Whatever versions of the truth it may hold, the public has no choice but to respect the court rulings that dictate Anwar Ibrahim's imprisonment . There are several questions about a prisoner's right to medical care in Malaysia, and the outcome in Anwar's case may provide some answers.

Anwar has lost the right to move about freely in society, but what should be asked now is whether he has truly lost the right to determine by whom and in what way, any interference to his bodily person is carried out, in the form of medical treatment.

This possibility for medical treatment at a centre of choice, applies to all prisoners willing to pay for it and who are also able to financially compensate the prison authorities for any expenses for escorts, travel, or other acceptable measures to ensure his restricted movements.

A prisoner's right to adequate medical attention is certainly not extinguished by incarceration in any civilised society. This begs discussion of the word 'adequate', and also, which sort of individuals have the ethical authority to decide what medical treatment is 'good enough' for mere prisoners of the state, as if they were some form of sub-human life.

Where members of the public do not have private medical cover or private funds, they will have no choice but to use public medical services.

The state is expected to provide the same quality of medical services to prisoners that it provides to the public at large. It is presumed therefore that the state health apparatus is comprehensive enough to provide reasonable and adequate medical care including specialist surgery, to all prisoners.

Here now is a crucial quandary - if for any reason the patient will not formally consent to a state-appointed doctor's interference with his body, the designated doctor simply cannot proceed. The absence of true consent (voluntary and unfettered) from the patient, exposes him to the prospects of a criminal charge of assault and battery and possibly a civil action too.

Malaysia claims it is able to provide what it considers adequate and reasonable spinal surgery for Anwar Ibrahim, and doctors within the public hospital system have offered him options of treatment.

So far no individual in Hospital Kuala Lumpur who will personally 'hold the knife' has been singled out, and his/her expertise and surgical track record for such spinal surgery has not been made clearly available.

References have sometimes been made about a 'team of doctors' working on Anwar's spine. A 'team' approach cannot be used to diffuse or deflect ultimate responsibility and liability for surgical work.

The surgical field for open spinal decompressive surgery is small and confined, and only one single doctor can take the responsibility for bone rongeuring, protection of the dura and spinal nerves, and control of bleeding. It is not clear whether Anwar knows who this proposed individual is.

Delaying Anwar Ibrahim the opportunity to exercise his residual and active right as a prisoner to access his chosen treatment, means he is losing the chance for what he believes to be optimal surgical relief of his condition.

It seems that what Anwar has been presented is a 'take it or leave it' approach and that his non-compliance so far with what is on offer at HKL, is construed as self-inflicted aggravation of his condition.

It may well be demonstrable that denying him the treatment of his choice will in fact contribute materially to Anwar's ultimate functional disability. I do not think this form of punishment was intended in his jail sentence.