18 53. One thorny issue in the field of health care in prisons concerns the role of prison doctors in relation to disciplinary matters. Medical practitioners working in prisons act as the personal doctor of prisoners, and ensuring that there is a positive doctor/patient relationship between them is a major factor in safeguarding the health and well-being of prisoners. Obliging prison doctors to certify that prisoners are fit to undergo punishment that might have an adverse effect on their health is scarcely likely to promote that relationship. Consequently, the CPT is very pleased to note that the rule in the 1987 version of the EPR laying down such a requirement will be removed in the revised EPR; this is a significant step forward. However, this still leaves open the question of the prison doctor’s role vis-à-vis prisoners who are undergoing disciplinary sanctions which might adversely affect their health and, more particularly, the punishment of disciplinary confinement. It is not uncommon for prison doctors to be required to visit such prisoners on a daily basis and advise the prison director if the termination or alteration of the measure is necessary for medical reasons, and the 1987 version of the EPR reflects this position. There are divergent and strongly held - views as regards the acceptability of such an approach. For some, the need to protect prisoners against the harmful consequences of sanctions such as disciplinary confinement must be seen as paramount. Holders of this view believe that in the absence of a requirement to visit on a daily basis, there is a real risk that prisoners undergoing punishment will lose adequate access to the doctor; they argue that not all prison doctors can be relied upon to properly monitor such prisoners on their own initiative and that prisoners in need of care may not themselves request to see the doctor or may even be unable to do so. For others, the requirement of a daily visit is potentially harmful to the doctor/patient relationship as it amounts to the doctor confirming on a daily basis that the prisoner concerned is fit for continued punishment (unless he advises the prison director to the contrary). Holders of this view fully accept the need for prison doctors to be very attentive to the situation of prisoners undergoing punishment, but argue that their visits to such prisoners should be on their own initiative and not imposed by prison regulations. CPT: 15TH GENERAL REPORT The revised EPR maintain the requirement of a daily visit by the doctor, but at the same time make concessions to the opposing view. The issue is dealt with in a medical rather than disciplinary framework and in a generic manner, covering all prisoners held under conditions of solitary confinement; the possibility is left open for the daily visit to be carried out by a qualified nurse rather than the doctor; and, perhaps most importantly, the doctor is no longer required to advise the director whether termination or alteration of a punishment measure is necessary, but instead has a general duty to report to him whenever a prisoner’s health is being put seriously at risk by continued imprisonment or any condition of imprisonment. This is probably as close as one is going to get to reconciling the different positions on this subject. 54. The CPT understands that the revised European Prison Rules could be adopted already in the course of 2005, and it very much hopes that this will be the case. The new rules will constitute an important reference point for the Committee. More generally, they will help to promote the consistent implementation in practice of up-to-date, positive standards for the treatment of prisoners, both in Europe and elsewhere.