Panel: Code of ethics for physicians with prisoners at risk of torture and cruel, inhuman, or degrading treatment

Guiding ethical principles
A prison physician's duty is to preserve and restore bodily and mental health of every patient.

UN official definitions

• Torture is any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such a pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. This definition does not include pain or suffering arising only from, inherent in, or incidental to lawful sanction (UN Convention Against Torture).
  
• Cruel, Inhuman, or degrading treatment or punishment should be interrupted so as to extend the widest possible protection against abuses, whether physical or mental, including the holding of a detained or imprisoned person in conditions which deprive him, temporarily or permanently, of the use of any of his natural senses, such as sight or hearing, or of the awareness of place and the passing of time. (UN Body of Principles for the Protection of All persons under Any Form of Detention or imprisonment).

Unofficial teaching definitions

• Torture is any act that intends to cause a prisoner to feel severe physical or mental pain or suffering. Torture occurs when a government official orders, supervises, consents to, allows, or performs acts that cause such pain or suffering. Torture is unacceptable for any reason, including when it is used to:
  
• Obtain information or a confession from the tortured person or some one else or
  
• Punish the tortured person or someone else for an act that he or she has done or is suspected of having done or
  
• Frighten or coerce the tortured person or someone else or
  
• Discriminate against a race, religion, political belief
  
• Or any other reason
  This definition does not include pain or suffering that is caused by legal prison conditions and sentences
  
• Cruel, Inhuman, or degrading treatment or punishment
  A physician should not:
  
• assist with torture and cruel, inhuman, or degrading treatment or punishment
  
• be present when a prisoner is subject to, or threatened with, torture and cruel inhuman, or degrading treatment.
  
• provide or withhold clinical facilities, equipment, supplies, or knowledge to support torture and cruel, inhuman, or degrading treatment.
  
• assist procedures that aim to decrease a prisoner's ability to resist interrogation or punishment;
  
• withhold, or threaten to withhold, medical assessment to treatment from a prisoner who is not cooperating with officials;
  
• assist in certifying a prisoner's fitness for interrogation, treatment, or punishment that might harm that person's physical or mental health.
  
• assist in certifying a prisoner's fitness for interrogation, treatment, or punishment to advise officials to modify procedures that might harm a prisoner's physical or mental health.
  
• A physician committing any of these acts may be guilty of torture and cruel, or degrading treatment or punishment.

Hunger strikes
A physician should not assist in force-feeding a prisoner who has rationally chosen to refuse nourishment. Two physicians shall assess the prisoner's ability to understand the results of refusing food or water.

Medical records
Medical records are a way to assist clinicians in improving a prisoner's physical and mental health.

A physician:

• should not allow medical information to facilitate torture and cruel, inhuman, or degrading treatment or punishment;
  
• must inform a prisoner if officials have access to the medical record
  
• must document a patient's complaints, symptoms, and signs of torture and cruel, inhuman, or degrading treatment or punishment
  A physician doing an autopsy or completing a death certificate on a prisoner must:
  
• fully record signs of abuse
  
• file such documents in a way that complies with national or international law

A physician who violates these rules may be guilty of unethical conduct or of assisting with torture or cruel, inhuman or degrading treatment or punishment.

Reporting abuse of prisoners

• a physician must report credible suspicions of torture and cruel, inhuman, or degrading treatment or punishment; and credible suspicions that clinicians are assisting torture or cruel, inhumane, or degrading treatment or punishment. Such reports should be given to government authorities, when possible. If this is not possible, they should be given to clinical societies, licensing bodies, or independent human-rights organizations.
  
• a physician who violates these rules may be guilty of unethical conduct or assisting with torture or cruel, inhuman, or degrading treatment or punishment.

Investigations of physicians

• Licensing bodies should investigate allegations of physician complicity in torture and cruel, inhuman, or degrading treatment or punishment. They should impose punishment, when appropriate, and refer credible allegations of illegal acts to government agencies. A licensing body that does not address allegations of physician's complicity with torture or cruel, inhuman, or degrading treatment or punishment may be complicit in such crimes.