Bioethics and Corrections: An Experiment in Bioethics in the Florida Department of Corrections
Thomas, David L., Corrections Today
Before the late 1960s, many state correctional systems operated relatively independently. The people working in corrections ranged from extremely professional on one end of the spectrum to abusive on the other. In the early 1970s, Florida, as most other states, found itself embroiled in many legal challenges. The publicly expressed philosophies of personal independence and freedom in the late 1960s and 1970s were reflected in the U.S. Supreme Court decisions. Within correctional systems, models based on rehabilitation rather than incarceration were the penitentiary approaches of the time. However, like all cyclic historical movements, this lasted several decades and then waned.
The late 1980s and 1990s saw a return to a public desire for more and tougher incarceration in its various wars on crime. Advocates of "hard time" were every bit as zealous as reform model supporters of a decade and a half earlier. These huge changes in public philosophy over a very short span of time created tremendous pressure on correctional systems to appropriately care for inmates. While pendulum swings between reform and retribution are common in the history of penology, such a great swing in such a short period of time was very unusual. The pressure facing corrections seemed greater than ever.
One approach to dealing with such pressure was the establishment of a forum based on the rational approach to the humane treatment of people, irrespective of their class in society. The Florida Department of Corrections elected to establish such a bioethics forum in 1995.
Beginning in the early 1970s, the Supreme Court was presented with and settled a variety of cases involving the substantive rights of inmates in correctional systems. These include access to courts, with the affirmative duty of prison officials to assist inmates in preparing and filing legal papers (Bounds v. Smith); freedom of speech, association and religion, unless the "interference is related to a legitimate penal interest" (Thornburgh v. Abbott); and some rights concerning personal property, searches and seizures (Hudson v. Palmer). Other decisions involving the Eighth Amendment sought to distinguish cruel and unusual punishment from the obvious realities of prison life. Rhodes v. Chapman assured due process and equal treatment, but went on to clearly state that "the Constitution does not mandate comfortable prisons."
In the fundamental case concerning health care (Estelle v. Gamble), the court found that deliberate indifference to the serious medical needs of inmates constitutes the "unnecessary and wanton infliction of pain" and, therefore, violates the Eighth Amendment. From this case, a series of decisions has evolved to ensure inmates three basic rights: access to medical care, receipt of care that is ordered and a professional medical judgment.
At the same time that these Supreme Court decisions were being made, many states were faced with federal District Court challenges, including (in Florida) Cellestino and Costello et al. v. Wainright, later Dugger and then Singletary; (in Texas) Ruiz v. Estelle, later Scott; and (in Georgia) Cason v. Seckinger. Most states increased their expenditures on health services for inmates and responded to court decisions. During the 1980s, many of the large prison systems operated under consent decrees with federal courts and monitoring teams.
Bioethics Committees In Community Hospitals
During the same two decades of these court actions came an explosive revolution in the health care industry. Many varieties of difficult and technical procedures became commonplace, medical miracles in diagnostics and therapies were regular occurrences, and costs were addressed seriously for the first time since 1965. Federally mandated concepts, such as "diagnostic related groups" (Instituted by Medicare as a cost-control measure, they were assigned patients who had been hospitalized and dictated the amount of reimbursement predicated on the simplest treatment of the diagnosis irrespective of the complexity of the individual case. …