ESSEX PAPER 3: INITIAL GUIDANCE ON THE INTERPRETATION AND IMPLEMENTATION OF THE UN NELSON MANDELA RULES No Role of Medical Staff in Discipline or Punishment Rule 46 underscores that medical staff should have no ‘role in the imposition of disciplinary sanctions or other restrictive measures’. This is in line with the UN 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.267 Similar provisions are included in the World Medical Association Statement on Body Searches of Prisoners,268 the International Council of Nurses Position Statement,269 and the Dual Loyalty Guidelines.270 This means that doctors must not play a role in the disciplinary basis for the imposition of sanctions. It also means that they must not assess whether a prisoner is medically ‘fit’ for the imposition of a sanction such as isolation. This is because the role of medical staff is to provide health-care, and it is ‘in the interests of safeguarding the doctor/patient relationship, that healthcare staff should not be asked to certify that a prisoner is fit to undergo punishment’.271 They must therefore not be involved in any decision-making which is not related to their patients’ health needs. Furthermore, sanctions such as solitary confinement are inherently harmful to a person’s health. It would therefore violate medical ethics, Rule 43 of the Nelson Mandela Rules which prohibits restrictions or disciplinary sanctions that amount to torture or other cruel, inhuman or degrading treatment or punishment as well as the fundamental mission of medical staff in prisons to provide care as set out in Rule 25, to make an assessment of medical ‘fitness’272 for a sanction. However, once a prisoner is undergoing disciplinary measures, the Essex Group noted that healthcare staff should pay particularly close attention to the health of prisoners held under any form of involuntary separation, including by visiting such prisoners on a daily basis and providing prompt medical assistance at the request of such prisoners or prison staff. In the same vein, Rule 46(3) provides health-care staff with ‘the authority to review and recommend changes to the involuntary separation of a prisoner in order to ensure that such separation does not exacerbate the medical condition or mental or physical disability of the prisoner’. The Essex Group noted that this access is protective and provides a route for the health- Principle 3 of UN Principles of Medical Ethics: ‘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 Principle 2: ‘It is a gross contravention of medical ethics, as well as an offence under applicable international instruments, for health personnel, particularly physicians, to engage, actively or passively, in acts which constitute participation in, complicity or, incitement to or attempts to commit torture or other cruel, inhuman or degrading treatment or punishment’. 267  WMA Statement on Body Searches of Prisoners, adopted by the 45th World Medical Assembly, Budapest, Hungary, October 1993 and editorially revised in May 2005 and October 2016, available at: http://www.wma.net/ en/30publications/10policies/b5 268  The International Council of Nurses, Position statement on Nurses’ role in the care of detainees and prisoners (adopted in 1998, reviewed and revised in 2006 and 2011) available at: http://www.icn.ch/images/stories/documents/publications/ position_statements/A13_Nurses_Role_Detainees_Prisoners.pdf 269  Dual Loyalty Guidelines, Guideline 14: ‘15. The health professional should not participate in police acts like body searches or the imposition of physical restraints unless there is a specific medical indication for doing so or, in the case of body searches, unless the individual in custody specifically requests that the health professional participate. In such cases, the health professional will ascertain that informed consent has been freely given, and will ensure that the prisoner understands that the health professional’s role becomes one of medical examiner rather than that of clinical health professional’. See also the Trencin Statement, 13-14. 270  CPT Standards, para. 73, p. 47. 271  Principle 3 and 4(b), UN Principles of Medical Ethics; Commentary to Recommendation REC(2006)2, Rule 43, p.21; CPT Standards, para. 73, p.47. 272  Penal Reform International and the Essex Human Rights Centre | 74