FACTSHEET Furthermore, the revised Standard Minimum Rules (Rule 47/2a) provide that restraints must be removed when the prisoner appears before a judicial or administrative authority to avoid humiliation but also in order to prevent situations compromising the presumption of innocence. What could monitoring bodies check? • Are restraints used routinely during transfers or only following an individual assessment of risk? Who takes this decision and based on what considerations and facts? What could monitoring bodies check? • What role do doctors play in the use of restraints? • Do detainees have access to medical care following the use of restraints in order to check any health effects suffered? • Are healthcare personnel aware of the standards of medical ethics (see above)? 3.6. Specific groups • Which instruments of restraint are used for transfers? Explicit standards have been enshrined relating to the use of restraints for children (up to the age of 18) and for women. • When are restraints attached and when are they Restraints applied on children must be ‘used only as a last resort and exclusively to prevent harm to the child or others’ and all methods of physical restraint for disciplinary purposes should be abolished’.55 Do they constitute the least intrusive means to address the risk of escape? removed? • Do detainees have to appear in restraints before a court or other authority? 3.5. The role of doctors Standards developed on medical ethics prohibit healthcare personnel from ‘participat[ing] in any procedure for restraining a prisoner or detainee unless such a procedure is determined in accordance with purely medical criteria as being necessary for the protection of the physical or mental health or the safety of the detainee, his fellow detainees, or his guardians, and presents no hazard to his physical or mental health’.52 The revised Standard Minimum Rules also reflect this principle by stressing that health-care personnel should not have any role in the imposition of disciplinary measures or other restrictive measures.53 “ The health professional should not perform any medical duties on shackled patients, inside or outside the custodial setting. The only exception should be where, in the health professional’s judgment, some form of restraint is necessary for the safety of the individual, the health professional and/ or others, and treatment cannot be delayed until a time when the individual no longer poses a danger. In such circumstances, the health professional may allow the minimum restraint necessary to ensure safety. 54 ” The use of instruments of restraint on women during labour, during birth and immediately after birth has been prohibited explicitly, in 2010, by the UN Bangkok Rules and is reiterated by the revised Standard Minimum Rules.56 An obstetrician and gynecologist explains: ‘Women in labour need to be mobile so that they can assume various positions as needed and so they can quickly be moved to an operating room. Having the women 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 hemorrhage 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.’57 Furthermore, restraints must never be used on a discriminatory basis, and vulnerabilities need to be taken into account regardless of the existence of 52. Principle 5 of the Principles of Medical Ethics relevant to the Role of Health Personnel, particularly Physicians. 53. Revised Standard Minimum Rules, Rule 46 (1). 54. Dual Loyalty & Human Rights in Health Professional Practice; Proposed Guidelines & Institutional Mechanisms, para. 13. 55. Committee on the Rights of the Child, Concluding observations on United Kingdom and Northern Ireland, 20 October 2008, UN-Doc. CRC/C/GBR/ CO/4, para. 39; see also Rule 64 of the United Nations Rules for the Protection of Juveniles Deprived of their Liberty; and Committee against Torture, Concluding observations on the United Kingdom (6-31 May 2013), advance unedited version, para. 28. Available at: http://www.justice.gov.uk/ downloads/human-rights/cat- concluding-observations-may-2013.pdf <accessed 22 October 2013>. 56. Rule 24, United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (the Bangkok Rules); Rule 48 (2) of the revised Standard Minimum Rules. 57. Amnesty International, ‘Not part of my sentence: Violations of the Human Rights of Women in Custody’, AI Index: AMR 51/01/99, March 1999. Penal Reform International | Instruments of restraint: Addressing risk factors to prevent torture and ill-treatment |7