PRACTICAL RECOMMENDATIONS ■ Consideration should be given to an arrangement whereby the medical officer is employed by the local health authority rather than by the prison authorities. ■ All prisoners should have regular access to a medical officer if they are unwell. Such access should always be covered by the requirements of medical confidentiality. The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment has stressed that "Freedom of consent and respect for confidentiality are fundamental rights of the individual. They are also essential to the atmosphere of trust which is a necessary part of the doctor/patient relationship, especially in prisons, where a prisoner cannot freely choose his own doctor." ■ The medical officer must always carry final responsibility for clinical decision-making in individual cases. ■ The medical officer should be supported by nursing staff who have recognized health-care qualifications. ■ Medical staff should never take part in any forced treatment of prisoners. This prohibition extends to the treatment of prisoners who are on hunger strike. ■ From time to time, medical officers may be required to certify causes of death which have occurred in custody. In such cases, the doctor should be careful to apply only clinical judgement and should not be influenced by any other external considerations, such as those of the management of the prison. ■ The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment has recommended that "Patients should be provided with all relevant information (if necessary in the form of a medical report) concerning their condition, the course of their treatment and the medication prescribed for them. Preferably, patients should have the right to consult the contents of their prison medical files, unless this is inadvisable from a therapeutic standpoint." ■ The European Committee has also stressed the professional independence of the medical staff. It has recommended as follows: "The health-care staff in any prison is potentially a staff at risk. Their duty to care for their patients (sick prisoners) may often enter into conflict with considerations of prison management and security. This can give rise to difficult ethical questions and choices. In order to guarantee their independence in health-care matters, the [Committee] considers it important that such personnel should be aligned as closely as possible with the mainstream of health-care provision in the community at large." TOPICS FOR DISCUSSION Discuss the relationship between the prison doctor and the director of the prison. Are there occasions when the medical officer can overrule the director? Discuss the role of the prison doctor in assessing whether prisoners are fit to undergo punishment. In some countries, the medical officer has to certify that a prisoner is fit to undergo any disciplinary measure. It can be argued that this amounts to an authorization for the punishment itself. An alternative arrangement would be for the doctor regularly to see any prisoner who is undergoing punishment and to advise the prison director if the prisoner becomes unfit. 74