Takeaway
I advocated for our team to humanize the care of our patient—namely removing handcuffs at the end of life. Even if you cannot change the outcome, speaking up for patients is one way to uphold dignity and embody the values of our profession.
Passion in the Medical Profession | September 17, 2025 | 2 min read
By Rebecca Ripperton, MD, Harvard University
Throughout medical school, I worked with many incarcerated patients—in prisons, detention centers, and hospitals. The memory of one that I met in the ICU has stayed with me like a splinter, festering with time.
Many years before I met the patient, he’d suffered a severe spinal cord injury, leaving him nearly paralyzed. When I first encountered him, he’d been admitted to the ICU with unexplained multi-organ failure. Guards had been stationed in and outside of the room and a pair of Department of Corrections-issued handcuffs bound his wrists to the rails of the hospital bed. While an endotracheal tube and ventilator marked him as our critically ill patient, his metal restraints served as a stark reminder that he was also a ward of the state.
Even under sedation, our patient moaned and tossed his head against the thin hospital pillow, his gown and sheets soaked with sweat from fever. Emboldened by prior experiences in the prison system, I asked the officers if they could remove his wrist restraints, as I had seen some physicians do in other carceral settings.
“We really can’t do that,” an officer responded.
I explained that our patient was so ill he depended on a ventilator to stay alive and that he was effectively paralyzed both by his neurologic injury and by medications. Moreover, the restraints were likely worsening his agitation; surely the presence of multiple armed guards provided more than adequate security. Still, they said no. Removal would require written approval through a series of bureaucratic appeals; it would be nearly impossible. I didn’t press the issue further or escalate the request. We continued on with rounds.
Soon we handed over the patient’s care to another team and a few days later, he died. The key eventually turned to remove his wrist restraints before autopsy.
Incarcerated patients are uniquely medically vulnerable. They are subject to systemic barriers that delay or discourage care and that translate into shortened lifespans and higher morbidity. But this patient wasn’t in a prison infirmary—he was in a hospital with vast resources. And for all the medical team’s diagnostic and therapeutic skill, we couldn’t take the small, safe, humane step of removing his restraints as he was paralyzed and dying. The image of him chained to his bed even in his last moments of life haunts me. It was needless. And I accepted it too quickly.
Removing our patient’s restraints wouldn’t have altered his medical course. But it still should have been done. For both patients and medical teams, even the smallest gestures at the end of life carry symbolic weight—what we do, or fail to do, reflects not only our care for the patient but also the values of our profession. Even if the guards had still refused after further advocacy on our patient’s behalf, we would have known that we had done our best, both medically and ethically. We would have shown our patient, the guards, and ourselves that dignity mattered—in life and in death.
Finally, “Scopes and Shields” is an excellent resource for caring for patients under law enforcement custody.
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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.