Dual loyalties 1.16
Prisoner accepts
Even if the prisoner accepts that the doctor can report the abuses, the doctor must consider how the information will be treated by the prison administration. If the doctor has any indications that the prison authorities condone the maltreatment, a formal report to them would likely result in reprisals against the prisoner. It would also be difficult to guarantee the confidentiality of what they record in an individual prisoner's health record. In countries were maltreatment is routinely practised, doctors may be unwise to document such injuries in the prison record. In such situations the doctor needs to look at alternative reporting mechanisms.
What should be done 'ideally' may not be possible. Prison circumstances may be very difficult, and the doctor must take into consideration his or her own situation as well. Is s/he in a position that s/he can report abuses without an element of risk for him or herself? Most prison doctors are not, and they may put themselves in a position where they are harassed by the staff or in worst case situations, lose their jobs.
If the doctor faces such problems, an alternative secure method for recording and reporting should be sought. Where possible, prison doctors should take advice from their professional association, prisoner support agencies, lawyers or human rights organisations. But even medical associations are no guarantee. The Scottish doctor, Simon Danson, was suspended and faced disciplinary procedures for speaking out on television about the maltreatment of prisoners by prison staff in Barlinnie jail in Glasgow, although the powerful British Medical Association backed him[2].
[2] The British Medical Association. The Medical Profession & Human rights. Handbook for a changing agenda, London: Zed Books Ltd, 2001.