Dual loyalties 1.9
Competing interests
The doctor's duty to secure that the prisoner receives appropriate health care, can often come into conflict with other interests of the prison administration. Medical services cost money and a thorough medical examination might disclose conditions that require expensive medical treatment. Referring a patient to a specialist service can be expensive, particularly as the patient will need accompanying custodial staff and other security measures, sometimes 24 hours a day, if there is not a secure hospital available within the prison system.
For economical reasons, a prison administration could, for example, try to put pressure on the doctor to abstain from referring patients to clinics outside the prison. Prison doctors must always take into consideration the standard of the health care services outside the prison. It would be difficult for doctors to insist on, for example, expensive examinations in poor countries where people outside prison have themselves no access to such examinations, and do not receive appropriate health care.
However, prisons do concentrate and breed some forms of disease, and it is in the interest of the whole community to have adequate services able to detect and treat these diseases. For example, it is impossible to control tuberculosis in a country if the prisons are not taken into the medical equation. Doctors have a duty to point this out to the health and political authorities - not only in the interests of their patients, but in the interest of public health.