Professional independence of health
care workers in prison
Jörg Pont, Vienna
Bucharest 27.02.2013
The essence of medical ethics in prison
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The primary task of the prison doctor and the other health
care workers is the health and well-being of the inmates.
The 7 essential principles for the practice of prison health
care, as set out by the CPT:
Free access to a doctor for every prisoner
Equivalence of care
Patient consent and confidentiality
Preventive health care
Humanitarian assistance
Professional independence
Professional competence
Bucharest 27.02.2013
Bucharest 27.02.2013
International consented documents on medical
ethics in prison
United Nations UNHRC
Council of Europe, CPT
World Medical Association
International Council of Nurses
Penal Reform International
Physicians for Human Rights
Bucharest 27.02.2013
73. A prison doctor acts as a
patient‘s personal doctor.
CPT standards
Bucharest 27.02.2013
prison‘s doctor
or
prisoners‘ doctor?
Bucharest 27.02.2013
“ Confidence of prisoners in the health care of a
prison can only be obtained if it is known to
everyone in the prison that for a prison
physician, nurse or health care worker the
patient has to have and indeed has priority
over order, discipline or any other interests of
the prison.”
Penal Reform International,
Making Standards Work, 2001
Bucharest 27.02.2013
Principle 3
It is a contravention of medical ethics for
health personnel, particularly physicians, to be
involved in any professional relationship with
prisoners or detainees the purpose of which is
not solely to evaluate, protect or improve
their physical and mental health.
UN Resolution 37/194, 1982
Principles of Medical Ethics relevant to the role
of health personnel in the protection of prisoners
Bucharest 27.02.2013
The prison doctor‘s job profile
• Individual medical care of prisoners
• Inspection of food, hygiene, living conditions
and physical/mental exercise of prisoners
• Advice to prison management and training to
everybody in prison in health care matters
Bucharest 27.02.2013
Professional independence and mental health
43. A mentally ill prisoner should be kept and cared for
in a hospital facility which is adequately equipped and
possesses appropriately trained staff.
The CPT Standards
12.1 Persons who are suffering from mental illness and
whose state of mental health is incompatible with
detention in a prison should be detained in an
establishment specially designed for the purpose.
European Prison Rules
Rec (2006)2
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Professional independence and mental health
• Assessment of mental competence for
consent
• No disclosure of patient-related medical data
or forensic certificates without patient‘s
consent.
• No blood/urine checks or participation in body
searches for security reasons
Bucharest 27.02.2013
Professional
Independence
 promotes the confidence of the
inmates to the medical care in
prison
 leaves no doubt as to the health
care team’s medical
professionalism and ethics
 prevents misunderstandings
 provides guidance in situations
of ethical conflicts
 supports quality assurance of
the medical work
 protects against legal appeals
 is internationally supported
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Dual Loyalty: the clinical role conflict
between professional duties to the patient
and obligations, express or implied, to the
interests of a third party such as the prison
government.
Physicians for Human Rights, 2002
Bucharest 27.02.2013
1. Awareness, training, support
Awareness and training in medical ethics for
health care professionals and
non-medical prison staff
Active support and oversight of prison health
care professionals by national professional
boards and health authorities
Bucharest 27.02.2013
2. Reduce dual loyalty conflicts
• Uncompromising separation of medical roles in
prison:
Professionals caring for prisoners should
adhere exclusively to caregiving in complete
professional independence.
Medical functions in the interest of the state,
prosecution, court or the security system to
be performed by professionals not involved in
the care of prisoners.
• Prison health care to be organized independent
of prison authorities.
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Integration of prison health care within the
community health care system
Completed:
Geneva, Wallis, Waadt;
Norway, France,
Australia: NSW;
England + Wales,
Scotland
In transition/planning:
Spain, Italy, Slovenia,
Turkey, Georgia,
Moldova, Russia
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Improved quality
Professional independence
Continuity of care
Common resources
Completion of public health
initiatives and epidemiological
surveillance
• Better recruitment and less
isolation of prison health care
staff
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3. Acceptance by the public and legal adaptation
Incorporation of principles of professional
independence of health care workers in
penitentiary laws
Advocacy of „Prison Health is Public Health“
Bucharest 27.02.2013
Geneva Declaration 2012 on Health
Care in Prison
http://ump.hug-ge.ch/
Geneva.Declaration@hcuge.ch
Bucharest 27.02.2013