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AAAS Scientific Responsibility, Human Rights and Law Program

Health Professionals and Torture

Resources & Background Reports



"No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment."

--Article 5 of the Universal Declaration of Human Rights

The Issue At a Glance

The revelations of prisoner abuse in U.S. operated detention centers in Iraq and Guantanamo Bay, Cuba have put the spotlight back on the issue of torture. Despite formal treaties and human rights declarations, torture occurs around the world. One aspect that is of particular concern to the scientific community is the role of health professionals, both in the obligations they have to treat individual suffering and in the instances where health professions have been complicit in the practice of torture.

Two reports published at the end of August, 2004 document numerous cases of the involvement of health professionals in the torture of prisoners held at Abu Ghraib prison in Iraq. The reports accuse medics of a range of crimes, from negligence to collusion in covering up torture-related deaths. While the reports claim that these violations were spurred by confusion over permitted interrogation practices and whether treatment of the prisoners should be governed by the Geneva Conventions, the complicity of health professionals should have been avoided by medical ethics training and better oversight.

The World Medical Association's Declaration of Tokyo asserts, "The doctor shall not provide any...knowledge to facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment, or to diminish the ability of the victim to resist such treatment." Many medical professional societies, such as the World Psychiatric Association and the International Council of Nurses, have similar statements forbidding medical involvement in torture and other acts that violate the dignity or physical integrity of the human beings in their members' care.

Medical professionals often find themselves in ethically dubious positions, being asked to supervise abuse, certify prisoners' fitness for execution or torture, or otherwise violate their singular loyalty to the patient. A 2002 report published by Physicians for Human Rights and the Health Sciences Faculty of the University of Cape Town, Dual Loyalty and Human Rights in Health Professional Practice, stresses that, while human rights violations flourish particularly in oppressive societies lacking basic freedoms of expression and association, they can also arise in more open societies when the health worker feels competing loyalties, such as in prisons and other detention facilities. In these situations the role of the medical professional is often ambiguous and they may not feel like they have adequate authority or security (financially or emotionally) to stand up to unethical practices.

Dual Loyalty points out that "in the absence of clear imperatives accompanied by training and support, [medical professionals] understandably tend to follow cultural practices, some of which are built into law" (Dual Loyalty, 32). Personal prejudices on the part of health workers can also manifest themselves in substandard or unethical clinical practices.

The report identified six major "dual loyalty practices" that violate human rights:

  • Using medical skills or expertise on behalf of the state or other third party to inflict pain or physical or psychological harm on an individual that is not a legitimate part of medical treatment.
  • Subordinating independent judgment, whether in evaluative or treatment settings, to support conclusions favoring the state or other third party.
  • Limiting or denying medical treatment or information related to treatment of an individual in order to effectuate policy or practice of the state or other third party.
  • Disclosing confidential patient information to state authorities or other third parties in circumstances that violate human rights.
  • Performing evaluations for state or private purposes in a manner that facilitates violations of human rights.
  • Remaining silent in the face of human rights abuses committed against individuals in the care of health professionals.

The key to resisting discriminatory practices, most concerned professionals agree, is accountability and transparency in decision making. "In all circumstances where departure from undivided loyalty takes place, what is critical to the moral acceptability of such departures is the fairness and transparency of the balancing of conflicting interests, and the way in which such a balancing is, or is not, consistent with human rights" (Dual Loyalty, 3). While resistance to violations of human rights must involve both individual and collective action founded on a universally-applicable human rights framework, knowledge of a generic set of human rights rules is not enough. Training of medical practitioners to question and apply "constructive doubt" in their daily procedures is vital to combating violations.

Dual Loyalty & Human Rights In Health Professional Practice: Proposed Guidelines & Institutional Mechanisms

  • A Project of the International Dual Loyalty Working Group A Collaborative Initiative of Physicians for Human Rights and the School of Public Health and Primary Health Care University of Cape Town, Health Sciences Faculty

 

Relevant International Treaties and Declarations

Quick Facts on Torture

  • Human rights organizations have cited 125 countries where individuals and families have been detained and then tortured or ill-treated.
  • Among the refugees from countries of state-sponsored torture, up to 35% have been tortured and 90% have seen the effects of torture.
  • There are an estimated 500,000 torture survivors in the United States from foreign countries.

Links to Organizations Working on the Issue of Torture

Manuals & Curricula

Selected News Articles & Commentaries

 

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