Scopes and Shields Restores Dignity to Incarcerated Patients
November 16, 2023
By Matt Griffith, M.D., MPH
She lay dying from a disease she could not prevent or control, far from her home, shackled to her bed, and alone. As a third-year resident, I admitted this woman as a direct transfer from the state prison for respiratory failure, likely an acute complication of her chronic fibrotic lung disease. She had been in the hospital for this condition before and was used to being shackled to her hospital bed. I had never cared for a shackled patient before, but to her this was a familiar burden. So was the burden of being watched at all times by law enforcement officers, when toileting, bathing, and while being examined. All familiar to her, yet all new and shocking to me. These new and troubling circumstances terrified me, yet my attendings, co-residents, the nurses, and staff didn’t question this practice, so I was reluctant to do so. My heart told me to protest against this dehumanizing treatment, but my desire to be seen as another reasonable and competent member of the team kept me silent. Despite treatment, her status worsened rapidly. Later that day she was intubated and proned. Still, she remained shackled, bound to her bed, and watched by law enforcement officers at all times though she posed no danger to me, herself, or anyone else. Despite our team’s best efforts to support and heal her, she ultimately suffered a cardiac arrest that night and died. Even after dying, she was only released from her bonds after I asked the officers to do so.
Reflecting on her care, I recalled my reading of Luke 23, where Luke reminds us that Jesus spent his last day on earth similarly bound. While on the Cross, to his left and right were unnamed criminals, convicted of different crimes than Jesus was, but sentenced to the same punishment. Although Luke never mentions the crimes these men are convicted of, tradition has labeled these men as thieves. The thief on his left, the Unrepentant Thief (sometimes referred to as Gestas), mocks him and tells Jesus to climb down off the cross and help him down as well. While, to his right, the Good Thief (sometimes referred to as St Dismas), does not ask to be taken down and instead only asks Jesus to “remember me when You come into Your Kingdom.” Jesus responded to the Good Thief, “Amen, I say to you, today you will be with me in Paradise.”
My understanding of this story had always been rather basic. I always took it to mean that, rather than ask Jesus to take away our burdens, whether fairly earned or not, we should bear our “crosses” in the knowledge that we will be relieved in life to come. However, reflecting on the care I provided for my patient caused me to notice a few new details about Luke’s Gospel. In the story of Jesus and the two criminals, we see Jesus guarantee that the Good Thief will be with him in Paradise after his death. On rereading this passage, despite the tradition that these men were thieves, I was reminded that Luke doesn’t tell us what the man is convicted of. Although this may seem like an omission to spare us an unseemly detail (i.e. Jesus’s last conversation on earth is with a convicted murderer), perhaps he is indicating that it does not matter. All of us, including those who are convicted of crimes, are worthy of the same Paradise, regardless of legal status.
Similarly, all patients are worthy of receiving dignified and ethical treatment regardless of their legal status or the crimes they have committed or been accused. We, as doctors, nurses and health care professionals, should deliver the same treatment to all who have fallen gravely ill and require our healing touch. Although we may already know this truth in our hearts and feel the call to action from our spirit, many of us think that a good citizen obeys the law without question. Therefore, we don’t question the extension of society’s punishments into our clinical spaces. However, Jesus’s final days, including his conviction and execution, should remind us that someone’s legal status does not define who they are. Luke, our patron saint of physicians, reminds us that all who are ill and dying deserve our care and grace.
Founders of Scopes & Shields L to R: CMA member Dr. Wes Ely, Dr. Kathleen Akgun, Dr. Matt Griffith, Dr. Erin DeMartino, and Dr. Amen Sergew.
I, along with other pulmonary and critical care medicine physicians and attorneys, have created a website called Scopes and Shields to help provide compassionate and ethical guidance for providers caring for patients in law enforcement custody. Specifically, the site is for providers who work outside of jails and prisons in civilian emergency departments, hospitals, and clinics. We present multiple common clinical scenarios on our website that you may have encountered or will encounter, followed by a response including guidance that has been evaluated and approved by ethical and legal experts. We intend that you may use it at “2 am” when you are unable to consult a legal or ethical expert in your workplace, or whenever you would like reassurance or guidance about appropriate practice when a patient arrives in your unit with law enforcement officers at their side. We encourage you to explore the other resources and advocacy opportunities provided on the website as well.
By engaging with Scopes and Shields, we hope that you will be able to provide the similar guarantee to your patients as Jesus provides to the Good Thief. That your patients will receive the same and best treatment you can offer, regardless of their legal status.
Dr. Matt Griffith is a pulmonary and critical care medicine physician and co-founder of Scopes & Shields. He is an assistant professor of Pulmonary Sciences and Critical Care Medicine at the University of Colorado Anschutz Medical Campus, as well as the Core Investigator at the Denver-Seattle VA Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care.