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"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
- The Universal Declaration
of Human Rights (UDHR)
The UDHR was adopted without dissent by the General Assembly of the United
Nations on 10 December 1948
- The UN Convention
Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment
Entered into force 26 June 1987
- The Convention defines torture as: "any act by which severe pain or
suffering, whether physical or mental, is intentionally inflicted on a
person for such purposes as obtaining from him or a third person information
or a confession, punishing him for an act he or a third person has committed
or is suspected of having committed, or intimidating or coercing him or
a third person, or for any reason based on discrimination of any kind,
when such pain or suffering is inflicted by or at the instigation of or
with the consent or acquiescence of a public official or other person
acting in an official capacity. It does not include pain or suffering
arising only from, inherent in or incidental to lawful sanctions."
- The Standard Minimum
Rules for the Treatment of Prisoners
Adopted by the First United Nations Congress on the Prevention of Crime and
the Treatment of Offenders, held at Geneva in 1955, and approved by the Economic
and Social Council by its resolution 663 C (XXIV) of 31 July 1957 and 2076
(LXII) of 13 May 1977
- Principles of Medical
Ethics relevant to the Role of Health Personnel, particularly Physicians,
in the Protection of Prisoners and Detainees against Torture and Other Cruel,
Inhuman or Degrading Treatment or Punishment
Adopted by General Assembly resolution 37/194 of 18 December 1982
- Geneva Convention relative
to the Treatment of Prisoners of War
Adopted on 12 August 1949 by the Diplomatic Conference for the Establishment
of International Conventions for the Protection of Victims of War, held in
Geneva from 21 April to 12 August, 1949 entry into force 21 October 1950
- World Medical Association Declaration
of Geneva International Code of Medical Ethics
Adopted by the 3rd General Assembly of the World Medical Association, London,
England, October 1949 and amended by the 22nd World Medical Assembly Sydney,
Australia, August 1968 and the 35th World Medical Assembly Venice, Italy,
October 1983
- World Medical Association
Declaration of Tokyo
Adopted by the 29th World Medical Assembly Tokyo, Japan, October 1975
Guidelines for Medical Doctors Concerning Torture and Other Cruel, Inhuman
or Degrading Treatment or Punishment in Relation to Detention and Imprisonment
- World Psychiatric
Association Declaration of Hawaii
As approved by the General Assembly of the World Psychiatric Association in
Vienna, Austria, on 10th July 1983
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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