transfusion) or even resorting to self‑mutilation in order to press for a demand, protest against authority or demonstrate support for a cause. 1.4 Medical consultations In line with CM Rec(2006)2 on the European Prison Rules (EPR), paragraph 42.1‑3 (Duties of the medical practitioner), the medical practitioner shall see every prisoner as soon as possible after admission, whenever inmates complain of illness, after injuries or violence and before release. If personally unable to see the new prisoner or prisoner patient in due time, the doctor must ensure that another physician or qualifed nurse will stand in.13 Wherever this is not possible, due to understafng of health‑care personnel and/or overcrowding of prisons, the frst of the seven essential principles of the CPT, access to a doctor, would be hampered. It is the responsibility of the health‑care staf to claim additional staf if needed and to document this claim. In its country visits, the CPT repeatedly identifed in many countries inadequate stafng of health‑care personnel in prisons. The sequels of insufcient health‑care stafng – lack of, or delays in, medical examinations, consultations or care – can amount to inhuman treatment, a violation of Article 3 of the ECHR.14 The patient’s consent As a rule, health‑care professionals must not carry out examinations or treat‑ ment without the consent of the patient. True consent requires proper infor‑ mation – “informed consent” – which should also take into account illiteracy, difculties in understanding and language barriers, often found in the prison population, a problem that the CPT has encountered in several country visits. In case of non‑consent or refusal, the doctor must make sure that the patient understands the implications of his/her decision and that the patient is informed that he/she can revoke his/her decision at any time. Any deroga‑ tion from the principle of patient consent is justifed only if it complies with the law, for example in the case of those mentally ill patients who do not have the capacity to understand the consequences or in cases of emergency treatment of unconscious patients. Non‑compliance with this ethical principle has been found time and again during CPT visits.15 The European Court of 13. CM: Recommendation Rec(2006)2 on the European Prison Rules (revised). 14. Pavalache v. Romania 38746/03; Khudobin v. Russia 59696/00, Hummatov v. Azerbaijan 9852/05. 15. CPT/Inf (2008)26, (2009)13, (2010)1, (2011)1, (2011)20. Prison health care and medical ethics Page 14