An Unwarranted Humanism: how Doctors Operate in the Russian Penal System

This article describes and analyzes the specific features of medical workers’ professional identity within the framework of the Russian penal system. The authors have studies the position of doctors in the organizational structure through the prism of Eliot Freidson’s concept of professional autonomy and Erving Goffman’s notion of the total institution. The empirical material is based on twenty-two semi-structured interviews with prison doctors, correctional officers, former prisoners, and human rights advocates. Organizational factors are vital for understanding the position of doctors: within the Russian penal system, doctors are not subject to the Ministry of Health, but to the Ministry of Justice. What emerges from this research is that the professional identity of doctors is mixed with institutional identity which resulted in a shift of loyalty from the patient toward a total institution. Despite prison doctors are formally independent from the prison administration, the professional autonomy of medical workers is limited significantly. In particular, they are restricted in following the professional ethical standards. In prisons, security is given a clear priority over healthcare. Doctors can work only through a system of ‘mutual concessions’ with correctional officers and the prison administration. These and some other conditions transform the doctor-patient relationship, creating an additional distance between them.

The paper is available by the link (in Russian).