professional independence of health care workers in prison

Professional independence of health care workers in prison

Jörg Pont, Vienna

Bucharest 27.02.2013

The essence of medical ethics in prison

1. The primary task of the prison doctor and the other health care workers is the health and well-being of the inmates.

2. 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


International consented documents on medical ethics in prison

United Nations UNHRCCouncil of Europe, CPT

World Medical AssociationInternational Council of Nurses

Penal Reform InternationalPhysicians for Human Rights


73. A prison doctor acts as a patient‘s personal doctor.

CPT standards


prison‘s doctoror

prisoners‘ doctor?


“ 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


Principle 3It 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, 1982Principles of Medical Ethics relevant to the roleof health personnel in the protection of prisoners


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


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.

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.

The CPT Standards

European Prison Rules Rec (2006)2


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


ProfessionalIndependence

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


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


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


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.


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

• 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


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“


Geneva Declaration 2012 on Health Care in Prison

http://ump.hug-ge.ch/

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