness from others, such as family members. Other men viewed their deaths as a blessing, as finally their physical and emotional pain was over.
Finding Purpose in the Midst of Purposelessness
One of the central findings that was shared among all 20 inmates pertained to how they defined their purpose in life and a sense of meaning for their existence. For the inmates who were facing the notion of dying behind bars, reflecting on and identifying a core purpose for their continued existence was central to their death preparation. Inmates’ self-identified life purpose largely dictated how they chose to spend their final days, weeks, and months.
For seven inmates, faith was the focal point for their overall purpose of life. They viewed a newfound faith in a higher being, a renewed faith, or an emerging faith as a key reason for their worth and continuance in life, regardless of the crimes that they had committed. Faith created for them a sense of meaning in life and in death, and it shaped how they were viewing their health status and pending death. Those individuals who were grounded in their faith viewed death as not an end but instead a beginning, one in which their crime had little relevance. One inmate indicated that he was welcoming death, as death was time for him to “go home” and start living anew. For this particular inmate, he saw his purpose in life as trying to introduce other inmates to Jesus Christ by leading Bible studies and being a model inmate. Another inmate had completed a minster-in-training program 10 years prior and viewed his ability to share his faith with other inmates, particularly younger inmates who were new to the prison system, as the reason he continued to live.
Other inmates used their faith to help ease guilt regarding their crimes. One inmate discussed the biblical story of Job and his ability to overcome many obstacles without losing his faith. Throughout his six facilitated ACP sessions, this inmate was never without his Bible and often referenced the spiritual tests he was being given while in prison. Another individual stated, “I have always been selfish, and now I am realizing how much better life is when I care about others. If there is God, I hope he wants me.” Another individual stated, “I made the choice to end up in prison,” but he knew “Jesus still has time if he really wants to come in and save me.” Drawing on one’s religious and spiritual belief system allowed inmates to identify reasons to behave prosocially, develop comforting conceptualizations about impending death, and spend their days engaging in activities that felt meaningful and personally fulfilling.
Thirteen inmates saw service to others as a core purpose in life, particularly as they were facing changes in their health and starting to face the prospect of death. The inmates who considered service a core purpose for living shared a strong commitment to helping other inmates, even as their own health status declined. Some of the inmates who valued service worked in volunteer roles such as with the prison hospice program, mentoring programs for younger inmates, and working with inmates who were suicidal or experiencing personal hardships. One inmate defined this by saying, “I have been here for over 50 years, so they know I know what I am talking about.” He went on to say, “all my prison friends have died so now I help others.” Another individual discussed how he did not want to receive help with “bathing, toileting, getting out of bed,” as his goal was to “service others, not others serve [him].” Another inmate defined his dying process as an instance of service to others by stating, “service can even occur in death should I be able to donate my body to science.” Finally, a different inmate shared, “I want to be a role model, and people see me with having strength in death.”
Other inmates saw their prison job as a form of service to others. For example, one inmate stated, “[my] job is the only thing I do to pass the time and give back to others.” For this inmate, his notion of service started at the beginning of his prison sentence over 25 years ago, as he would donate blood when the local blood bank would come. Other inmates have been forced to reevaluate what service to others means for them personally, as their ability to provide service in a certain way often diminished as their disease process progressed. One inmate explained that historically he had helped others by working with other inmates on projects and serving as a mentor. However, as his health had declined, he grew increasingly dependent on other inmates for his personal care, including taking him to the yard for time outside. This inmate stated he tries to share “words of advice” during the time the younger inmates take him outside. He shares with these younger inmates his philosophy on life and advises how best to “survive in prison.” His philosophy, “I laugh at life as I have very little control. If I can’t laugh, I can’t live.”
As the inmates discussed their advance care plans, nine inmates shared small aspects of prison life that make life worth living. These items, while small, were aspects of their lives that created anticipation, excitement, or as one inmate indicated, made him feel “like a person.” One inmate defined the small things as playing video games, watching TV, and helping with donations given to the prison. A different inmate stated that the video games on the units made prison feel more like home, which helped his life have greater meaning. Another inmate identified that certain foods were “small things” that made life worth living, particularly hard-boiled eggs. The small things in life were also associated with relationships with others. For several inmates, the friendships that were established while incarcerated gave life meaning, particularly as they were preparing to die. A different inmate stated that as long as his sister comes several times a year for visitation, his life has purpose and value.
Preparing for the Inevitable
Through the ACP sessions, inmates discussed funeral plans or burial wishes. Inmates’ thoughts and reactions to funeral planning were somewhat divided, according to whether or not the inmates’ family members were involved. Inmates who were in contact with family members or friends relied on these individuals to assist with funeral planning upon their death. Some inmates noted that they already had family plots where they would be buried and some had already discussed their funeral service with family members. As one inmate stated, “I am excited for my service, as it will be the first time I have been on the outside since I was 19.” Another inmate shared, “page 177 and page 166 are my favorite songs, and they need to be played in and outside during my memorial.”
Inmates who were not in contact with family members struggled with the thought of their death and burial. These inmates were aware of the prison policy that states inmates are cremated and their ashes buried at one of the state’s prisons in the event no family member or friend wishes to claim the remains. Universally, these inmates requested that “anything be done with my ashes” but bury them on prison property. One particular inmate went as far as to say, “pour me in a pothole, but not one ash on prison property.” For the inmates who had no other means or options to support a burial and service outside of prison, being buried on prison property symbolized them still “not having freedom” and instead being “imprisoned even in death.”
Interestingly, of the 20 inmates in this study, 18 did not feel a memorial service at the prison was necessary with many vehemently requesting that one not be held. These inmates questioned the value of a memorial service, as many had been moved from other prisons to the medical classification center and felt that they did not have the relationships in this new prison to warrant a service. These inmates, however, were more likely to want a memorial service if there was some way to have the service held at their “home prison.” Other inmates were resistant to a memorial because they were unsure what would be shared about them that had any meaning to others. A few men felt that due to their prison status, they were not deserving of any special recognition or attention. Even when challenged by the facilitator about the purpose of a memorial, some still felt that it was unnecessary. Controlling the memorial service (or lack thereof) was an important aspect of death preparation for these inmates.
Discussion
As the number of inmates dying in prison due to old age and serious disease continues to rise, the provision of EOL care will increase in need and importance. Our study provides a vivid illustration of what preparing for death in the prison context is like for dying inmates. Through the process of facilitated ACP sessions, inmates revealed their concerns, struggles, and aspirations to find meaning when dying in an environment perceived as wholly unconducive to dying.
The importance of high-quality EOL care and the facilitation of a “good death” are widely accepted (Ellershaw, Dewar, & Murphy, 2010; Meier et al., 2016), although the accessibility of achieving a good death is not equitable across diverse social settings, such as prisons (Burles et al., 2016). Indeed, a fundamental disconnect exists between the aims of incarceration and caregiving (Dubler, 1998), which complicates the provision of EOL care in this setting. Interestingly, though, many of the issues participants in this study discussed in regard to their preparing for death mirrored issues that arise in the regular community context of EOL, such as grief and loss, management of emotions, and reflecting on purpose (Ardelt & Koenig, 2007; Willis, Lewis, Ng, & Wilson, 2015). Thus, a paradox emerges whereby dying individuals in the community and those behind bars wrestle with similar struggles while preparing to die, yet differ in regard to their propensity for a good death.
“Sense of closure” is considered an important component of a good death (Kehl, 2006) but was something participants in this study particularly struggled with. Overwhelming feelings of grief and loss featured prominently in the inmates’ ACP narratives. The grief was multifaceted, pertaining to a variety of issues both related and unrelated to their current disease process. Inmates lost time to live a normal life on the outside and along with this, they lost ties to family members. Inmates could never recover time spent in prison nor the time missed with family members. Likewise, inability to say goodbye and/or resolve tension with loved ones could never be reconciled, given their incapacitation. Furthermore, for the inmates with life sentences and no chance of parole, the possibility of a happier future was also not plausible. All of these instances of irreconcilable grief challenged inmates’ ability to achieve a sense of closure.
Our study provides a first look at grief from actual dying inmates’ perspectives. In conducting a review of the tasks of grief in prison, Hendry (2009) concluded, “it is clear that issues of masculinity and culture have a strong impact on the ability of incarcerated men to resolve grief issues” (p. 270). Interestingly, the implementation of grief counseling groups inside correctional facilities has been examined in the literature, and this research suggests that the group format is a fruitful approach for addressing this vulnerable population’s grieving (Ferszt, Salgado, DeFedele, & Leveillee, 2009; Olson & McEwen, 2004). Accordingly, prisons that operate hospice programs may consider the incorporation of group grief support into their care programs in an attempt to better address the prominent psychosocial suffering and grieving that emerge for dying inmates who may or may not feel able to adequately express and manage their grief. Although inmates may not feel a sense of closure is realistic, the availability of such support would likely enhance inmates’ well-being as they engage in death preparation by providing a space to talk about their grief.
“Being in control,” another attribute of a good death identified by Kehl (2006), emerged as a roadblock in preparing for death, especially in regard to the location of death. Inmates possessed little control about whether or not they would die in the community or in prison as the decision of parole lies not in their hands. Even for inmates who were certain they would die in prison, lack of control was experienced by having little say in which prison facility they would ultimately die in. Our findings support past findings in which dying inmates experienced hindered personal agency while engaging in ACP due to feeling as though they possessed little control over their fate and deeply mistrusted prison medical staff.
“Leaving a legacy” was one attribute of a good death that inmates struggled with in terms of being remembered as a criminal or being buried on prison grounds. Interestingly, though, many inmates attempted to address this issue by finding meaning in acts of selflessness during the time they had left to live. Inmates felt that providing services to others, mentoring younger inmates, or taking on volunteering roles were all ways in which they could not only fulfill a sense of purpose and meaning in life but also redeem themselves for the bad acts that had led to their incarceration.
Conclusion
For the participants in this study, the process of engaging in ACP sparked preparations for their impending deaths. Inmates struggled to manage a variety of losses and overwhelming emotions while striving to achieve a sense of purpose in their final days. Findings highlight the importance of correctional hospice programs offering grief support services in addition to identifying the specific types of losses faced by dying inmates. Additionally, our findings shed light on ways in which prison medical staff can support and facilitate meaning-making while preparing for death, by supporting inmates’ desires to serve others and making volunteering roles available. While the limitations of this study must be acknowledged (see Sanders et al., 2017), this study effectively reminds us of terminally ill inmates’ needs as dying patients while also illustrating the complexities they face while preparing to die in prison, thereby improving our understanding and ability to provide appropriate care and promote good deaths.
Footnotes
Declaration of Conflicting Interests
The authors disclosed no conflicts of interest with respect to the research, authorship, or publication of this article. For information about JCHC’s disclosure policy, please see the Self-Study Program.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.