Health staff working in prisons have the same professional and ethical obligations to their patients as staff working in the community health services. However, the particularities of the prison environment in which the main objectives of the administration are security, safety and maintaining discipline can often conflict with the duty of care of the health staff. This leads to so called “dual loyalties” in which the ethical and professional obligations to the patient may be compromised by the duty to the prison administration.
Health staff must be carefully selected to work in places of detention and must be trained in the specificities of prison health, in particular on health and human rights and dual loyalties. They must receive support from the Ministry of Health and professional healthcare bodies. Their professional and ethical independence is crucial to establishing the trust of detainees so that they can provide health care without discrimination.