How Everyday Limitations Shape Medical Parole Decisions in Massachusetts

Medical parole — sometimes called compassionate release — is designed to give people in prison who are seriously ill or severely incapacitated a chance to spend the remainder of their lives outside correctional facilities. The idea sounds straightforward: if someone’s physical or cognitive condition is so debilitating that they no longer pose a threat to public safety, keeping them incarcerated serves little purpose. But despite that intent, medical parole remains rarely granted in many places, including Massachusetts.

A new study by researchers at Boston University’s Chobanian & Avedisian School of Medicine takes a close look at why approvals are so uncommon and what actually influences these decisions. The research team reviewed 31 medical-parole applications sent to the Massachusetts Department of Correction (MADOC) between 2022 and 2023 through Prisoner Legal Services. Their analysis uncovered two major factors that carried statistically significant weight: the recommendation of the prison superintendent and the applicant’s inability to perform activities of daily living (ADLs) such as bathing, dressing, and eating.

The Massachusetts medical parole law requires that applicants demonstrate a debilitating condition that appears incurable, one that is likely to result in death within 18 months, or a permanent physical or cognitive incapacity so severe that the individual can no longer present a public-safety risk. Even with this strict standard, the overall approval numbers remain low. Since the law took effect in 2018, a little over 100 people have been granted medical parole statewide as of mid-2024 — a small number compared to the total population of sick or aging incarcerated individuals.

What the Study Shows About How Decisions Are Made

The researchers examined each petition and identified which elements were associated with a successful outcome. Two stood out clearly:

Superintendent recommendation: If the superintendent of the facility where the person was incarcerated supported the medical parole request, the chances of approval increased significantly. Superintendents appear to function as important gatekeepers in the process, likely because the commissioner overseeing medical parole decisions relies heavily on their judgment.
ADL limitations: Applicants who needed assistance with basic self-care tasks had notably higher approval rates. This suggests reviewers prioritized clear, measurable indicators of severe impairment over less visible health concerns.

Another interesting and somewhat surprising finding involved disciplinary history. Many assume that past disciplinary problems would hurt a parole application. Instead, the study found the opposite: people with a history of disciplinary actions were more likely to be approved. The researchers believe this correlation reflects a demographic pattern rather than a moral judgment. People incarcerated for longer periods tend to accumulate more disciplinary incidents over time, and simultaneously, they are more likely to experience age-related or chronic health decline. In other words, the approval trend may be linked to length of incarceration, not behavior.

Why These Findings Matter

Medical parole is often framed as both a humanitarian measure and a practical one. Releasing people who are no longer capable of harming others can reduce overcrowding in facilities, lower correctional health-care costs, and ensure that seriously ill individuals receive appropriate care outside prison walls. But the system only works when decisions are made consistently and transparently.

This study highlights an important limitation: decisions may hinge more on institutional opinion — particularly that of the superintendent — than on any standardized assessment of medical need. That sometimes results in wide variability between facilities. If one superintendent is more cautious or unsupportive of releases, approval rates in that facility could be significantly lower.

It also raises questions about whether current rules and procedures create unnecessary barriers. Medical parole applications require extensive medical documentation, a structured release plan, a risk assessment, and review by multiple layers of the correctional department. Even small delays in this process can become critical when applicants are facing terminal or rapidly progressing conditions.

The Required Medical Parole Process in Massachusetts

To understand why approval rates are low, it helps to understand the process mandated by state regulations (specifically 501 CMR 17.00):

A petition can be filed by the incarcerated person, an attorney, a relative, a medical provider, or a DOC employee.
Once the application is submitted, the superintendent has 21 days to issue a written recommendation.
After that, the commissioner must issue a decision within 45 days.
Petitions must include extensive medical information, documentation of the person’s condition, and a detailed medical parole plan explaining how the person will receive care and where they will live.
Even after approval, individuals remain under the supervision of the Massachusetts Parole Board. If their health improves significantly, or if they violate parole conditions, they may be returned to custody.

Why Medical Parole Remains Underused

Despite its purpose, medical parole is rarely granted. There are several reasons researchers and advocates have pointed out:

Strict eligibility standards make many chronically ill people ineligible. Someone can be gravely ill but still not meet the criterial threshold of terminal prognosis or total incapacitation.
Administrative delays sometimes push decisions beyond the period when release could meaningfully improve the person’s remaining quality of life.
Institutional risk aversion encourages decision-makers to err on the side of caution, even when medical evidence indicates low public-safety risk.
Complex application requirements make it difficult for applicants to gather all necessary documents without legal assistance.

Many advocates argue that these obstacles undermine the original purpose of the law: to reduce unnecessary suffering and allocate correctional resources more effectively. The study suggests that reforms may be needed to standardize assessments, reduce dependence on individual superintendents’ opinions, and make medical evaluations more central to the decision.

Broader Context: Medical Parole Nationwide

Outside of Massachusetts, compassionate release policies vary widely across states and in the federal prison system. However, many share similar patterns:

Low approval rates, even among applicants with advanced illnesses.
High administrative burdens, including lengthy review processes.
Lack of standardized criteria for evaluating medical need and public-safety risk.

Some states rely more heavily on external medical review boards, while others place nearly all authority in correctional administrators. States with independent medical review systems often show more consistent decision patterns and higher approval rates for individuals who clearly meet criteria.

Advocates across the country have pushed for stronger, more medically informed parole frameworks, arguing that compassionate release reduces health-care costs, eases overcrowding, and aligns with basic standards of human dignity. As the U.S. prison population continues to age, these questions are becoming even more urgent.

Why This Research Matters for Policy and Public Understanding

The Boston University study contributes real data to a topic that is often discussed but rarely examined at this level of detail. With only 31 cases in the dataset, the sample size is small, but the patterns it uncovers are important. The findings bring attention to the need for:

More transparency in decision-making.
Clearer medical criteria that prioritize functional limitations.
Less reliance on administrative opinions that vary between institutions.
More timely review so applicants do not die waiting for decisions.

As policymakers consider reforms, this research may help inform new approaches that prioritize medical necessity, equity, and humane treatment.

Research Reference:
Key Characteristics of Medical Parole Applications in Massachusetts in 2022–2023
https://www.nature.com/articles/s41598-025-24358-0