Minimum standards for health care in adult and juvenile correctional systems have been issued by the American Correctional Association and the National Commission on Correctional Health Care. These standards provide for autonomy in medical decision-making and attempt to establish a philosophy that health care in prison systems should be equivalent to the community level of care. Problems associated with the content and application of these standards are examined. Ethical considerations to be followed by physicians, nurses, and other health care providers who work in prisons are noted that pertain to inmate rights, resource rationing, confidentiality, consent, participation in executions, provider obligations to patients, and preventive care. A bioethics program is described that includes a bioethics committee, a bioethics consultation service, staff education, empirical investigation, and evaluation. Institutional facets of resolving problems in a system where security needs often conflict with the delivery of adequate health care are considered. 19 notes