Changing the Way We Die

Compassionate end-of-life care and the hospice movement

Hospice at the Oscars

A mind-bending film shows how hospice can transform the worst environment.

Inmate Bertrum "Herky" Burkett gives Jack Hall a massage

If hospice can work in a prison, maybe it can work anywhere. That’s the feeling I got after viewing the astoundingly tender Oscar-nominated documentary, Prison Terminal: The Last Days of Private Jack Hall. It debuts on HBO on Monday, March 31. http://www.prisonterminal.com

Working solo inside one of America’s oldest maximum-security prisons, Edgar Barens was granted unprecedented access for a year. The award-winning Chicago filmmaker focused on a murderer’s 14 days in the Iowa State Penitentiary’s hospice, where his caregivers also were felons. A one-time segregationist, Jack Hall was given sponge baths at the end of his life by black volunteers, mostly murderers like himself.

“Just rest easy, pardner,” one of the inmates tells Hall. “I’m right here.”

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Jack Hall was a decorated veteran of World War II. He drank, having never escaped the horrors he experienced in battle and in a German prison. When his son committed suicide and he heard a drug dealer bragging about it, Jack killed the man. http://www.youtube.com/watch?v=iYCL47ass7E

Incarcerated more than 21 years, Hall died at age 83.

“The problem of prisoners dying is getting worse and worse because we are sentencing people for so long,” Barens told ABCNews.com. Barens’ previous film, A Sentence of Their Own, also focused on the criminal justice system.

No other country comes close to the United States in the percentage of people incarcerated. The costs keep rising, far outstripping education. Among the 2.5 million people in prison are increasing numbers of elderly, chronically ill and terminally ill prisoners. They cost an average $65,000 a year, compared with $27,000 for healthy prisoners. Suffering from severe chronic obstructive pulmonary disease, Jack Hall spent 12 years in the prison infirmary before being transferred to hospice.

Like other hospices, the prison hospice uses a team approach, with doctors and nurses, but the hands-on caregivers are kidnappers and murderers who have gone through a 14-week training program. Often these volunteers are the only visitors, and the only one with the patient when he dies.

Being a hospice volunteer has given a first-degree murderer this perspective: “It gives me a feeling inside, that for once I’m somebody that nobody thought I could be.” 

Only 75 of 1,800 prisons in America have hospices, but because of security concerns, very few prison hospices are staffed by inmates. Tough-minded Marilyn Sales, a nurse administrator for the Iowa Department of Corrections, had to overcome resistance from prisoners as well as staff to get the Iowa program launched in 2006.

But human beings’ need for meaning won out. As one of the leading lights of hospice and palliative care in the country, Dr. Ira Byock, commented about Prison Terminal:

“Faced with living and dying inside, the inmates we meet have chosen to live in community with one another. The commitment of the inmate hospice volunteers – and the competence and reverence with which they provide care—shows that dying people’s comfort and dignity can be preserved even in the least desirable situations. Our society could learn a lot from the example they set.”

Think you don’t care about prisoners and prisons aren’t your problem? Prison Terminal is mind-bending.

– Sheila Himmel 

Fran Smith and Sheila Himmel are the co-authors of a new book on compassionate end-of-life care, Changing the Way We Die.

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