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Treating shackled patients

BMJ 1997; 314 doi: (Published 25 January 1997) Cite this as: BMJ 1997;314:306

Patient's best interest in receiving most appropriate treatment without delay must prevail

  1. Ilora G Finlay, Professor of palliative medicinea,
  2. B S Dwarak Sastry, Consultant physicianb,
  3. Gareth A O Thomas, Consultant physicianb
  1. a University of Wales College of Medicine, Holme Tower Marie Curie Centre, Penarth CF64 3YR
  2. b University Hospital of Wales, Cardiff CF4 4XW
  3. c Dryburn Hospital, Durham DH1 5TW
  4. d BMA, London WC1H 9JP

    Editor–By publishing Richard Smith's editorial entitled “Don't treat shackled patients” the BMJ failed in its duty to publish factually correct information.1 Specific “rules” for treating prisoners in NHS hospitals do not exist. Smith's analogy with the Nuremberg trials is irresponsible and inappropriate.

    The rules governing British doctors, in the General Medical Council's guidance Good Medical Practice, state: “You should always seek to give priority to the investigation and treatment of patients solely on the basis of clinical need.”2 These rules are breached by a refusal to treat shackled patients.

    The BMA's medical ethics committee has set out guidelines (not rules) on treating prisoners (box),3 but these are not referenced in the editorial. The statement by the secretary of state for the Home Office that “when a prisoner is escorted to hospital, physical restraints will continue to be used in most cases unless there is a medical objection”4 is at variance with these.

    Prisoners have a fundamental right to “the same standards of health care as are available to the rest of society … and … the best possible care in the particular circumstances.”3 The prison service has “a responsibility to balance the need to hold prisoners securely with the duty to treat them with humanity and to maintain their dignity and privacy”4; the governor has duties of safe custody and care.

    Security measures to prevent escapes require individual rigorous assessment of risk for each prisoner attending hospital; this should consider the risks of violence and absconding and the current medical condition.5 Doctors, including prison medical officers, can cooperate with …

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