Ethics Armed forces doctor

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6. Treating detainees

Key messages

  • Detainees must be given the same quality and standard of care as all other patients.
  • A doctor’s role in relation to detainees should be restricted to assessing, protecting or improving the physical and mental health of patients.
  • It is unacceptable for doctors to declare detainees fit for detention, interrogation, questioning or any form of punishment, or to participate in such activities.
  • Doctors should never use their knowledge or skills, or an individual’s health information, to participate, assist or advise in the interrogation, questioning or punishment of detainees.
  • Detainees, like all adult patients with capacity, are entitled to refuse treatment and this right must be respected.

 

Health personnel… charged with the medical care of prisoners and detainees have a duty to provide them with protection of their physical and mental health and treatment of disease of the same quality and standard as is afforded to those who are not imprisoned or detained.  

United Nations Principles of Medical Ethics in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment

During operational deployment, forces are likely to have cause to detain individuals from military or civilian populations. Regardless of their specific legal status, which will vary according to the operation, all detainees will require medical assessment and support.

Where the examination and treatment of detainees is part of their regular duties, doctors should ensure that they are familiar with the extensive military doctrine covering the medical examination and treatment of detainees on which we offer further sources of information. The following guidance does not attempt to repeat the procedural detail of such doctrine, but applies the core principles outlined throughout this tool kit to those scenarios that doctors in the armed forces are likely to encounter when providing care to detainees.

 

What are doctors' responsibilities in providing medical support to detainees?

Medical care and treatment must be provided with impartiality and without discrimination. This means that detainees must be given the same quality and standard of care as all other patients. In accordance with the principle of equivalence, the ethical standards required of doctors apply equally to the treatment of detainees as to all other patients.

 

A doctor’s role in relation to detainees should be restricted to assessing, protecting or improving the physical and mental health of patients.

As well as providing direct medical support to detainees, doctors also have responsibilities in monitoring the standards of health and hygiene within a detention facility, such as access to food and water, sanitation, heating, lighting and ventilation.

Whenever a doctor considers that a detainee’s physical or mental health will be harmed by continued detention, or by the conditions in detention, this should be reported to the commander of the detention facility and to the medical authorities.

Doctors also have a duty to ensure that their patients are not being abused while in detention, and to act on any evidence of abuse.

Explore further guidance on identifying and reporting abuse

 

Can doctors declare detainees fit for detention, interrogation, questioning or punishment?

While it is clearly in detainees’ interests to be medically examined on entering detention, on transfer between different detention facilities and on release, it is unacceptable for doctors to declare detainees fit for detention, interrogation, questioning or any form of punishment. Instead, doctors should identify specific medical needs resulting in advice that a detainee is not fit for detention, interrogation or questioning. Alternatively, a doctor can declare that there are no medical reasons for the doctor to intervene, or that a detainee is not fit for detention, interrogation or questioning. Similarly, doctors must not question detainees about matters unless relevant to their medical care.

Detainees may be particularly vulnerable to the abuse of their medical information. Doctors should therefore be especially careful to ensure the confidentiality of all personal medical information, including any medical records, where a detainee is subject to interrogation, or could be at a later stage.

 

Are doctors allowed to assist in the interrogation, questioning, punishment or restraint of detainees?

Under no circumstances should doctors use their knowledge or skills, or an individual’s health information, to participate, assist or advise in the interrogation, questioning or punishment of detainees. To do so would remove the crucial distinction between the medical and military roles, and as such would be a serious breach of medical ethics.

Doctors must not participate in any procedure to restrain a detainee unless it is for the protection of the detainee’s health or safety, or for the protection of fellow detainees or detention facility staff, including the doctor, and does not risk harming the patient’s health.

The circumstances where it will be acceptable for doctors to be involved in restraint are likely to be very unusual. Where used, the type of restraint should be the least intrusive available and the minimum amount of restraint necessary, for the shortest period possible, to achieve the objective.

 

What happens if a detainee refuses to be medically examined?

Those who are detained are likely to view members of the detaining authority, including medical staff, with caution. They may refuse examination through anxiety. Doctors can increase levels of trust by explaining their medical role and duty of confidentiality, the purpose of the examination, and the fact that they are not involved in the process of detention or questioning. Such explanation is likely to require time and the involvement of an interpreter.

If a detainee continues to withhold his or her consent to medical examination after being provided with all relevant information, this refusal must be respected and documented. Only an external visual inspection should be carried out. This should not extend to forcibly undressing the detainee. Having a formal record of an individual’s pre-detention health is important. Such records enable any subsequent changes to be clearly linked to conditions inside detention and protect detainees from the increased risk of suffering injury, including self-harm, during detention. Detainees, like all adult patients with capacity, are however entitled to refuse treatment or examination and this right must be respected.

 

Case study: when is a doctor not a doctor?

You are asked to take part in an interrogation.

Members of your unit running the detention facility tell you that your involvement will be legal if you are removed from the medical chain of command. When you question this idea, you are told that all you have to do is make it perfectly clear to the detainees that you are not their doctor.

Is this correct?

Doctors must not take part in this process.

  • They must always act in the best interests of their patients.
  • The military doctor’s role is first and foremost as a health professional.

Simply telling detainees that an interrogator is acting outside of his or her capacity as a doctor would not alleviate the ethical conflict here, or limit the damage to patients’ trust in an independent, impartial medical service. Any attempts to involve doctors in interrogation, punishment, non-medical questioning or restraint should be resisted and reported immediately using the medical chain of command.

 

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Ethical decision making for doctors in the armed forces tool kit (PDF)