A Nonideal Approach to Truthfulness in Carceral Medicine

This chapter examines truthfulness, or veracity, in the context of health care services within prisons, jails, and detention facilities in the United States. Mainstream discussions of bioethics often highlight the general importance of veracity within the patient-provider relationship, including providers’ obligations and constraints with respect to telling the truth to their patients, and, to a lesser extent, patients’ responsibilities and concerns regarding truthful reporting to their providers. However, a great deal of this literature largely overlooks how structural barriers to health care impact the functions of veracity in the provision of health care—including racist and sexist biases in clinical judgment, inadequate staffing, infrastructure, and accessibility in medical facilities, and institutionally specific constraints. Through an analysis of Assata Shakur’s political autobiography, this chapter focuses on such structural barriers to health care in carceral facilities with a focus on the institutionally specific constraints that arise through the punitive aims of carceral facilities. By focusing on the intersection between punishment and health, this chapter argues that bioethicists and clinicians alike would be better equipped to analyze structural barriers to health care that exist both within and beyond prison walls through a nonideal approach.