The Bangkok Rules 29 Rule 10 All women are entitled to treatment and care equivalent to that of community standards for their gender specific health-care needs. Due to the typical background of women in prison, risk factors and their health care needs as women, women’s prisons require a gender-specific framework for health care which emphasizes reproductive and sexual health, mental health care, treatment for substance abuse and counselling victims of physical and sexual abuse. Due to cultural reasons, and/or because of past negative experiences with men, including being subjected to sexual abuse or violence, women may not wish to be examined by a male medical specialist and may even feel re-traumatized by such an examination. This Rule takes into account this possibility, providing women with the right to request examination and treatment by a female medical specialist. Women should not have to provide a reason for such a request. The rule recognises that in some circumstances an adequately qualified woman medical practitioner may not be available, especially in emergency situations. In these cases the presence of a woman member of staff should help prevent any perceived or real risk of harassment, and reassure the woman prisoner concerned. Rule 11 The principle of confidentiality which applies to all medical examinations requires that patients should be examined individually, on their own, without the presence of any other person, unless specifically requested by the patient. In prisons, doctors may in exceptional circumstances request the presence of prison staff, if they feel at risk. Doctors should be advised by prison staff about the nature of the possible risks involved, in these cases, for the doctor to make an informed decision. However, in all cases security staff should be out of hearing of the patient and medical specialist.46 The presence of male staff in the examination and treatment of a woman prisoner may cause extreme distress and violates the right to privacy and should be avoided in all cases. Rule 12 High levels of domestic violence and physical and sexual abuse against women prior to their imprisonment have been documented in countries worldwide. Women who are admitted to prison are more likely than men to suffer from mental health problems, often as a result of domestic violence, physical and sexual abuse. This Rule underlines the need to ensure that mental health care provided in women’s prisons should be gender sensitive and interdisciplinary. Women’s distinctive mental health-care and psychological support needs should be recognized, including for example, of those who demonstrate acute distress and depression due to isolation, separation from children, families and communities. Rule 12 expressly underlines that treatment should be individualized and aim to address the reasons that provoke distress, depression, as well as psychiatric problems, based on a integrated and holistic approach of counselling, psychosocial support and medication, if necessary. This Rule takes account of the reality that in many prison systems women prisoners’ unique mental health-care ___________ 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, Principle 1 provides that “[h]ealth personnel, particularly physicians, charged with the medical care of prisoners and detainees, have a duty to provide them with protection of their physical and mental health and treatment of disease of the same quality and standard as is afforded to those who are not imprisoned or detained.” Confidentiality of medical examinations is one of the key principles which apply to the healthcare of all persons, including those in prison. The International Code of Medical Ethics of the World Medical Association (adopted in 1949, amended in 1968, 1983 and 2006), states that “[a] physician shall respect a patient’s right to confidentiality. It is ethical to disclose confidential information when the patient consents to it or when there is a real and imminent threat of harm to the patient or to others and this threat.” Thus the breaching of any confidentiality is exceptional and the decision to disclose any information due to real and imminent harm to the patient or others must be taken by the physician and /or with the consent of the patient. 46