The tensions of care-giving ideals and the realities of modern health systems are an acknowledged part of palliative care. The community palliative care nurse specialist (PCNS) is pivotal in identifying those at risk and their issues of care, support and loss. This chapter discusses the challenges faced by clinical nurse specialists caring for palliative clients who are in the criminal justice system (CJS), using direct evidence, where it exists, and related evidence from other disciplines and personal experience. Offenders can feature in a community case load either in the system prior to a case being heard, after sentence is completed or on parole. The rights of marginalised patients in the community are the same as they are for any other patient, but their needs may be vastly different. Caring for a person who is through the CJS requires a multidisciplinary team (MDT)-led, patient-centred, holistic approach.