ESSEX PAPER 3: INITIAL GUIDANCE ON THE INTERPRETATION AND IMPLEMENTATION OF THE UN NELSON MANDELA RULES The experts noted that the provision has been informed by 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, and in particular Principle 5 which states that: ‘[i]t is a contravention of medical ethics for health personnel, particularly physicians, to participate 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 prisoner or detainee himself, of his fellow prisoners or detainees, or of his guardians, and presents no hazard to his physical or mental health.’377 The Essex group pointed out that the Nelson Mandela Rules have sought to reconcile the tension between this principle and the specific duty of care towards prisoners under such measures. While required to pay ‘particular attention to the health of prisoners held under any form of involuntary separation, including by visiting such prisoners on a daily basis’ they ‘shall not have any role in the imposition of disciplinary sanctions or other restrictive measures’. At the same time, health-care personnel should report adverse effects of such measures to the director of the facility, without delay, and have the authority to review and recommend changes ‘to ensure that such separation does not exacerbate the medical condition or mental or physical disability of the prisoner’.378 à S ee Chapter 4, Health-care – medical ethics 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, adopted by UN General Assembly resolution 37/194 of 18 December 1982. 377  Balancing security and dignity, 2nd edition, p. 15, with reference to Rule 46 of the Mandela Rules. 378  Penal Reform International and the Essex Human Rights Centre | 97