Position Statements
Motion 86-3-14: Universal screening of incarcerated inmates with HTLV III antibody testing should not be done.
Motion 87-8-9: ACHSA reaffirms its previous policy (per Motion 86-3-14) to the effect that "universal screening of incarcerated inmates with HTLV III antibody testing should not be done"; ACHSA endorses public health surveillance studies concerning the prevalence of AIDS in the population so long as such studies meet requirements for protection from human research risk; and the ACA is urged to endorse these positions.
Policy statement adopted September 1991:
Recalling its 1986 position against mandatory HIV testing, the Board of Directors of the American Correctional Health Services Association opposes the provision of the 1990 federal Omnibus Crime Act which ties federal law enforcement grant funds to state laws mandating HIV testing of sex offenders and the American Medical Association position favoring mandatory universal HIV testing of incarcerated inmates. It is our position that mandatory testing is costly and serves no useful public health function. We do believe that voluntary HIV testing, along with an effective AIDS education program, should be aggressively encouraged among correctional inmates.
If and when mandatory HIV testing of offenders or inmates is required in a state or jurisdiction, it is our position that correctional health care staff should not be involved. Participation in such non-consensual testing violates the trust between health care provider and patient and undermines the effectiveness of correctional health care staff. Any mandated testing should be performed by providers who are not affiliated with correctional institutions and who are not responsible for ongoing care of the offenders or inmates.
Adopted 22 September 1991
The ACHSA Board of Directors supports the right of non-condemned prisoners to voluntarily donate organs during life or at the time of death. We are opposed to organ donation by condemned prisoners, since such a policy would result in medicalizing executions, would be seen as mitigating the impact of executions, and would also be in violation of our provisional code of ethics which prohibits health professionals from being involved in any aspect of implementation of the death penalty.
Adopted 23 September 1992
Semen donation, artificial insemination, ovum recovery, in vitro fertilization, and fertilized ovum implantation are elective reproductive procedures. Inmates should have access to these procedures in accordance with prevailing community standards.
Adopted 10 March 1993
WHEREAS the harmful effects of tobacco have been well documented, and
WHEREAS some correctional jurisdictions provide inmates with free tobacco and cigarette papers
WHEREAS many correctional jurisdictions do not provide any smoke-free housing units
WHEREAS an increasing number of prisons and jails are adopting restrictions on smoking, including a growing number of entirely smoke free and tobacco free jails and prisons, and
WHEREAS the American Correctional Health Services Association is dedicated to health promotion and disease prevention,
NOW THEREFORE BE IT RESOLVED that the Board of Directors of the American Correctional Health Services Association urges its members to work toward abolishing the practice of distributing free smoking materials to inmates, and to work toward the establishment of smoke-free housing units and the prohibition of smoking in their jails and prisons.
NOW THEREFORE BE IT FURTHER RESOLVED that the Board of Directors of the American Correctional Health Services Association urges that, at a minimum, all health care units in jails and prisons shall be smoke-free.
Adopted 10 March 1993
WHEREAS children who are under the auspices of the juvenile court and are placed in private residential treatment facilities are eligible for Medicaid services, while those housed in public detention and residential treatment programs are ineligible, and
WHEREAS those children placed in private group homes, ranches, etc. have a better opportunity of having their health care needs addressed because they have Medicaid resources, and
WHEREAS this results in a two-tiered health care system and leaves those youth in government programs less opportunities to access services, and
WHEREAS when the sole source of limited funding for health care is dependent upon local government resources, the result is those youth involved in the criminal justice system are seen as competing for local youth healthcare resources rather than members of the community being served, and
WHEREAS the lack of federal monies for these high risk youth is exacerbating the problem, and
WHEREAS, without adequate and appropriate health care resources to diagnose and treat communicable diseases, these youth will pose a serious health risk to the general community upon their release, and
WHEREAS, the Federal Office of Maternal and Child Health has described these youth as "forgotten youths" and as of highest medical risk in our society.
THEREFORE, BE IT RESOLVED that it is the policy of the American Correctional Health Services Association that all children incarcerated in juvenile detention and confinement facilities are eligible for Medicaid as are children placed in non-government facilities, providing all these youth the opportunity for comparable health care services regardless of their placement.
Adopted 7 August 1994
The Policy and Standards Committee, chaired by Steven Spencer, MD, began their work on a position statement on the management of the hunger striking prisoner in response to a statement issued by the World Medical Association (WMA). The original WMA statement was published in the Winter 93 issue of CorHealth.
Prior to the development of this ACHSA position statement, the WMA statement was distributed to all state Department of Corrections and state medical associations, along with a questionnaire regarding their policies. Responses were received from 23 state corrections departments and 6 state medical societies.
A draft statement was developed and presented for discussion at the 1994 Multi-disciplinary Training Conference. More than 100 participants contributed their thoughts for consideration.
The following statement was based on the input from state departments of corrections, state medical societies, and concerned health care professionals. This statement was officially adopted by the ACHSA Board of Directors on 7 August 1994.
The management of a hunger striking prisoner presents an ethical conflict between the obligation to preserve life and relieve suffering on the one hand, and the obligation to respect patient autonomy on the other. Correctional health care providers should make every reasonable effort to honor patient self-determination. However, the deprivation of freedom which incarceration imposes will affect decision making by the inmate patient. Therefore, special efforts in patient education and counseling are indicated.
A prisoner may begin a hunger strike for various reasons. If pursued, it may have a fatal outcome, unless there is medical intervention. Correctional health care providers have a special duty to protect inmates from self-destructive behavior. When a prisoner initiates a hunger strike, and efforts to counsel and dissuade are not successful in terminating the strike, the responsible physician is obligated to obtain thorough medical and psychiatric evaluations and to monitor weight loss and other parameters of deteriorating health in an appropriate medical setting. Treatment of intercurrent medical problems must be offered. The hunger striking inmate should be informed that authorization will be requested to intervene with forced feeding when life is in danger.
Since forced feeding is a form of involuntary treatment, the responsible medical authority must seek the consent of the court or a legally appointed guardian, following the local requirements for involuntary treatment. The physician should make it clear to the court and to all others concerned, however, that ethical medical conduct in this setting demands medical intervention to preserve life from actions that are self-destructive.
ACHSA members should give careful consideration to the development of policies and procedures which provide a responsible and compassionate approach to the hunger striking prisoner, and which make it clear that efforts will be made to intervene with forced feeding in order to save life.
|
