April 2009

The isolation or separation of a prisoner from other prisoners is practiced in Israeli prisons.  Isolation is done for purposes of punishment, for protection of the prisoner from other inmates, or for protection of the State.  Isolation implies the prevention of physical contact with other prisoners, and sometimes with the prison staff as well.  From data submitted to the Israeli Medical Association (IMA) Ethics Committee, it appears that 150 out of 20,000 prisoners in Israel are held in isolation or separation.

Isolation or separation for 48 hours can be imposed by authority of the prison director.  A longer amount of time requires a disciplinary court judgment, and the approval of an officer with a rank equivalent to that of colonel. Isolation or separation lasting more than six months requires court approval.  Isolation brings with it the limitation of other rights, such as use of the telephone or television, smoking or visitors.

Isolation or separation for long periods may cause severe mental harm to the prisoner-whether or not he suffered from a prior mental illness.  All would agree that prolonged isolation is likely to cause irreversible mental harm.

The decision to place someone in isolation is not a medical one, but the Israeli Prison Service (IPS) Commission regulations state that "Placement of a prisoner in an isolation cell requires a medical examination, or in absence of a physician, examination by a paramedic."  The regulations also state that a prisoner held in isolation is entitled to a daily visit by a paramedic and a doctor's visit at least once a week.  These visits should be recorded in the register including the date of the visit, the name of the medical professional and his or her findings.

The regulations further state that isolation may be stopped by "a doctor's determination-and in absence of a doctor, a paramedic-that holding the prisoner under the current conditions is not appropriate in light of his medical limitations." Sometimes a specific prisoner requires, in addition to a regular medical examination, also a psychiatric examination.  Such an examination is not regularly carried out prior to isolation, so as not to be interpreted as "approval" for the isolation. 

Several psychiatrists, members of Physicians for Human Rights, approached the Israel Psychiatric Association (IPA) and requested that the latter clearly and publicly state its position in order to preserve the rights of those prisoners held in isolation, their health and the ethical principles.  The IPA, for their part, felt that the issue was fundamental and warranted the issuance of a statement by the IMA. 

The IMA Ethics Committee therefore held a discussion on this subject with the participation of Dr. Alex Adler, Chief Medical Officer of the IPS, Dr. Moshe Berger, head of the Psychiatric Service in the IPS, Adv. Dina Lehman, legal advisor to the IPS Psychiatric Service, and Dr. Adi Doron, representative of the IPA.  Following the discussion, the ethics committee formulated a position paper, which comes to balance between the State's need to protect its own security as well as that of its prisoners, and the obligation to preserve the health and dignity of the prisoners.

Position paper

Prohibition of Physician Participation in Separation and Isolation in Israeli Prisons
 

• Separation and isolation are practiced in Israeli prisons as a form of punishment or as a means of protecting the prisoner or the State.
• Prolonged isolation or separation has a negative effect on the mental and physical health of the prisoner.
• A physician shall not take part, actively or passively, in punitive measures against a prisoner.
• A physician shall not give medical approval for isolation or separation.
• A physician who examines a prisoner who is likely to be placed in isolation or separation shall take special care to maintain strict medical confidentiality and shall not make use of any information he has for other than medical reasons.
• A physician who examines a prisoner in isolation or separation shall maintain his professional autonomy in choosing appropriate treatment, out of responsibility for the physical and mental health and welfare of the prisoner.
• A physician who identifies a tangible threat to the health of a prisoner as a result of his being in isolation or separation shall utilize his professional authority in order to end these restrictions immediately.
• The Israeli Medical Association calls upon the Director-General of the Ministry of Health and the government to transfer the IPS physicians to the employ of the Ministry of Health in order to prevent the inherent conflict of interest in which they find themselves.