Intended for healthcare professionals


Examining the role of healthcare professionals in the use of solitary confinement

BMJ 2017; 359 doi: (Published 24 October 2017) Cite this as: BMJ 2017;359:j4657
  1. Cyrus Ahalt, co-director,
  2. Alex Rothman, associate director of policy,
  3. Brie A Williams, founding director
  1. Criminal Justice and Health Program, University of California, San Francisco, Department of Medicine, Division of Geriatrics, 3333 California Street Suite 380, San Francisco, CA 94118, USA
  1. Correspondence to: B Williams brie.williams{at}

Cyrus Ahalt and colleagues explore the conflicting responsibilities of healthcare professionals involved in solitary confinement, a correctional practice that persists in prisons around the world despite a growing body of evidence describing its harmful effects

Key messages

  • The United Nations defines solitary confinement exceeding 15 days as torture, reflecting mounting evidence of associated psychological and physiological harms

  • Healthcare professionals who work in prisons face unique challenges for which they often lack adequate guidance and support

  • Professional medical organisations, such as the World Medical Association and the World Health Organization, and international bodies, such as the United Nations, should lead reform of prison health systems and support healthcare providers practising in these settings

  • Promoting the translation of standards from community care to prison health systems may reduce dual loyalty concerns among healthcare providers

  • Prison healthcare providers should be supported by training in medical ethics

Prison healthcare professionals work in a unique clinical environment designed to punish rather than to heal.123 Amid global calls for penal reform, healthcare professionals have an ethical responsibility4 to speak out about correctional practices that endanger health and human rights.5 We examine this responsibility in relation to prolonged solitary confinement, a practice that persists in prisons around the world.

Prolonged solitary confinement is widespread

Juan Méndez, the United Nations special rapporteur on torture, has defined solitary confinement lasting longer than 15 days as torture,6 a finding subsequently incorporated into the UN’s minimum rules for the treatment of prisoners, also referred to as the Mandela rules. These rules require that solitary confinement be used only in exceptional circumstances, as a last resort, and for the shortest amount of time possible.7 Yet solitary confinement of longer than 15 days remains in widespread use around the world,89 including in Scandinavian nations often described as paragons of progressive penal …

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