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Massachusetts Bill H.2333, An act to establish the Massachusetts incarcerated individual bone marrow and organ donation program , was introduced in February 2023 and sparked immediate controversy. In their analysis of the proposed legislation, Albertsen et al. raise the ethical issue of unequal opportunity for sentence reduction and examine Bill H.2333 relative to mainstream theories of punishment. This commentary broadens the lens to the landscape of parole and medical parole, underscoring the complex demands placed on incarcerated individuals seeking sentence reduction in Massachusetts.

Background There are roughly 6,000 individuals incarcerated in the Massachusetts Department of Corrections (MADOC), and in 2025, 32% of these individuals were age 50 and older. Older incarcerated individuals have a higher burden of chronic disease, and caring for them is associated with higher healthcare costs. In 2018, Massachusetts passed legislation enabling medical parole, a process by which an individual can be released due to terminal illness or permanent incapacitation. Existing literature suggests medical parole is underutilized. The aim of this study was to characterize the cause of death of individuals in MADOC custody to determine potential medical parole eligibility and gaps in referrals. Methods We conducted a retrospective analysis of deaths of individuals in MADOC custody between 2021 and 2023 using death records obtained from MADOC and death certificates from the Massachusetts Vital Statistics Program. Cause of death was categorized through structured review of death certificates and supplemental MADOC medical documentation. Results Between January 1, 2021 and December 31, 2023, 87 individuals died in MADOC custody. The primary disease processes leading to death involved infection (28%), complications of chronic disease (25%), and cancer (22%). Nearly half (41.7%) of infection-related deaths were due to COVID-19. The most common causes of death categorized by primary organ system were cardiovascular conditions (26%) and respiratory conditions (25%). The majority of deaths were attributed to acute causes (58%). Conclusions In our study, nearly half of the population died in custody from a chronic condition or complications related to a chronic condition and could have been identified for medical parole eligibility. The majority of individuals died from acute causes, suggesting the need for an expedited review process and expanded eligibility criteria. A small number of correctional facilities and hospitals saw the majority of deaths, and these locations may be ideal targets for future interventions. Further work is needed to compare death data before and after the COVID-19 pandemic, assess barriers to utilization of medical parole, and explore other interventions to decrease the number of deaths in MADOC custody.

The United States has a rapidly aging prison population with complex medical comorbidities. Medical parole has been proposed as a mechanism to address the heavy medical burden posed by the aging and chronically ill prison population. Current studies demonstrate medical parole is underutilized, but little is known about the factors considered when rendering a medical parole decision. The aim of this study was to describe the characteristics of medical parole applications in Massachusetts and identify predictors of the final parole decision. We conducted a retrospective review of 31 applications submitted by a non-profit legal services organization between 2022 and 2023. Univariate analysis demonstrated that a supportive superintendent recommendation and prison-contracted clinician assessment that an applicant could not perform ADLs independently were statistically significant factors in approval of medical parole. Unexpectedly, a history of disciplinary action while incarcerated was also associated with a higher likelihood of application approval, suggesting prior disciplinary action does not decrease the chances of a successful parole application. Our study suggests the superintendent and prison medical clinicians are key stakeholders with influence on the likelihood of approval of a medical parole application. Further work is needed to assess parole board decision-making when evaluating applications.

This chapter offers a brief institutional history of McCloy’s 1950 Advisory Board on Clemency for German War Criminals as a case study in how the best of intentions and hopes for “American Justice” could succumb to muddled bureaucratic mandates, questionable operating procedures, and a flawed understanding of the law that blurred the lines between an appellate court and a clemency panel. Even in the few cases where the Advisory Board sounded and behaved most like a “normal” clemency panel in its denial of applications or grants of mercy to the old, sick, and the few prisoners who presented a compelling case for sentence adjustments, the Board took great liberty in overruling the judgements imposed on the Nazi war criminals at Nuremberg. The Advisory Board determined that American punishments fit the crime in only thirteen of eighty-nine cases.

Little is known about clinical documentation for youth exposed to parental justiceinvolvement (e.g., parole, probation, jail, prison). We reviewed the electronic health records of 100 youth with at least one mention of parental incarceration between 2011–2019 from a large Midwestern pediatric hospital-based institution to describe clinical documentation and health characteristics. Within the sample, youth more commonly experienced incarceration of a father-identified figure (68%) as opposed to a mother-identified figure (32%). Seventeen percent (17%) of the youth were between zero and four years of age when clinicians documented exposure to a parent's incarceration. Nearly one-third of youth charts had no documentation regarding service referrals or follow-up from providers upon disclosure of parental incarceration. Few clinician documentation details were present related to the context of parental justice involvement (timing, type, and duration). Future research is needed to better understand the intersection of parental justice involvement and child health and service connection.

This Article addresses disability discrimination in community supervision programs, a large-but frequently overlooked-component of the criminal legal system and important contributor to America's mass incarceration crisis. The long-standing concerns of legal scholars and advocates about disability discrimination in prisons and policing, particularly against people with mental health disabilities, apply with equal measure to probation and parole. This Article examines the experiences of people with intellectual/developmental, cognitive, and mental health disabilities to understand how disability discrimination manifests in probation and parole programs and identifies numerous policies and practices that likely run afoul of two major federal disability rights laws: the Americans with Disabilities Act and the Rehabilitation Act. In explaining why such disability discrimination goes seemingly unchecked, this Article identifies major jurisdictional barriers to enforcement in the federal courts: the Preiser-Heck bar on certain civil rights litigation, abstention doctrines that insulate state criminal court decisions from review, and Eleventh Amendment limits on damages actions against state entities. Given those barriers, this Article suggests that supervision programs ensure robust compliance with disability discrimination laws by utilizing a universal design approach, providing appropriate accommodations to supervisees, and eliminating discriminatory standards. It further argues that defense lawyers and other criminal justice actors should receive training about disability discrimination laws, so they are better able to recognize and remediate disability discrimination. Finally, it suggests the expansion of diversion programs for people with disabilities, particularly those who may struggle to comply with traditional probation programs.

Adults aged 50 years or older constituted 10% of the US prison population in 2012 and 20% in 2017.1 Many factors have contributed to the aging ofthe prison population, including reduced judicial discretion (e.g., mandatory minimum sentences, three strikes legislation), indeterminate sentencing, and the reintroduction of life without parole.2 As many incarcerated older adults experience multiple physical and mental health conditions at higher rates than do nonincarcerated persons,2 prison yards are now peppered with walkers, wheelchairs, and other durable medical equipment. Incarcerated older adults are also vulnerable to predation and often live in environments not designed to meet their physical needs.3 As a result, older adults generate high costs for overcrowded correctional systems, many of which are ill suited to provide the complex medical care needed for patients of advanced age or approaching the end of life. In response to the aging of the prison population, many jurisdictions have introduced or reinvigorated legal mechanisms to release or parole people with life-limiting illness early to their communities.4 Nearly all states have some form of early release policies,4 including medical parole, medical release, and geriatric parole, to name a few (all herein referred to as compassionate release). Such mechanisms are critical release valves for bloated US correctional facilities and can serve as supportive, human rights-oriented strategies for unifying families at the end of life and transferring persons to community-based health care systems that are better equipped to meet their complex health needs.Despite the existence of compassionate release policies, a recent analysis paints a bleak portrait of their use.4 Only 4% of requests in the Federal Bureau of Prisons are granted, and anecdotal evidence points to similarly low rates among many state prison systems,4 indicating underuse of these mechanisms as an important approach to decarceration. The limited use of compassionate release is driven by numerous systemic barriers at the patient, professional, and policy levels. We describe these barriers and strategies to combat them and promote human dignity and decarceration among this medically vulnerable population.

Background People returning to communities from prison or jail face stressors related to securing housing, including discrimination, restrictions based on prior felony convictions, and limited economic and social resources. Existing housing programs can effectively reduce housing instability but often do not fully address the needs of people involved in the criminal justice system experiencing homelessness who often have co-occurring chronic medical issues, and psychiatric and substance use disorders. Methods Project CHANGE is an ongoing program to deliver person-centered, integrated care and services to individuals involved with the criminal justice system and experiencing homelessness. Applying a Screening, Brief Intervention, (Referral to) Treatment framework, a comprehensive needs assessment is followed by delivery of intensive housing and vocational case management; and psychiatric, substance use, and medical services in a single location by an interdisciplinary team. Participants are followed with study interviews for 12 months. The current analysis was designed to assess the baseline characteristics and needs of the sample population, and the intensity of contact required for integrated service delivery. Results Between November 2019 and September 2021, 86 participants were enrolled, of whom 64% had been released from prison/jail in the past 6 months; the remainder were on parole, probation, or intensive pretrial supervision. Participants were unstably housed (64%) or residing outdoors (26.7%) or in a shelter (24.4%). Most participants had high medical need and frequent healthcare engagement through outpatient and emergency department visits. Most participants were at-risk for clinical depression, and half were diagnosed with anxiety, dissociative, stress-related, somatoform, and other non-psychotic psychiatric disorders. Over 12-month follow-up, the interdisciplinary team made over 500 contact encounters, over half of which resulted in direct services provided, including obtaining vital documents for homelessness verification, housing applications, and employment coaching. Conclusion Navigation of services can be particularly challenging for individuals experiencing criminal justice involvement, homelessness, and co-occurring medical, psychiatric, and substance use issues, which can be addressed holistically in an integrated service model. Integrated service delivery was time-, resource-, and staffing-intensive, and challenged by the COVID-19 pandemic, requiring innovative solutions to sustain participant engagement.

This paper examines the multilayered dynamics behind the drivers of overdose deaths, criminal legal-system involvement, and the drug war infiltration of people’s everyday lives—especially for people under community supervision. While incarceration receives more media and academic attention because of its particular cruelty, almost twice as many people—3.7 million, or one in every sixty-nine U.S. adults—are under community supervision. Probation and parole are commonly understood as “alternatives to incarceration” or “lenient sentences,” but people on supervision must endure constant monitoring, perpetually under the threat of incarceration. Drug war policies and practices have profoundly shaped probation and parole. Regardless of someone’s original sentence, abstinence from drugs, drug testing, submission to warrantless searches, and court-ordered treatment are routine features of supervision. The putative goal of community supervision is to ensure successful reintegration; yet drug war surveillance enacts extensive barriers, while not reducing drug use or drug-related harms like overdose. In order to ensure health, financial security, and overall well-being of those under supervision, policymakers, probation and parole officers, clinicians, service providers, and researchers must work to identify and remove barriers to care, including routine drug testing, substandard or forced substance use disorder treatment, and poor-quality services and support.