R-2003-02-2007_OVE

Handbook of WMA Policies
World Medical Association  R-2003-02-2007
WMA RESOLUTION
ON
THE RESPONSIBILITY OF PHYSICIANS IN THE DOCUMENTATION
AND DENUNCIATION OF ACTS OF TORTURE OR CRUEL
OR INHUMAN OR DEGRADING TREATMENT
Adopted by the 54th
WMA General Assembly, Helsinki, Finland, September 2003
and amended by the 58th
WMA General Assembly, Copenhagen, Denmark, October 2007
The World Medical Association,
1. Considering the Preamble to the United Nations Charter of 26 June 1945 solemnly
proclaiming the faith of the people of the United Nations in the fundamental human
rights, the dignity and value of the human person,
2. Considering the Preamble to the Universal Declaration of Human Rights of 10
December 1948 which states that disregard and contempt for human rights have
resulted in barbarous acts which have outraged the conscience of mankind,
3. Considering Article 5 of that Declaration which proclaims that no one shall be
subjected to torture or cruel, inhuman or degrading treatment,
4. Considering the American Convention on Human Rights, which was adopted by the
Organization of American States on 22 November 1969 and entered into force on 18
July 1978, and the Inter-American Convention to Prevent and Punish Torture, which
entered into force on 28 February 1987,
5. Considering the Declaration of Tokyo, adopted by the World Medical Association in
1975, which reaffirms the prohibition of any form of medical involvement or presence
of a physician during torture or inhuman or degrading treatment,
6. Considering the Declaration of Hawaii, adopted by the World Psychiatric Association
in 1977,
7. Considering the Declaration of Kuwait, adopted by the International Conference of
Islamic Medical Associations in 1981,
8. Considering the 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 the
United Nations General Assembly on 18 December 1982, and particularly Principle 2,
which states: “It is a gross contravention of medical ethics… for health personnel,
particularly physicians, to engage, actively or passively, in acts which constitute
participation in, complicity in, incitement to or attempts to commit torture or other
cruel, inhuman or degrading treatment…”,
R-2003-02-2007 Copenhagen
Denunciation of Acts of Torture
9. It is too early to assess the likelihood of success in any specific therapy and the place
of stem cells amongst a variety of forms of treatments.
10. Considering the Convention Against Torture and Other Cruel, Inhuman or Degrading
Treatment or Punishment, which was adopted by the United Nations General
Assembly on December 1984 and entered into force on 26 June, 1987,
11. Considering the European Convention for the Prevention of Torture and Inhuman or
Degrading Treatment or Punishment, which was adopted by the Council of Europe on
26 June 1987 and entered into force on 1 February 1989,
12. Considering the Resolution on Human Rights adopted by the World Medical
Association in Rancho Mirage, in October 1990 during the 42nd
General Assembly and
amended by the 45th
, 46th
and 47th
General Assemblies,
13. Considering the Declaration of Hamburg, adopted by the World Medical Association
in November 1997 during the 49th
General Assembly, calling on physicians to protest
individually against ill-treatment and on national and international medical
organizations to support physicians in such actions,
14. Considering the Istanbul Protocol (Manual on the Effective Investigation and
Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or
Punishment), adopted by the United Nations General Assembly on 4 December 2000,
15. Considering the Convention on the Rights of the Child, which was adopted by the
United Nations on 20 November 1989 and entered into force on 2 September 1990,
and
16. Considering the World Medical Association Declaration of Malta on Hunger Strikers,
adopted by the 43rd
World Medical Assembly Malta, November 1991and amended by
the WMA General Assembly, Pilanesberg, South Africa, October, 2006,
RECOGNIZING
1. That careful and consistent documentation and denunciation by physicians of cases of
torture and of those responsible contributes to the protection of the physical and mental
integrity of victims and in a general way to the struggle against a major affront to
human dignity,
2. That physicians, by ascertaining the sequelae and treating the victims of torture, either
early or late after the event, are privileged witnesses of this violation of human rights,
3. That the victims, because of the psychological sequelae from which they suffer or the
pressures brought on them, are often unable to formulate by themselves complaints
against those responsible for the ill-treatment they have undergone,
4. That the absence of documenting and denouncing acts of torture may be considered as
a form of tolerance thereof and of non-assistance to the victims,
5. That nevertheless there is no consistent and explicit reference in the professional codes
of medical ethics and legislative texts of the obligation upon physicians to document,
Handbook of WMA Policies
World Medical Association  R-2003-02-2007
report or denounce acts of torture or inhuman or degrading treatment of which they
are aware,
RECOMMENDS THAT NATIONAL MEDICAL ASSOCIATIONS
1. Attempt to ensure that detainees or victims of torture or cruelty or mistreatment have
access to immediate and independent health care. Attempt to ensure that physicians
include assessment and documentation of symptoms of torture or ill-treatment in the
medical records using the necessary procedural safeguards to prevent endangering
detainees.
2. Promote awareness of the Istanbul Protocol and its Principles on the Effective
Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading
Treatment. This should be done at country level using different methods of information
dissemination; including trainings, publications and web documents.
3. Disseminate to physicians the Istanbul Protocol.
4. Promote training of physicians on the identification of different modes of torture, in
recognizing physical and psychological symptoms following specific forms of torture
and in using the documentation techniques foreseen in the Istanbul Protocol to create
documentation that can be used as evidence in legal or administrative proceedings.
5. Promote awareness of the correlation between the examination findings, under-
standing torture methods and the patients’ allegations of abuse;
6. Facilitate the production of high-quality medical reports on torture victims for sub-
mission to judicial and administrative bodies;
7. Attempt to ensure that physicians observe informed consent and avoid putting
individuals in danger while assessing or documenting signs of torture and ill-treatment;
8. Attempt to ensure that physicians include assessment and documentation of symptoms
of torture or ill-treatment in the medical records using the necessary procedural safe-
guards to prevent endangering detainees.
9. Support the adoption in their country of ethical rules and legislative provisions:
1) aimed at affirming the ethical obligation on physicians to report or denounce acts
of torture or cruel, inhuman or degrading treatment of which they are aware; de-
pending on the circumstances, the report or denunciation would be addressed to
medical, legal, national or international authorities, to non-governmental
organizations or to the International Criminal Court. Doctors should use their
discretion in this matter, bearing in mind paragraph 68 of the Istanbul Protocol.
2) establishing, to that effect, an ethical and legislative exception to professional
confidentiality that allows the physician to report abuses, where possible with the
subject’s consent, but in certain circumstances where the victim is unable to express
him/herself freely, without explicit consent.
R-2003-02-2007 Copenhagen
Denunciation of Acts of Torture
3) cautioning physicians to avoid putting individuals in danger by reporting on a
named basis a victim who is deprived of freedom, subjected to constraint or threat
or in a compromised psychological situation
10. Place at their disposal all useful information on reporting procedures, particularly to
the national authorities, nongovernmental organizations and the International Criminal
Court.
Istanbul Protocol, paragraph 68: “In some cases, two ethical obligations are in conflict.
International codes and ethical principles require the reporting of information concerning
torture or maltreatment to a responsible body. In some jurisdictions, this is also a legal
requirement. In some cases, however, patients may refuse to give consent to being exa-
mined for such purposes or to having the information gained from examination disclosed
to others. They may be fearful of the risks of reprisals for themselves or their families. In
such situations, health professionals have dual responsibilities: to the patient and to society
at large, which has an interest in ensuring that justice is done and perpetrators of abuse are
brought to justice. The fundamental principle of avoiding harm must feature prominently
in consideration of such dilemmas. Health professionals should seek solutions that promote
justice without breaking the individual’s right to confidentiality. Advice should be sought
from reliable agencies; in some cases this may be the national medical association or non-
governmental agencies. Alternatively, with supportive encouragement, some reluctant
patients may agree to disclosure within agreed parameters.”