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Clinical Framework for the Treatment Relationship With Mentally Disabled Inmates  

Author:  James L. Knoll IV, MD.

Source: Volume 23, Number 03, Summer 2022 , pp.49-63(15)

Correctional Health Care Report

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The general medical ethics principles of beneficence, confidentiality, and non-malfeasance (first do no harm) do not evaporate at the security gates of a prison. However, there are some special nuances to the treatment relationship in corrections that the correctional health professional quickly comes to realize. In the community, clinicians in private practice may pick and choose those patients with whom they will begin a treatment relationship. Once established, the doctor-patient, or clinician-patient, relationship creates the legal recognition of a duty of care owed to the patient. In contrast, correctional clinicians usually do not have this choice, particularly because resources tend to be in short supply. This is but one nuance of the correctional treatment relationship, and there are others to which the competent correctional clinician must attend. This article addresses the impact of the corrections culture on the treatment relationship, as well as the fundamental foundations of the treatment relationship. The author discusses important challenges faced by all health care providers and also those specific to correctional mental health treatment. Finally, this chapter takes a look at the special topic of treatment of patients on death row.

Keywords: Correctional Culture and Treatment; Consent to Treatment; Confidentiality; Duty to Protect; Dual Agency; Liability Risk Management; Treating the Difficult Patient; Psychopathy; Malingering; Treatment On Death Row

Affiliations:  1: SUNY Upstate Medical University.

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