This article discusses the importance and applications of traditional medical ethics in the health care of inmates under the distinctive conditions of a custodial setting.
It is not only important that prison physicians and health care workers as individuals comply with medical ethics, but also that medical ethics are made known to and accepted by the inmates and the prison administration. Numerous ethical dilemmas are encountered in prison health care. The principles of privacy, confidentiality, and consent, which are fundamental in medical care, conflict with principles of custodial care, namely, that security and safety come first. Also, access to and quality of medical care may be compromised by the lack of resources and overcrowding. Further, the professional independence of the prison doctor, who is employed and salaried by the prison administration, may lose the decisionmaking power customary in health care. Although ethical dilemmas in inmate health care must be solved on a case-by-case basis, accepted international rules and standards on medical ethics can guide prison doctors and prison staff through many of these dilemmas. The essential ethical principles for inmate health care are contained in the document developed by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment 2004. It mandates free access to a doctor for every prisoner, inmate health care equivalent to that given to the general public, patient consent and confidentiality, preventive health care, humanitarian assistance, professional independence, and professional competence. Compliance with these principles promotes inmates' confidence in the medical care they receive, leaves no doubt as to the doctor's medical professionalism and ethics, prevents misunderstandings, provides guidance in ethical conflict, supports quality assurance in medical work, and protects against law suits. 11 references and a list of United Nations documents that pertain to inmate health care