specialized treatment that is not available on site, they should be transferred to external facilities.553 265. It is essential that medical examinations be conducted in a diligent and thorough manner, and in full confidentiality. Prison staff should not be present during examinations, except when required by medical personnel themselves, nor should they monitor these examinations. They should not interfere, pressure, intimidate or give orders to medical personnel.554 The principles of clinical independence,555 medical ethics,556 autonomy of patients and informed consent557 are to be safeguarded.558 Moreover, international bodies and experts have stressed on several occasions that medical care should not be conditioned on detainees’ compliance or co-operation with prison authorities and interrogators.559 Adequate medical care entails access to adequate medication and to a “level of health care that is equivalent to that available to the general population”.560 Detainees also have a right to access their medical records.561 266. Health professionals owe a primary duty to their patients, irrespective of their employer or chain-of-command.562 They should document and report their suspicions of torture or illtreatment to the competent authorities or international agencies, without putting their patients at risk.563 Medical investigations into allegations of torture or ill-treatment are to include, inter alia, a detailed record of the detainee’s account, “all physical and psychological findings” of the examination, and a determination of the probable cause of these findings.564 Furthermore, medical personnel have a duty to document and report if conditions of detention, including continued detention, affect the physical and mental 553 “Standard Minimum Rules for the Treatment of Prisoners”, op. cit., note 280, Rule 22. As previously mentioned, the United States has pledged to observe the United Nations Standard Minimum Rules for the Treatment of Prisoners, as part of its OSCE commitments. OSCE Vienna Document, op. cit., note 90, para. 23.3. 554 UN Special Rapporteur on torture, Interim report to the General Assembly, A/68/295, op. cit., note 304, paras. 51-53. 555 Istanbul Protocol, op. cit., note 313, para. 57: “The principle of professional independence requires health professionals always to concentrate on the core purpose of medicine, which is to alleviate suffering and distress and avoid harm, despite other pressures.” 556 Ibid., para. 51: “The central tenet of all health-care ethics (…) is the fundamental duty always to act in the best interests of the patient, regardless of other constraints, [and] pressures”. 557 Ibid., paras. 63-64: “An absolutely fundamental precept of modern medical ethics is that patients themselves are the best judge of their own interests. (…) [There is a] duty for doctors to obtain voluntary and informed consent from mentally competent patients to any examination or procedure. This means that individuals need to know the implications of agreeing and the consequences of refusing.” 558 UN Special Rapporteur on torture, Interim report to the General Assembly, A/68/295, op. cit., note 304, para. 54. 559 UN Special Procedures, “Situation of detainees at Guantánamo Bay”, op. cit., note 23, para. 70. See, also, IACHR, Eduardo F. Capote Rodríguez, Case No. 6091, Resolution 3/82, 8 March 1982, <http://www.cidh.org/annualrep/81.82eng/Cuba6091.htm>. 560 UN Special Rapporteur on torture, Interim report to the General Assembly, A/68/295, op. cit., note 304, para. 54. 561 UN HRC, General Comment No. 34, Article 19: Freedoms of opinion and expression, CCPR/C/GC/34, 12 September 2011, para. 18, <http://www2.ohchr.org/english/bodies/hrc/docs/GC34.pdf>. 562 Istanbul Protocol, op. cit., note 313, para. 66. 563 Ibid., paras. 67, 69, 72; UN Special Rapporteur on torture, “Study on the phenomena of torture”, op. cit., note 283, para. 137. See, also, UN Special Rapporteur on torture, Interim report to the General Assembly, A/68/295, op. cit., note 304, para. 53: “Rule 24 [of the Standard Minimum Rules for the Treatment of Prisoners] should insist on the obligation of medical personnel to detect, treat, properly document and refer to the authority responsible for investigating allegations of torture or other ill-treatment any signs of torture or other ill-treatment or any case where there are allegations or reasonable grounds to believe that torture or other ill-treatment may have occurred prior to admission or while in detention”. 564 “Principles on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment”, 4 December 2000, Principle 6(b), <http://www.ohchr.org/EN/ProfessionalInterest/Pages/EffectiveInvestigationAndDocumentationOfTorture.aspx>. 115