ESSEX PAPER 3: INITIAL GUIDANCE ON THE INTERPRETATION AND IMPLEMENTATION OF THE UN NELSON MANDELA RULES use of force and of restraints are ‘clearly high risk situations insofar as the possible ill-treatment of prisoners is concerned, and as such call for specific safeguards’362 – as the CPT has diagnosed. The Essex group discussed the update to provisions on the use of instruments of restraint, and noted overarching principles363 which apply to the use of force, of arms and of instruments of restraints, measures that are often used in combination by staff responding to incidents. (See Chapter 6, Incident Management – Use of force and arms): •  prohibition of certain methods/instruments •  legality •  necessity •  proportionality •  use in the least painful way, not causing humiliation or degradation. The Essex group recalled the prohibition of the use of restraints that are ‘inherently degrading or painful’ (Rule 47(1)), which derives from the general prohibition of torture and other cruel, inhuman or degrading treatment or punishment. They emphasised that such cases foreclose the invocation of considerations of necessity or proportionality to ever justify their use. The experts noted the explicit prohibition of chains and irons as illustrative examples of instruments of restraint which have been considered inherently degrading and painful. They emphasised that the absence of a longer list of prohibited items merely reflects reasons of practicality. They referred to their second expert meeting, where they had noted the ‘challenges involved in updating the lists of prohibited instruments and methods of restraint’ as terminology varies between states and technology is always evolving with the risk that the list becomes quickly outdated and underinclusive.364 The Essex group stressed that the term ‘instruments of restraint’ should be interpreted to include all forms of restraint, including chemical restraints, and noted the prohibition in the Beijing Rules of administering medicines as a means of restraint.365 The experts recalled the prohibition of instruments of restraint being used on women during labour, during childbirth and immediately after childbirth, enshrined in Rule 48(2) as well as in Rule 24 of the Bangkok Rules. They recommended this principle to be expanded to late pregnancy and noted that the prohibition has been introduced to account for the fact that the use of restraints on women in such situations raises concerns about degrading treatment as well as medical complications. They noted that women in labour need to be mobile to assume various positions and so they can be moved to an operating room quickly if necessary.366 CPT 2nd General Report, CPT/Inf (92) 3, para. 53. 362  Balancing security and dignity 2nd edition. 363  Essex 2, para. 48. 364  Rule 55 of the UN Rules for the Protection of Juveniles Deprived of their Liberty states that medicines ‘must not be administered with a view to eliciting information or a confession, as a punishment or as a means of restraint’. 365  See concerns detailed by Dr Garcia, obstetrician and gynaecologist at Northwestern University’s Prentice Women’s Hospital: ‘Having the woman in shackles compromises the ability to manipulate her legs into the proper position for necessary treatment. The mother and baby’s health could be compromised if there were complications during delivery, such as haemorrhage or decrease in fetal heart tones. If there were a need for a C-section (caesarean delivery), the mother needs to be moved to an operating room immediately, and a delay of even five minutes could result in permanent brain damage for the baby’. (Statement provided to Amnesty International by Chicago Legal Aid to Incarcerated Mothers, December 1998, in Amnesty International, Not part of my sentence: Violations of the Human Rights of Women in Custody, March 1999, AI Index: AMR 51/01/99); see also American College of Obstetricians and Gynaecologists, Committee Opinion Number 511, Reaffirmed 2016, November 2011. 366  Penal Reform International and the Essex Human Rights Centre | 94