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Meeting end-of-life care needs for patients in custody

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To the Editor: The medicolegal complexities of withholding and withdrawing medical treatment in end-of-life (EOL) settings have been discussed in the Journal by White and colleagues.1 EOL care is becoming increasingly important in the incarcerated population, posing unique challenges for health services.

Although health teams are accustomed to discussing EOL issues and instituting advance care directives (ACDs) within the general community, knowledge of the legal implications of implementing ACDs in the prison setting is lacking.

We see that it is becoming more important to have reference frameworks when exploring the EOL wishes of inmates. An ageing prisoner population, increasing incarceration times, underuse of preventive and screening schemes before incarceration, mental illness, illicit drug use, and high rates of tobacco smoking and alcohol misuse are some of the identified behaviours limiting life expectancy in this group.2

To ascertain current Australian practices, we emailed the prison health authorities of other jurisdictions. A number of jurisdictions are beginning to engage patients in custody regarding their EOL care wishes, and are trialling the implementation of ACDs. However, to our knowledge, no jurisdiction has established EOL care policies for prisoners with life-limiting diagnoses.