clearly unjustifed. Such an approach could be considered as degrading for both prisoners and the health‑care staf concerned.52 Professional independence of prison health‑care staf The health‑care staf in any prison are potentially staf at risk. Their duty to care for their patients, sick prisoners, may often confict with considerations of prison management and security. This can give rise to difcult ethical questions and choices. In order to guarantee their independence in health‑care matters, it is important that such personnel are aligned as closely as possible to the mainstream of health‑care provision in the community. Whatever institutional arrangements are made for the provision of health care in prison, it is essential that prison doctors’ clinical decisions are governed only by medical criteria and that the quality and efectiveness of their work are assessed by a qualifed medical authority.53 Doctors treating both prisoners and prison staf There are reservations about the practice of prison doctors treating both pris‑ oners and prison staf.54 The resources allocated for medical care for prisoners are often limited, and sharing doctors’ working time could be to the detriment of the quality of that care. If exceptionally required by particular circumstances in an establishment, such a dual responsibility should be accompanied by very specifc safeguards guaranteeing an even‑handed approach. For example, it should be stipulated beforehand what percentage of the doctors’ working time could be devoted to staf. It is also desirable that the two stocks of medication (for prisoners and staf respectively) be kept separate from each other. It might even be envisaged that the doctor has two separate places for consultation. Prisoners acting as health‑care staf The involvement of inmates in a prison’s health‑care service should be seen as a last resort, even when they have medical qualifcations. Prisoners should not be involved in the performance of health‑care tasks that require specialised training, and under no circumstances should they perform the distribution of medicines. 52. CPT/Inf (2011)29. 53. CPT/Inf (2004)36. 54. CPT/Inf (2006)11. Medical ethics in prison Page 25