European NPM Project 8th Thematic NPM Workshop: Geneva, Switzerland on 20-21 March 2012

Jean-Pierre Restellini, MD, LLBHead of the National Commission for the Prevention

of Torture (Swiss NPM) and Acting 2nd Vice-President of the CPT

“The immigration removal process and preventive monitoring”

Use of chemical restraints

A matter of general medical ethics

A matter of general medical ethics

The basic ethical and legal principles guiding the exercise of the medical profession, in particular the regulations on patient’s consent (…) are also applicable to detained persons.

A doctor is often subjected to constraints relating to security …, but his primary goal should always remain the welfare and dignity of the patient.

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Swiss Academy of Medical Sciences guidelines

“The exercise of medical activities in respect of detained persons (2002)”

Swiss Academy of Medical Sciences guidelines

“The exercise of medical activities in respect of detained persons (2002)”

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Swiss Academy of Medical Sciences guidelines

“The exercise of medical activities in respect of detained persons (2002)”

Swiss Academy of Medical Sciences guidelines

“The exercise of medical activities in respect of detained persons (2002)”

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6.4 Should the doctor reach the conviction that the means required to carry out the measure (e.g. gagging, tight and long-lasting binding, … ,etc.) represent an immediate and serious health hazard for the patient, he shall notify the responsible authorities immediately, informing them that he will not assume medical responsibility over the case if they do not renounce the intended measure, and that as a result he cannot lend them his support.

Swiss Academy of Medical Sciences guidelines

“The exercise of medical activities in respect of detained persons (2002)”

Swiss Academy of Medical Sciences guidelines

“The exercise of medical activities in respect of detained persons (2002)”

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7. Agreement to a medical treatment or to a coercive treatment

7.2 Any medication, in particular psychotropic drugs, shall be administered to detained persons only after they have given their consent, and only on the basis of a strictly medical decision.

Swiss Academy of Medical Sciences guidelines

“The exercise of medical activities in respect of detained persons (2002)”

Swiss Academy of Medical Sciences guidelines

“The exercise of medical activities in respect of detained persons (2002)”

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7.3 In the case of an emergency, and based on the same criteria as those applied to persons that are not detained, the doctor may forfeit a patient’s consent in cases where the patient is

1° not in full possession of his capacity of discernment, due to a major psychiatric disorder,

2° represents an immediate danger for himself or for third persons

CAVE: cumulative conditions !

CPT recommandationsCPT recommandations13th General Report on the CPT's activities

covering the period 1 January 2002 to 31 July 2003

The administration of medication to persons subject to a deportation order must always be carried out on the basis of a medical decision taken in respect of each particular case.

Save for clearly and strictly defined exceptional circumstances, medication should only be administered with the informed consent of the person concerned.

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In practice In practice Administration of drugs

1. BEFORE THE FLIGHT2. DURING THE FLIGHT

A. security on boardB. emergency situations for the

patient's health ?C. what psychotropics to use in case of

need?

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9Geneva march 2012 European NPM Project’s