90 The term was defined in 1982 in the UN Principles of Medical Ethics Relevant to the Role of Health Personnel in the Protection of Prisoners20: ‘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,’ and, expressed in fewer words, in the CPT Standards21: ‘A prison doctor acts as a patient‘s personal doctor’. — A prison doctor acts as a patient‘s personal doctor. — NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism ANNUAL REPORT 2017 In order to reduce the risk of dual loyalty, two steps are essential. Firstly, the uncompromising separation of medical roles in prison, i.e. health professionals caring for prisoners should exclusively provide care based on professional independence. Medical functions in the interest of the state, prosecution, court or the security system are to be performed by health professionals not involved in the care of prisoners. Secondly, prison healthcare should be organised independently of prison authorities.22 In the vast majority of European countries, prison healthcare governance is still under the responsibility of the same ministry that is responsible for the execution of detention or imprisonment, i.e. Ministries of Interior or Ministries of Justice or Corrections. It stands to reason that these administrations focus primarily on their main tasks and have less understanding and less expertise in healthcare issues. Norway with its ‘import model’ and the Swiss canton of Geneva were pioneers in Europe, transferring healthcare governance from the Ministry of Justice to public healthcare administrations or the Ministry of Health. They were followed by France, the United Kingdom, Iceland, the Swiss cantons Vaud, Wallis and Neuchatel, Cyprus, Kosovo and recently Finland. A number of other European countries are planning such a shift or are still in the process of transition. 20 Office of the United Nations High Commissioner for Human Rights: UN Resolution 37/194, 1982 Principles of Medical Ethics relevant to the Role of Health Personnel, particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment http://www.ohchr.org/EN/ProfessionalInterest/Pages/MedicalEthics.aspx 21 The CPT Standards. www.coe.int/en/web/cpt/standards 22 WHO/UNODC. Good governance for prison health in the 21st century. A policy brief on the organization of prison health www. unodc.org/documents/hiv-aids/publications/Prisons_and_other_closed_settings/Good-governance-for-prison-health-in-the-21stcentury.pdf