Dying for a Change: Understanding Compassionate Release Policies in the United States

Author: Shivani Kaushik, PhD, MSSW, University of British Columbia – Okanagan

As the United States prison population continues to age, the question of how society supports incarcerated individuals at the end of life has become increasingly urgent 1. With more than two million people behind bars, and sentencing practices that often ensure incarcerated people grow old and in many cases, die, within correctional facilities, the nation is confronting a human rights dilemma: Can incarcerated people expect a dignified death, and are existing compassionate release policies sufficient to ensure it? 

Conducting a systematic review utilizing rigorous PRISMA guidelines, this study analyzed decades of research examining U.S. compassionate release policies, programs intended to allow terminally ill or severely debilitated individuals to spend their final days in the community instead of a correctional facility. Although these policies exist in every U.S. state, the study reveals they remain profoundly underutilized, often hindered by structural barriers, ambiguous eligibility criteria, and pervasive public stigma. Ultimately, the findings highlight the need for sweeping reform to protect the basic human rights and dignity of dying incarcerated people. 

The Growing Crisis of Aging and Illness Behind Bars

The demographic shift within U.S. carceral systems is stark. Increasing numbers of incarcerated people are older adults, many of whom live with chronic or terminal illnesses 2. Longer sentencing practices, including mandatory minimums and life-without-parole sentences, have ensured that individuals are more likely to age inside the prison system rather than reenter their communities. 

Simultaneously, correctional facilities face significant challenges in providing adequate healthcare, let alone specialized end-of-life or palliative care 3. With overcrowded populations, limited staffing, and insufficient resources, prisons are often ill-equipped to deliver compassionate, comprehensive support to those who are terminally ill. For many imprisoned people, the prospect of dying in a setting designed for punishment rather than care becomes an unavoidable reality. 

Compassionate release policies were developed as an alternative; an attempt to mitigate not only the financial burden of providing intensive medical care in prisons but also the ethical implications of forcing individuals to suffer and die while incarcerated 4. Yet despite the promise of these programs, they remain largely inaccessible and inconsistently applied 5. 

A Systematic Review of What Is Known

The systematic review synthesized findings from databases including MEDLINE, CINAHL, PsycINFO, PubMed, and others, ultimately identifying 20 relevant studies (17 qualitative and 3 quantitative). These studies examined the landscape of compassionate release policies in the U.S., their implementation, and barriers to their use. 

The overarching conclusion: although compassionate release is available on paper, it is seldom attainable in practice. 

Four major themes emerged from the analysis, each highlighting a critical barrier impacting the feasibility and fairness of the compassionate release process. 

1. Complicated and Inaccessible Policy Language

One of the most significant barriers is the complexity of the policies themselves. The review found that the language outlining compassionate release eligibility and processes is often confusing, ambiguous, or overly technical. This creates challenges not only for incarcerated people but also for lawyers, healthcare providers, and review boards. 

In many cases, inmates are simply unaware that compassionate release is an option. Even when they are aware, understanding how to apply, which criteria they must meet, or how to navigate bureaucratic requirements becomes nearly impossible without legal or administrative support. 

2. Restrictive and Inconsistent Eligibility Criteria

Eligibility requirements vary widely across states. Some require a terminal diagnosis with a specific prognostic timeframe, such as a life expectancy of six months, while others allow for broader considerations like advanced age or severe functional impairment. Many states rely heavily on medical prognostication, despite the reality that predicting life expectancy with precision is notoriously difficult. 

As a result, people who could potentially benefit from compassionate release may be deemed “not sick enough,” even when they are facing clear physical decline or irreversible illness. Others may deteriorate or die before their applications are reviewed. Regrettably, these inconsistencies create inequitable access, where an inmate’s chances of dying in community rather than prison depend largely on geography and administrative discretion. 

3. Over-Reliance on Prognostication

Medical providers often struggle with predicting terminal timelines, particularly in chronic progressive conditions such as dementia, heart failure, or COPD. Yet many compassionate release laws hinge on strict prognostic thresholds. This places physicians in an ethically challenging position as their clinical judgment directly determines an inmate’s eligibility for freedom. 

Moreover, the process can take months, even years, rendering time-sensitive decisions ineffective. Some applicants die waiting for a response. Others become ineligible as their conditions evolve. The review highlights that a more nuanced, flexible, and clinically informed approach is necessary. 

4. Public Stigma and Social Apathy

Perhaps the most profound barrier is societal. Public stigma against incarcerated individuals shapes everything from political will to policy implementation. Many community members and policymakers view compassionate release as an undeserved mercy rather than a human rights obligation. 

This punitive orientation devalues the suffering of incarcerated people and positions their needs as less worthy of attention, resources, or empathy. As a result, calls for compassionate reform often fail to gain traction. Advocates continue to argue that reframing end-of-life care as a human rights issue, not a matter of leniency, may help shift public perception. Moreover, by adopting an international human rights framework emphasizes the importance of dignity, autonomy, and access to healthcare for all people, including those who are imprisoned. 

Implications for Research, Policy, and Practice

The review identifies several urgent needs for improvement: 

1. Increased education and collaboration

Healthcare professionals, legal advocates, correctional staff, and policymakers must work together to improve knowledge about compassionate release policies. Consistent training can help ensure that eligible individuals are identified early and supported through the application process. 

2. Clearer, more standardized policies

Simplifying and standardizing eligibility criteria across states could reduce inequities and confusion. Policies that are easy to understand and apply would improve both access and fairness. 

3. Reduced reliance on rigid prognostic timelines

Compassionate release should consider functional status, suffering, and quality of life as opposed to strict life expectancy predictions. 

4. Addressing systemic stigma

Community education and policy advocacy are essential to shift cultural attitudes toward incarcerated people, particularly those who are terminally ill. Social workers and healthcare professionals can play pivotal roles in reshaping narratives about dignity, mortality, and justice. 

5. More research on inmate experiences

There is a notable gap in literature addressing the lived experiences of dying incarcerated people, their families, and correctional healthcare providers. Future research must center these voices and narratives to inform more humane and effective policies. 

The Role of Social Workers

Social workers are uniquely positioned to advocate for incarcerated individuals seeking compassionate release. Their skills in assessment, counseling, advocacy, and systems navigation make them essential allies for imprisoned people living with terminal illness. Social workers can assist in preparing applications, documenting needs, engaging interdisciplinary teams, and conducting research that informs policy reform. 

At the heart of this work lies a commitment to dignity. As Henry Ward Beecher famously noted, “Compassion will cure more sins than condemnation.” For incarcerated people facing the end of life, compassionate release offers not only relief from unnecessary suffering but also recognition of shared humanity, a vital right no sentence should take away. 

Conclusion

The systematic review makes clear that compassionate release policies in the U.S. are failing to meet their intended goals. While intended to offer mercy and dignity, these policies often fall short due to complex language, inconsistent eligibility criteria, reliance on uncertain prognostic timelines, and widespread social stigma. As the incarcerated population continues to age, these shortcomings will only become more pressing. Reforming compassionate release is not merely a logistical challenge but a moral imperative. Ensuring that individuals can die with dignity, regardless of the crimes they committed, reflects a society’s commitment to human rights, justice, and compassion. 

_________________________________________ 

About the Author

Shivani Kaushik, PhD, MSSW, has over a decade of experience in the social services field and a strong background in teaching, research, and practice. She is currently an Assistant Professor of Teaching in the School of Social Work at the University of British Columbia (Okanagan). Her clinical work includes supporting diverse populations, with a particular focus on individuals experiencing loss, grief, and anticipatory grief. Dr. Kaushik has extensive training in end-of-life and palliative care and brings a deep commitment to social justice to her work. She is especially passionate about reducing barriers to compassionate, equitable health care for marginalized communities. 

_________________________________________

References

 

1. Turner, M., Payne, S., & Barbarachild, Z. (2011). Care or custody? An evaluation of palliative care in prisons in North West England. Palliative Medicine, 25(4), 370–377.  
2. Institute for Crime & Justice Policy Research (2016). World prison brief. Prison Studies. https://www.prisonstudies.org/country/united-states-america 
3. Maschi, T., & Richter, M. (2017). Human rights and dignity behind bars. Journal of Correctional Health Care, 23(1), 76–82. doi: 10.1177/1078345816685116.  
4. Berryessa, C. (2020). Compassionate Release as a “Right” in the Age of COVID-19. The American Journal of Bioethics, 20(7), 185-187. doi: 10.1080/15265161.2020.1777348 
5. Maschi, T., Leibowitz, G., Rees, J., & Pappacena, L.M. (2016). Analysis of US Compassionate and Geriatric Release Laws: Applying a Human Rights Framework to Global Prison Health. Journal of Human Rights and Social Work, 1, 165-174.