Our most fundamental constitutional right is that no person may be deprived of life, liberty, or property without due process of law. When an individual is deprived of liberty by the state, the state assumes the responsibility for caring for the basic needs of that individual. A prisoner is unable to go out and get food and water, so the state must provide it. If the state did not provide it, the prisoner would be deprived of life. This is also the basis for a prisoner’s right to medical care: a prisoner deprived of necessary medical care may be deprived of life or health. It is the extent of this constitutional right to care that is at issue.

The legal standard for judging the adequacy of prison medical care delivered by state employees is whether there is a deliberate indifference to the prisoners’ welfare. (Medical care practitioners who work for private contractors are liable for ordinary malpractice.) The prisoner need not show that the prison officials intend harm through inadequate or improper medical care. A mere showing of malpractice is not enough, however. The legal standard for prison medical care is much lower than the standard for free persons. This poses an ethical dilemma for prison medical care practitioners: when is it ethically permissible to provide lower- quality medical care for prisoners? Although the easy answer is “never,” there are few prisons that will fund community standard medical care for prisoners. Is it unethical for physicians to work for these institutions, or is it better to provide the care that is possible under the limited circumstances?