NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism ANNUAL REPORT 2017 88 Furthermore, the public often has no understanding of the importance of prison health for public health, and may ask why money should be spent on the healthcare of offenders in times of budget cuts in healthcare for ‘decent’ people in the community. International standards and guidelines for providing healthcare in prison To cope with these problems, to meet these conflicting demands and to avoid misunderstandings, it is essential that: ››physicians and healthcare workers caring for detainees stick to sound medical ethics and ››medical ethics are made known, understood and accepted by the whole prison community, i.e. the prisoners and the prison administration. In the past decades, a number of internationally accepted standards and guidelines on prison healthcare ethics have been developed and issued by the United Nations6,7, the Council of Europe8,9,10, the World Medical Association (WMA)11, the International Council of Nurses12, Penal Reform International13 and Physicians for Human Rights14. The essence of all these documents can be summarised as follows: The sole task of healthcare workers is the health and well-being of the inmates and this task has to be provided with free access to healthcare for all inmates while maintaining confidentiality and respect for the patient’s autonomy, including preventive healthcare and humanitarian support based on clinical independence and professional competence. Compliance with these principles and guidelines not only ensures the ethical conduct of healthcare professionals in prison, but also provides very tangible professional advantages such as promotion of the inmates’ confidence in medical care in prison, confirmation of the doctor’s medical professionalism and ethics, prevention of misunderstandings, guidance in conflict situations, quality assurance of the medical work and safeguarding against legal complaints. — Compliance with these principles and guidelines not only ensures the ethical conduct of healthcare professionals in prison, but also provides very tangible professional advantages. — 6 Principles of Medical Ethics relevant to the Role of Health Personnel, particularly Physicians for the Protection of Detained Persons and Prisoners Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, 1982 www.cirp.org/library/ethics/ UN-medical-ethics 7 The United Nations Standard Minimum Rules for the Treatment of Prisoners (The Nelson Mandela Rules) www.unodc.org/ documents/justice-and-prison-reform/GA-RESOLUTION/E_ebook.pdf 8 Council of Europe: The CPT standards CPT/Inf/E(2002) 1-Rev 2010 http://www.cpt.coe.int/en/docsstandards.htm 9 Council of Europe: Recommendation Rec (2006)2 on the European Prison Rules https://wcd.coe.int/ViewDoc.jsp?id=955747 10 Ethical and Organisational Aspects of Health Care in Prison. R (98) 7, 1998 https://rm.coe.int/16804fb13c 11 World Medical Association Policies https://www.wma.net/policy/ 12 Int. Council of Nurses: Nurses‘ role in the care of detainees and prisoners. Adopted 1998, revised 2011 www.icn.ch/images/ stories/documents/publications/position_statements/A13_Nurses_Role_Detainees_Prisoners.pdf 13 Penal Reform International: Making Standards Work. An international handbook on good prison practice. 2nd edition, 2001. www. penalreform.org/publications/making-standards-work-international-handbook-good-prison-practice 14 Physicians for Human Rights: Dual Loyalty and Human Rights in Health Professionals Practice. http://physiciansforhumanrights. org/library/report-dualloyalty-2006.html