Ethics of prison interventions joerg.pont@meduniwien.ac.at Milano, 5 October 2012

Prisons: Total Institutions Erving Goffman: Asylums, 1961 Michel Foucault: Surveiller et punir, 1975 Milano, 5 October 2012

Total Institution Closed setting cut off from society Repressive organization, hierarchic structures Formal bureaucratic regimentation of all spheres of individual life that take place under one roof Strict discipline and constant surveillance Violent subculture Little individual responsibility of inmates Deprivation of resources, stimuli, privacy, choices and autonomy Milano, 5 October 2012

International consented documents on medical ethics in prison United Nations UNHRC Council of Europe, CPT World Medical Association WMA International Council of Nurses ICN Penal Reform International PRI Physicians for Human Rights PHR Milano, 5 October 2012

The essence of medical ethics in prison The sole task of 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 Milano, 5 October 2012

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 Milano, 5 October 2012

The essence of medical ethics in prison The sole task of 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 Milano, 5 October 2012

Medical ethics Prison reality Confidentiality, privacy, consent Equivalence of medical care Free access to medical care Professional independence Prison Health is Public Health Disease prevention Health promotion and taking over responsibility for health Aftercare, Throughcare Recommendations, declarations, rules: „soft law“ Safety and security first Lack of resources Overcrowding, understaffing Employment by prison admin. Lack of public support Pathogenic environment Deprivation of autonomy and self-determination Separation from society Penitentiary laws Milano, 5 October 2012

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 Milano, 5 October 2012

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. Milano, 5 October 2012

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 Milano, 5 October 2012

3. Acceptance by the public and legal adaptation Incorporation of principles of medical ethics into penitentiary laws Advocacy of „Prison Health is Public Health“ Milano, 5 October 2012

Geneva Declaration 2012 on Health Care in Prison http://ump.hug-ge.ch/ Geneva.Declaration@hcuge.ch Milano, 5 October 2012