​End-of-life care for inmates

Hospice to me is something special because it allows me to gain peace as I start to prepare to pass into eternity.” This statement was shared by a 59-year-old inmate. Serving 72 years for double murder, he had recently been admitted to the hospice unit. One in every five prisoners in the United States has tested positive for the coronavirus, more than four times the rate of the general population¹ Numerous health issues that had worsened over the last few years placed this offender in the high-risk category for COVID-19. He knew that, short of an absolute miracle, he was never getting out of prison.

With an increasingly aging prison population, end-of-life care for inmates is becoming a more prominent issue. Ultimately, every correctional facility will have inmates who are diagnosed with a terminal condition. These can be times of great sorrow, loneliness, confusion, and emotional pain for inmates.

The chaplain’s role

What is a chaplain’s role in the hospice process of a dying inmate? A chaplain should be seen as one who cares for all when it comes to pain and struggles. A chaplain is a person who cares for the soul and gives hope without discrimination. A chaplain should be able to communicate spiritual compassion, regardless of a person’s religious beliefs. A chaplain’s role in the hospice program is crucial because many people turn toward spirituality for comfort at the end of their life. The expert spiritual care and counsel a chaplain provides is paramount in helping patients come to terms with their condition and find peace.

Hospice chaplains are dedicated to providing patients with “care and spiritual counsel that meets their needs and is in accordance with [their] wishes. If a patient does not wish to engage with a . . . chaplain or [receive] any form of spiritual care, they do not have to.

“Chaplains do not seek to convert patients . . . [to] a specific religion but to instead meet the patient where they are on their spiritual journey and help the patient discover renewed meaning and spiritual peace. . . .

“A cornerstone of the hospice philosophy of care is that no one should be alone at the end of life. No matter the time of day or night, the hospice team, including the hospice chaplain, is dedicated to ensuring that no patient dies alone.”² To aid in this, many prisons have introduced hospice programs where fellow inmates are selected and trained to assist with dying inmates and become their daily living assistants. The chaplain makes sure these assistants are always at the bedside of a dying inmate to provide comfort and support.

Chaplains are not there to “fix” anything. They are there to listen to the inmates as they talk about what’s important to them. Hospice patients talk about their impending deaths or about God, but mostly they talk about unfinished business, unanswered questions, regrets over their past, family issues, and their feelings of not yet being ready to die. “Listening to final inquiries like these has long been the domain of a family [pastor,] priest, or rabbi. But for a growing number of [older persons] who do not know a member of the clergy,”³ that bedside responsibility has now been given to the chaplain.

Some chaplains refer to what they do as fostering a more “caring and successful” experience by helping inmates gain peace in the final hours of their lives. In the hospice idiom, the job of the chaplain is to make dying easier. End-of-life care for hospice inmates is not about people becoming more spiritual or religious. It’s about a shift in the way people are meeting the spiritual needs and the emotional needs of inmates before they take their last breath. It’s about making sure that no hospice patient dies alone.