–4–
Whichever course is chosen, the accommodation capacity of the psychiatric facility in
question should be adequate; too often there is a prolonged waiting period before a necessary
transfer is effected. The transfer of the person concerned to a psychiatric facility should be treated
as a matter of the highest priority.
44.
A mentally disturbed and violent patient should be treated through close supervision and
nursing support, combined, if considered appropriate, with sedatives. Resort to instruments of
physical restraint shall only very rarely be justified and must always be either expressly ordered by
a medical doctor or immediately brought to the attention of such a doctor with a view to seeking his
approval. Instruments of physical restraint should be removed at the earliest possible opportunity.
They should never be applied, or their application prolonged, as a punishment.
In the event of resort being had to instruments of physical restraint, an entry should be made
in both the patient's file and an appropriate register, with an indication of the times at which the
measure began and ended, as well as of the circumstances of the case and the reasons for resorting
to such means.
c.
Patient's consent and confidentiality
45.
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.
i) patient's consent
46.
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.
They should be able to ask for this information to be communicated to their families and
lawyers or to an outside doctor.
47.
Every patient capable of discernment is free to refuse treatment or any other medical
intervention. Any derogation from this fundamental principle should be based upon law and only
relate to clearly and strictly defined exceptional circumstances which are applicable to the
population as a whole.
A classically difficult situation arises when the patient's decision conflicts with the general
duty of care incumbent on the doctor. This might happen when the patient is influenced by personal
beliefs (eg. refusal of a blood transfusion) or when he is intent on using his body, or even mutilating
himself, in order to press his demands, protest against an authority or demonstrate his support for a
cause.
In the event of a hunger strike, public authorities or professional organisations in some
countries will require the doctor to intervene to prevent death as soon as the patient's consciousness
becomes seriously impaired. In other countries, the rule is to leave clinical decisions to the doctor in
charge, after he has sought advice and weighed up all the relevant facts.
48.
As regards the issue of medical research with prisoners, it is clear that a very cautious
approach must be followed, given the risk of prisoners' agreement to participate being influenced by
their penal situation. Safeguards should exist to ensure that any prisoner concerned has given his
free and informed consent.