Background: Compassionate release refers to a policy that allows for a reduction in term of imprisonment or early release of an incarcerated person due to their terminal illness or a debilitating disease. Compassionate release may be pursued at the federal or state level, however, the processes and criteria for compassionate release vary significantly by jurisdiction. Therefore, it is important for clinicians to know what jurisdiction their patient is incarcerated in for more specific information. This Fast Fact will introduce the process for compassionate release and identify best clinical practices.

Federal compassionate release: At the Federal level, the U.S. Sentencing Commission identifies general criteria for compassionate release for incarcerated persons who are terminally ill or facing other “extraordinary and compelling” circumstances (1). Despite efforts to increase rates of compassionate release, the federal grant rate remains low – approximately 16% of motions for federal compassionate release were granted in 2024 (2). Information on eligibility criteria, applications, and required documentation may be found at the Families Against Mandatory Minimums (FAMM) website (1). 

State compassionate release: Eligibility criteria and the complexity of the process varies between each state correctional system. Nearly all states have a policy for compassionate release. Generally, an incarcerated person with a debilitating medical condition who is gravely ill OR with advancing age and poor functional status may be eligible for compassionate release at the state level (3). A do not resuscitate (DNR) or do not intubate (DNI) code status is not generally required for compassionate release, and an incarcerated person is not mandated to pursue comfort-focused goals of care to be eligible. A time-limited prognosis, ranging from “imminently” terminal to 2 years or less to live, or permanent incapacitation due to medical illness, is a requirement in most states and varies by jurisdiction. The process and requirements for clinician input vary significantly by state. Additional information on eligibility criteria, applications, and required documentation for each state’s compassionate release process also can be found at the FAMM website (4).

Reason for compassionate release: Caring for incarcerated older adults and those who are terminally ill, including addressing their pain, physical, emotional, and spiritual needs, poses significant care challenges for incarcerated patients who are often experiencing rapidly changing clinical needs.  Additionally, there are financial challenges to the carceral system. The inability to provide appropriate care contributes to burn out and even moral injury among correctional staff. Compassionate release reduces carceral health care costs and reduces burden on staff (3).

Best practices for compassionate release include:  The process of compassionate release can take weeks to months for final approval. The legal system considers the inmate’s conduct, nature of the offense, and any potential threat to public safety when evaluating compassionate release eligibility.  Clinicians can help by providing clear and effective documentation of the medical situation and prognosis. 

1. Effective clinical documentation about the patient’s medical situation. Clinicians are often asked to document a written certification that depicts the incarcerated person’s current health status.  Information should be conveyed using clear and concise language, defining medical terminology in a simple manner including: the life-limiting diagnosis and its associated prognosis, treatments tried and failed, evidence and degree of functional and/or cognitive impairment if present, existing comorbidities, and any nursing or custodial care needs (5). 
2. Effective documentation of the community standard of care for the incarcerated person’s primary diagnosis and any limitations that may impair the incarcerated person’s ability to receive the appropriate standard of care within the carceral system (if appropriate) (5). 
3. Convene with other clinicians to formulate the most accurate, consensus prognosis.  Utilization of prognostication tools and clinical judgment are essential to identify candidates in a timely manner. Use phrasing such as “end of life trajectory” or offer prognostic ranges (e.g., less than 6-12 months) when prognostic uncertainty exists.
4. Work with your interdisciplinary team including social workers, nurses, case managers, chaplains to identify a confirmed discharge plan, housing arrangements, and family support after the incarcerated person’s release. The provision of resources for health insurance enrollment and/or veterans’ benefits are vital to include in requests for compassionate release (3). 
5. Effective communication with the decision-making body (e.g., Parole Board, resentencing court). Ensure that all pertinent health-related information has been received and to appeal denials when necessary. You may need to resubmit requests as the condition progresses. 

References   

1. Federal compassionate release criteria: Which prisoners qualify? https://famm.org/wp-content/uploads/2018/04/FS-Fed-Comp-Rel-Criteria.pdf  Accessed February 24, 2025. 
2. United States Sentencing Commission Compassionate Release Data Report: Fiscal Year 2024. 2024. https://www.ussc.gov/research/data-reports/compassionate-release-data-reports Accessed February 24, 2025.
3. Price, M. Everywhere and nowhere: Compassionate release in the states. Families Against Mandatory Minimums, 2018. https://famm.org/wp-content/uploads/2023/12/Exec-Summary-Report.pdf  Accessed March 30, 2025. 
4. Families Against Mandatory Minimums. FAMM – Families For Justice Reform. United States, 2002. https://famm.org/our-work/second-chances/compassionate-release-your-states-laws/ Accessed February 24, 2025. Accessed February 24, 2025. 
5. Kanbergs A, Garcia-Grossman I, Ahalt C, et al. A stepwise guide for healthcare professionals requesting compassionate release for patients who are incarcerated. Int J Prison Health. 2023; 19(1):77-87. doi: 10.1108/IJPH-09-2021-0095 .

Authors’ Affiliations: University of California San Diego, San Diego, CA (VNO); California Medical Facility, Vacaville, CA (MD, JC); California Correctional Healthcare Services, Elk Grove, California, USA (MD); University of California, San Francisco (JC) .
Conflicts of Interest: The authors have no conflicts of interest to disclose. 
Version History:  first electronically published in August 2025; originally edited by Sean Marks MD.