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ISTANBUL PROTOCOL II. RELEVANT ETHICAL CODES

of professional misconduct if they deviate from detainees separate from the sole purpose of evaluating,
professional standards without reasonable justification. protecting or improving their physical and mental
health (principle 3); to apply their knowledge and
146. It is important to note that the ethical obligations skills in order to assist in the interrogation of prisoners
of health professionals apply to all encounters with and detainees in a manner that may adversely affect
individuals wherein professional knowledge and/ the physical or mental health or condition of such
or skills are applied for some purpose. Conducting prisoners or detainees and which is not in accordance
a clinical evaluation of alleged or suspected cases of with the relevant international instruments (principle 4
torture, whether in medico-legal, law enforcement, (a)); to certify the fitness of prisoners or detainees
military, primary health-care or other settings, is for any form of treatment or punishment that may
a procedure based on professional knowledge and adversely affect their physical or mental health (such
skills that entails potential benefits and risks to the as prolonged solitary confinement) or to participate in
individual. The term “patient” 261 is commonly used the infliction of any such treatment or punishment that
to refer to individuals who are the subject of some is not in accordance with the relevant international
health professional intervention and, therefore, instruments (principle 4 (b)); and to participate in
includes alleged victims of torture or ill-treatment. any procedure for restraining prisoners or detainees
Whether health professionals refer to alleged victims unless such a procedure is determined in accordance
of torture or ill-treatment as “patients” or not, the with purely medical criteria as being necessary for
ethical obligations of health professionals apply to the protection of the physical or mental health or the
all clinical evaluations. The core ethical obligations safety of prisoners or detainees themselves, of their
that are discussed in this chapter – beneficence, fellow prisoners or detainees, or of their guardians, and
non-maleficence, confidentiality and respect for presents no hazard to their physical or mental health
patient autonomy – apply equally in times of armed (principle 5). The Principles of Medical Ethics also
conflict and other emergencies and in times of recall the non-derogable nature of the above-mentioned
peace, and military personnel have the same ethical principles under any circumstance (principle 6).
obligations as civilian health professionals. 262
148. Health professionals, like all other persons working in
1. United Nations statements relevant prison systems, must observe the Standard Minimum
to health professionals Rules for the Treatment of Prisoners (the Nelson
Mandela Rules), which require that medical, including
147. The United Nations has specifically addressed the psychiatric, services must be available to all prisoners
ethical obligations of doctors and other health without discrimination and that all sick prisoners or
professionals in the Principles of Medical Ethics those requesting treatment be seen daily. The United
relevant to the Role of Health Personnel, particularly Nations Rules for the Treatment of Women Prisoners
Physicians, in the Protection of Prisoners and Detainees and Non-custodial Measures for Women Offenders
against Torture and Other Cruel, Inhuman or (the Bangkok Rules) complement the Nelson Mandela
Degrading Treatment or Punishment. 263 The Principles Rules and articulate specific ethical duties to protect
of Medical Ethics impose on health personnel a duty women deprived of their liberty. 264 These requirements
to provide medical care for all detainees and protect reinforce the ethical obligations of physicians and
their physical and mental health, in accordance other health-care professionals, discussed below, to
with the principles of non-discrimination and equal treat and act in the best interests of their patients. Rule
medical treatment (principle 1). They also specify 32 (1) of the Nelson Mandela Rules states that “the
the circumstances that constitute a violation of relationship between the physician or other health-care
medical ethics and invoke the responsibility of health professionals and the prisoners shall be governed by
personnel, including: to engage, actively or passively, the same ethical and professional standards as those
in acts of torture or ill-treatment (principle 2); to applicable to patients in the community”. This includes
be involved in a professional relationship with the “duty of protecting prisoner’s physical and mental

261 “Patient” is defined not only as “an individual awaiting or under medical care and treatment”, but also as “the recipient of any of various personal services” and “one that is
acted upon”. The word “patient” derives from the Latin “pati”, which means to suffer.
262 WMA and others, ethical principles of health care in times of armed conflict and other emergencies (adopted in 2015). See also WMA regulations in times of armed conflict
and other situations of violence (adopted in 1956 and last revised in 2012).
263 General Assembly resolution 37/194, annex.
264 Bangkok Rules, rules 10 and 12–18.

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