Family_Violence-Oct2010

1
THE WORLD MEDICAL ASSOCIATION, INC.
WMA STATEMENT
ON
FAMILY VIOLENCE
Adopted by the 48th General Assembly Somerset West, Republic of South Africa, October 1996,
editorially revised at the 174th Council Session, Pilanesberg, South Africa, October 2006 and
amended by the WMA General Assembly, Vancouver, Canada, October 2010
Preamble
Recalling the World Medical Association Declaration of Hong Kong on the Abuse of the Elderly
and the World Medical Association Statement on Child Abuse and Neglect, and profoundly
concerned with violence as a public health issue, the World Medical Association calls upon
National Medical Associations to intensify and broaden their efforts to address the universal
problem of family violence.
Family violence is a term applied to physical and/or emotional mistreatment of a person by
someone in an intimate relationship with the victim. The term includes domestic violence
(sometimes referred to as partner, spouse, or wife battering), child physical abuse and neglect, child
sexual abuse, maltreatment of older people, and many cases of sexual assault. Family violence can
be found in every country in the world, cutting across gender and all racial, ethnic, religious and
socio-economic lines. Although case definitions vary from culture to culture, family violence
represents a major public health problem by virtue of the many deaths, injuries, and adverse
psychological consequences that it causes. The physical and emotional harm may represent chronic
or even lifetime disabilities for many victims. Family violence is associated with increased risk of
depression, anxiety, substance abuse, and self-injurious behaviour, including suicide. Victims often
become perpetrators or become involved in violent relationships later on. Although the focus of this
document is the welfare of the victim, the needs of the perpetrator should not be overlooked.
Although the causes of family violence are complex, a number of contributing factors are known.
These include poverty, unemployment, other exogenous stresses, attitudes of acceptance of violence
for dispute resolution, substance abuse (particularly alcohol), rigid gender roles, poor parenting
skills, ambiguous family roles, unrealistic expectations of other family members, interpersonal
conflicts within the family, actual or perceived physical or psychological vulnerability of victims by
perpetrators, perpetrator pre-occupation with power and control, and familial social isolation,
among others.
Position
There is a growing awareness of the need to think about and take action against family violence in a
unified way, rather than focusing on the particular type of victim or community affected. In many
families where partner battering occurs, for example, there may be abuse of children and/or of older
people as well, often carried out by a single perpetrator. In addition, there is substantial evidence
that children who are victimized or who witness violence against others in the family are later at
increased risk as adolescents or adults of being re-victimized and/or becoming perpetrators of
Vancouver, October 2010 Family Violence/Oct2010
2
violence themselves. Finally, more recent data suggest that victims of family violence are more
likely to become perpetrators of violence against non-intimates as well. All of this suggests that
each instance of family violence may have implications not only for further family violence, but
also for the broader spread of violence throughout a society.
Physicians and NMAs should oppose violent practices such as dowry killings and honour killings.
Physicians and NMAs should oppose the practice of child marriage.
Physicians have important roles to play in the prevention and treatment of family violence. Of
course they will manage injuries, illnesses, and psychiatric problems deriving from the abuse. The
therapeutic relationships physicians have with patients may allow victims to confide in them about
current or past victimization. Physicians should inquire about violence routinely, as well as when
they see particular clinical presentations that may be associated with abuse. They can help patients
to find methods of achieving safety and access to community resources that will allow protection
and/or intervention in the abusive relationship. They can educate patients about the progression and
adverse consequences of family violence, stress management and availability of relevant mental
health treatment, and parenting skills as ways of preventing the violence before it occurs. Finally,
physicians as citizens and as community leaders and medical experts can become involved in local
and national activities designed to decrease family violence.
Physicians recognise that victims of violence may find it difficult to trust their physician at first.
Physicians must be prepared to develop a trusting relationship with their patient over time until s/he
is ready to accept advice, help and intervention.
Recommendations
The World Medical Association recommends that National Medical Associations adopt the
following guidelines for physicians:
• All physicians should receive adequate training in the medical, sociological, psychological and
preventive aspects of all types of family violence. This would include medical school training
in the general principles, specialty-specific information during postgraduate training, and
continuing medical education about family violence. Trainees must receive adequate
instruction in the role of gender, power and other issues of family dynamics in contributing to
family violence. The training should also include adequate collecting of evidence,
documentation and reporting in cases of abuse.
• Physicians should know how to take an appropriate and culturally sensitive history of current
and past victimization.
• Physicians should routinely consider and be sensitive to signs indicating the need for further
evaluations about current or past victimization as part of their general health screen or in
response to suggestive clinical findings.
• Physicians should be encouraged to provide pocket cards, booklets, videotapes, and/or other
educational materials in reception rooms and emergency departments to offer patients general
information about family violence as well as to inform them about local help and services.
Vancouver, October 2010 Family Violence/Oct2010
3
• Physicians should be aware of social, community and other services of use to victims of
violence, and refer to and use these routinely.
• Physicians have the obligation to consider reporting to appropriate protection services
suspected violence against children and other family members without legal capacity.
• Physicians should be acutely aware of the need for maintaining confidentiality in cases of
family violence.
• Physicians should be encouraged to participate in coordinated community activities that seek to
reduce the amount and impact of family violence.
• Physicians should be encouraged to develop non-judgemental attitudes toward those involved
in family violence so their ability to influence victims, survivors and perpetrators is enhanced.
For example, the behaviour should be judged but not the person.
• National Medical Associations should encourage and facilitate coordination of action against
family violence between and among components of the health care system, criminal justice
systems, law enforcement authorities, family and juvenile courts, and victims’ services
organizations. They should also support public awareness and community education.
• National Medical Associations should encourage and facilitate research to understand the
prevalence, risk factors, outcomes and optimal care for victims of family violence.
!!!