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Professional independence of health care workers in prison Jörg Pont, Vienna Bucharest 27.02.2013.

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Presentation on theme: "Professional independence of health care workers in prison Jörg Pont, Vienna Bucharest 27.02.2013."— Presentation transcript:

1 Professional independence of health care workers in prison Jörg Pont, Vienna Bucharest

2 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 Bucharest

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4 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

5 73. A prison doctor acts as a patient‘s personal doctor. CPT standards Bucharest

6 prison‘s doctor or prisoners‘ doctor? Bucharest

7 “ 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

8 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

9 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

10 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 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 Bucharest

11 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

12 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 Bucharest

13 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

14 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

15 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. Bucharest

16 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 Bucharest

17 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

18 Geneva Declaration 2012 on Health Care in Prison / Bucharest

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