1. Ethics of prison interventions
Milano, 5 October 2012

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Geneva Declaration 2012 on Health Care in Prison
Milano, 5 October 2012