End-of-Life Decision Making

Idaho
Department of
Correction

Standard
Operating
Procedure

Operations
Division

Operational
Services
Control Number:
401.06.03.086
Version:
2.2
Page Number:
1 of 4
Adopted:
3-1-2001
Reviewed:
6-11-2012

Title:
End-of-Life Decision Making

This document was approved by Shane Evans, director of the Education,
Treatment, and Reentry Bureau, on 6/11/12 (signature on file).
Open to the general public: Yes
BOARD OF CORRECTION IDAPA RULE NUMBER 401
Medical Care
POLICY CONTROL NUMBER 401
Clinical Services and Treatment
DEFINITIONS
Standardized Terms and Definitions List
Advance Directives: Documents such as a living will, healthcare proxy, or do not
resuscitate order in which an offender expresses his wishes as to how future healthcare
should be delivered or declined, to include decisions that must be made when he is no
longer capable of expressing his wishes.
Contract Medical Provider: A private company or other entity that is under contract with
the Idaho Department of Correction (IDOC) to provide comprehensive medical, dental,
and/or mental health services to the IDOC’s incarcerated offender population.
Facility Health Authority: The contract medical provider employee who is primarily
responsible for overseeing the delivery of medical services in an Idaho Department of
Correction (IDOC) facility.
Facility Medical Director: The highest ranking physician in an Idaho Department of
Correction (IDOC) facility.
Health Authority: The Idaho Department of Correction (IDOC) employee who is primarily
responsible for overseeing or managing the IDOC’s medical services. (The health authority
is commonly referred to as the health services director.)
PURPOSE
The purpose of this standard operating procedure (SOP) is to establish procedures for
executing an advance directive for (a) offering an offender the opportunity to outline medical
treatment options he would exercise in an end-of-life situation, or (b) specifying which
individual(s) may make end-of-life decisions on his behalf.
Control Number:
401.06.03.086
Version:
2.2
Title:
End-of-Life Decision Making
Page Number:
2 of 4

SCOPE
This SOP applies to all Idaho Department of Correction (IDOC) healthcare services staff,
offenders, contract medical providers, and subcontractors.
RESPONSIBILITY
Health Authority
The health authority is responsible for:
• Monitoring and overseeing all aspects of healthcare services, and
• The implementation and continued practice of the provisions provided in this
SOP.
When healthcare services are privatized, he will also be responsible for:
• Reviewing and approving (prior to implementation) all applicable contract medical
provider policy, procedure, and forms; and
• Monitoring the contract medical provider’s performance, to include but not limited
to reviewing processes, procedures, forms, and protocols employed by the
contract medical provider to ensure compliance with all healthcare-related
requirements provided in respective contractual agreements, this SOP, and in
National Commission on Correctional Healthcare (NCCHC) standard P-I-04,
End-of-Life Decision Making. (See section 3 of this SOP.)
Contract Medical Provider
When healthcare services are privatized, the contract medical provider is responsible
for:
• Implementing and practicing all provisions of this SOP, unless specifically
exempted by written contractual agreements;
• Ensuring that all aspects of this SOP and NCCHC standard P-I-04 are
addressed by applicable contract medical provider policy and procedure;
• Ensuring facility health authorities utilize all applicable contract medical provider
policy, procedure, forms, and educational information to fulfill all healthcare-
related requirements provided in this SOP, NCCHC standard P-I-04, or as
indicated in their respective contractual agreement(s);
• Ensuring facility health authorities utilize all applicable contract medical provider
policy, procedures, forms, and educational information to assist offenders in
completing advance directives in accordance with Idaho law;
• Ensuring all applicable contract medical provider policy, procedure, and forms
are submitted to the health authority for review and approval prior to
implementation; and
• Ensuring that continuing education for qualified health professionals includes, but
not be limited to, formal presentations on end-of-life issues and care.
Note: Nothing in this SOP shall be construed to relieve the contract medical provider(s)
of any obligation and/or responsibility stipulated in respective contractual agreements.
Control Number:
401.06.03.086
Version:
2.2
Title:
End-of-Life Decision Making
Page Number:
3 of 4

Facility Medical Director
The facility medical director will be responsible for reviewing (with the attending
physician) all cases of terminal illness and monitoring processes to ensure that the
offender receives thorough and accurate explanations of all available options regarding
end-of-life care.
In addition, the facility medical director and facility health authority (or designees) will be
jointly responsible for ensuring that all issues regarding the offender’s competence to
initiate an advance directive have been sufficiently addressed by qualified health
professional staff.
Facility Health Authority
The facility health authority will be responsible for:
• Ensuring the presence of an adequate number of appropriately trained staff and
materials are available to meet the requirements of this SOP;
• Establishing and monitoring contract medical provider policy and procedure to
ensure that all elements of this SOP and NCCHC standard P-I-04 are
accomplished as required;
• Establishing and monitoring contract medical provider policy and procedure to
ensure that language and cultural barriers to communication are addressed
before a discussion about advance directives is conducted with the offender;
• Establishing and monitoring contract medical provider policy and procedure to
assure that advance directives are filed appropriately and executed in
accordance with the offender’s express wishes; and
In addition, the facility health authority and facility medical director (or designees) will be
jointly responsible for ensuring that all issues regarding the offender’s competence to
initiate an advance directive have been sufficiently addressed by qualified health
professional staff.
Table of Contents
General Requirements ......................................................................................................... 3
1. Types of Advance Directives .......................................................................................... 3
2. Guidelines ...................................................................................................................... 4
Terminally Ill Offenders ............................................................................................. 4
3. Compliance .................................................................................................................... 4
References ........................................................................................................................... 4
GENERAL REQUIREMENTS
1. Types of Advance Directives
The following are three (3) types of advance directives that offenders may utilize:
• Living Will. A living will specifies which clinical interventions an offender wants
done.
Control Number:
401.06.03.086
Version:
2.2
Title:
End-of-Life Decision Making
Page Number:
4 of 4

• Healthcare Proxy. A healthcare proxy specifies who can make healthcare decisions
for the offender when the offender is incapacitated. (Note: An offender shall not be
allowed to serve as a healthcare proxy for another offender.)
• Do Not Resuscitate (DNR) Order. A DNR order serves as the offender’s specific
refusal of certain extraordinary measures that may prolong his life.
2. Guidelines
• Healthcare services staff shall encourage an offender during clinic encounters to
consider advance directives while the offender is capable of making decisions and
before the effects of illness or disease have reduced the offender’s capacity to
consider the benefits, burdens, and risks of alternative treatments.
• An offender shall be provided education about his diagnosis, prognosis, care options,
the consequences of choosing an advance directive, and the availability of palliative
care and hospice services.
• Healthcare services staff shall provide the forms or documents needed to complete
the type of advance directive the offender wants to utilize.
Terminally Ill Offenders
• The designation of terminal illness shall be assigned by the attending physician in
agreement with the facility medical director and facility health authority, and after
such diagnosis has been made utilizing medical diagnostic testing that meets
community standards of care.
• An opportunity to execute advance directives shall be provided to terminally ill
offenders.
• Terminally ill offenders may be transferred to facilities with infirmaries and/or end-of-
life care programs.
Note: When an offender is given the designation of terminal illness, also see policy
324, Release of Offenders from the Custody of the Idaho Department of Correction
and SOP 324.02.01.002, Parole of Offenders with a Terminal Disease or Permanent
Incapacitation.
3. Compliance
Compliance with this SOP and all related IDOC-approved protocols will be monitored by the
health authority (or designee) by using various sources to include: this SOP, clinical practice
guidelines, routine reports, program reviews, and record reviews.
REFERENCES
National Commission on Correctional Health Care (NCCHC), Standards for Health Services
in Prisons, Standard P-I-04, End-of-Life Decision Making
Policy 324, Release of Offenders from the Custody of the Idaho Department of Correction
Standard Operating Procedure 324.02.01.002, Parole of Offenders with a Terminal Disease
or Permanent Incapacitation
– End of Document –