Inmates, like patients in the community, shy away from a program that confronts them with the fact that they are dying. To confront dying is a major life step, regardless of where one is living. I encountered some surprises in working with inmate patients, some of which have been mentioned in the few articles that have appeared about prison hospices. My experiences confirm what others have reported. And I have a few observations of my own to add.
Inmates are hesitant to come into the hospice program for several reasons.
If an inmate accepts that his condition is terminal, he doesn't want to die in prison. Nothing signifies defeat as much as dying in prison. Inmates do not trust correctional medical care in general, and the hospice program falls under that umbrella. Hospice acknowledges the patient's vulnerability, but inmates cannot afford to appear weak and needy. I was surprised to see that inmates can be non-compliant with pain medication.