Dual loyalties 1.8
Unhindered access to all prisoners
In countries, where the authorities neglect the welfare of the prisoners, there may be difficulties in ensuring even basic conditions such as nutrition and hygiene for the prisoners. Many prisons are overcrowded with lack of basic hygienic conditions: with sometimes polluted water and lack of sanitary facilities and insufficient and or inadequate food.
It is important that the doctor should have unhindered access to all prisoners. In addition to diagnosing possible communicable diseases, the examination must consist of a full evaluation of both the physical and mental state of the prisoner. It is important to identify mental affections that might be a contraindication to imprisonment, that may make imprisonment difficult, or hamper any form of rehabilitation. The prisoner's physical capacity to work must also be part of the overall evaluation.
Overcrowding affects all aspects of health, particularly environmental health, and may lead to inadequate access even to primary health care and communicable disease services. Overcrowded prisons also breed violence with all its repercussions. Conditions in such overcrowded prisons will of course vary from context to context with local conditions and cultural factors (the very definition of overcrowding will vary from one continent to another, for example).
Some prisons may even only function as 'death chambers' where prisoners slowly die of insufficient health care, lack of adequate nutrition, and contagious diseases such as untreatable (or sometimes even treatable) tuberculosis, and of course also such affections as AIDS. Under such circumstances it will be difficult for the doctor to do much for the individual prisoner. Here and in all cases, however, a doctor's duty would be to press for better overall conditions, arguing that prisoners are deprived of their liberty, but not of basic human decency and dignity. As this may come into conflict with the prison doctor's employer (the prison system), it may well be an issue of dual loyalties.