WMA-and-Torture

The
 World
 Medical
 Associa0on
 
and
 Torture
 
Dr.
 Margaret
 Mungherera
 
Senior
 Consultant
 Psychiatrist,
 Mulago
 Hospital
 
 
President,
 Uganda
 Medical
 Associa0on
 

 President
 Elect
 of
 the
 World
 medical
 Associa0on
 
The
 World
 Medical
 Associa0on
 
•  Was
 founded
 in
 1947
 by
 27
 Na0onal
 Medical
 Associa0ons.
 
•  Now
 102
 na0onal
 medical
 associa0ons
 including
 the
 
Uganda
 Medical
 Associa0on.
 
•  One
 of
 its
 main
 objec0ves
 is
 to
 promote
 the
 highest
 
possible
 ethical
 and
 professional
 standards
 among
 doctors.
 

 
 
 
1949:
 
 Developed
 the
 Interna0onal
 Code
 of
 Medical
 Ethics
 

 Has
 become
 the
 basis
 of
 ethical
 codes
 of
 conduct
 for
 
doctors
 and
 other
 cadres
 of
 health
 professionals
 
throughout
 the
 world.
 
Interna0onal
 Code
 of
 Medical
 Ethics
 

 
A. 
 Covers
 the
 3
 main
 principles
 of
 Medical
 
Ethics:
 

 
1.  PATIENT
 AUTONOMY
 
2.  DO
 NO
 HARM
 
3.  BEST
 INTEREST
 OF
 THE
 PATEINT
 

 
 
What
 is
 Torture?
 

 According
 to
 the
 UN
 Conven0on
 against
 Torture,
 
Torture
 is
 defined
 as:
 

 Any
 act
 or
 omission,
 by
 which
 severe
 pain
 or
 suffering
 
whether
 physical
 or
 mental,
 is
 inten0onally
 inflicted
 on
 
a
 person
 by
 or
 at
 the
 ins0ga0on
 of
 or
 with
 the
 consent
 
of
 any
 person
 whether
 a
 public
 official
 or
 other
 person
 
ac0ng
 in
 an
 official
 or
 private
 capacity
 for
 such
 
purposes
 as
 -­‐
 
 
(a)  Obtaining
 informa0on
 or
 a
 confession
 from
 the
 
person
 or
 any
 other
 person;
 
Defini0on
 of
 Torture…
 
(a) Punishing
 that
 person
 for
 an
 act
 he
 or
 she
 or
 
any
 other
 person
 has
 commi_ed
 or
 is
 
suspected
 of
 having
 commi_ed
 or
 of
 
planning
 to
 commit;
 or
 

 
(b) In0mida0ng
 or
 coercing
 the
 person
 or
 any
 
other
 person
 to
 do,
 or
 to
 refrain
 from
 doing,
 
any
 act.
 
 
Torture……
 

 The
 main
 purpose
 of
 torture
 is
 to
 reduce
 the
 
vic0m
 to
 severe
 helplessness
 so
 as
 to
 impair
 
his
 or
 her
 func0oning
 cogni0vely,
 emo0onally
 
and
 behaviorally.
 
 

 
 The
 torturer
 not
 only
 sets
 out
 to
 incapacitate
 
the
 vic0m
 physically
 but
 intends
 to
 break
 
down
 the
 vic0m’s
 personality.
 
 

 
Torture…..
 
•  The
 inten0on
 is
 to
 remove
 the
 vic0m’s
 sense
 
of
 being
 grounded
 in
 his
 or
 her
 family
 and
 
society
 with
 hopes,
 dreams
 an
 aspira0ons.
 
 
•  The
 inten0on
 is
 also
 to
 break
 the
 will
 of
 the
 
vic0m
 by
 de-­‐humanizing
 him
 or
 her.
 
•  Torture
 has
 a
 wide
 range
 of
 physical
 and
 
psychological
 consequences.
 
 
Effects
 of
 Torture
 
•  Psychological
 effects
 of
 torture
 are
 probably
 
the
 worst
 consequences
 of
 torture
 for
 
survivors.
 This
 is
 because
 they
 tend
 to
 last
 
longer,
 are
 more
 incapacita0ng
 and
 may
 be
 
life
 long.
 
 
Consequences
 of
 the
 Psychological
 
effects
 
 

 The
 psychological
 consequences
 of
 torture
 on
 
individuals
 have
 devasta0ng
 consequences
 on
 
the
 SOCIAL
 and
 ECONOMIC
 development
 of
 
COMMUNITIES
 and
 therefore
 hinders
 
 
POVERTY
 ERADICATION
 and
 NATIONAL
 
DEVELOPMENT.
 
 
WMA
 and
 Torture
 
•  In
 1975,
 the
 WMA
 adopted
 the
 GUIDELINES
 to
 
DOCTORS
 regarding
 Torture,
 Cruel,
 Inhuman
 
or
 Degrading
 Treatment
 or
 Punishment
 in
 
rela0on
 to
 Deten0on
 or
 Incarcera0on.
 
 

 
 (THE
 DECLARATION
 OF
 TOKYO)
 

 
Torture…..
 

 According
 to
 the
 Tokyo
 Declara0on:
 

 A
 doctor
 shall
 not
 condone
 or
 par0cipate
 in
 
any
 act
 of
 torture,
 cruel,
 inhuman
 or
 
degrading
 procedures
 whatever
 offence
 the
 
vic0m
 is
 suspected,
 accused
 or
 guilty
 of.
 
 
The
 Tokyo
 Declara0on
 
 
•  This
 Declara0on
 resolves
 that:
 

 A
 doctor
 shall
 NOT
 condone
 or
 par0cipate
 in
 
any
 act
 of
 torture,
 cruel,
 inhuman
 or
 
degrading
 procedures
 whatever
 offence
 the
 
vic0m
 is
 suspected,
 accused
 or
 guilty
 of.
 
 
Torture…
 
•  May
 2009:
 
 WMA
 
 resolved
 to
 support
 the
 Tokyo
 
Declara0on
 and
 prohibited
 physicians
 from
 
par0cipa0ng
 in
 any
 act
 of
 torture.
 
•  October
 2011:
 
 

 WMA
 
 
 resolved
 to
 create
 a
 MONITORING
 AND
 
REPORTING
 MECHANISM
 to
 ensure
 that
 doctors
 
adhere
 to
 the
 Tokyo
 Declara0on.
 
 

 This
 Resolu0on
 also
 encourages
 Na0onal
 Medical
 
Associa0ons
 to
 support
 doctors
 in
 difficult
 situa0ons.
 
The
 Istanbul
 Protocol
 
•  In
 2000
 

 The
 Istanbul
 Protocol
 was
 adopted
 by
 the
 United
 
Na0ons
 General
 Assembly.
 

 The
 Istanbul
 Protocol
 is
 the
 a
 Manual
 on
 the
 
Effec0ve
 Inves0ga0on
 and
 Documenta0on
 of
 
Torture
 and
 other
 forms
 of
 Cruel,
 Inhuman
 and
 
Degrading
 Treatment
 or
 Punishment.
 

 It
 has
 been
 adopted
 by
 the
 WMA.
 
 
Istanbul
 Protocol…….
 
•  The
 WMA
 was
 involved
 in
 the
 pilo0ng
 the
 Istanbul
 Protocol
 .
 
Uganda
 
 -­‐
 
 one
 of
 the
 4
 sites
 in
 the
 world.
 
•  Involved
 Uganda
 Medical
 Associa0on,
 Interna0onal
 Centre
 for
 
Treatment
 of
 Tortured
 Vic0ms
 (IRCT)
 training
 of
 50
 doctors,
 50
 
lawyers
 and
 10
 Human
 Rights
 advocates
 in
 the
 use
 of
 this
 Manual.
 
•  Since
 then
 several
 doctors,
 clinical
 officers,
 legal
 officers,
 police,
 
prison
 officers,
 human
 rights
 agencies
 like
 Uganda
 Human
 Rights
 
Commission
 have
 been
 trained.
 
•  The
 African
 Centre
 for
 Treatment
 of
 Tortured
 Vic0ms
 (ACTV)
 
coordinates
 this
 training
 program
 supported
 by
 the
 European
 
Union.
 
The
 Uganda
 Law
 on
 torture
 
 

 The
 Uganda
 Preven0on
 and
 Prohibi0on
 of
 Torture
 Act
 
2012:
 

 adopted
 the
 defini0on
 of
 Torture
 as
 provided
 for
 by
 
the
 UN
 Conven0on
 against
 Torture.
 

 
 Ar0cle
 6
 sec0on
 (c):
 
 

 
“
 rehabilita0on
 including
 –
 
 
(i)  medical
 and
 psychological
 care,
 or
 
(ii) 
 legal
 and
 psychosocial
 services
 to
 the
 vic0m
 in
 case
 
of
 trauma.”
 

 
Istanbul
 Protocol….
 

 Uganda
 Medical
 Associa0on
 is
 advoca0ng
 for
 
the
 Istanbul
 Protocol
 to
 be
 incorporated
 into
 
the
 opera0onal
 guidelines
 for
 this
 Law.
 

 The
 Associa0on
 par0cipated
 in
 the
 
 
development
 of
 the
 Ministry
 of
 Health
 policy
 on
 
Forensic
 Medical
 Services
 and
 succeeded
 in
 
having
 the
 Istanbul
 Protocol
 incorporated
 into
 
it.
 

 
WMA
 Statement
 on
 Ethical
 Issues
 
concerning
 Pa0ents
 with
 Mental
 
Illness
 
•  Adopted
 at
 47th
 WMA
 General
 Assembly,
 Bali,
 
Indonesia,
 1995
 
Preamble:
 
 
”
 Pa0ents
 with
 mental
 illness
 should
 be
 viewed,
 
treated
 and
 granted
 the
 same
 access
 to
 care
 
as
 any
 other
 medical
 pa0ent.
 
 
WMA
 on
 Mental
 illness….
 

 “Recogni0on
 should
 be
 given
 to
 the
 fact
 that
 a
 
large
 propor0on
 of
 pa0ents
 with
 mental
 
illness
 are
 treated
 by
 doctors
 who
 are
 not
 
psychiatrists.
 The
 same
 ethical
 obliga0ons
 and
 
limita0ons
 would
 apply
 to
 these
 doctors”
 
 
WMA
 on
 Mental
 Illness….
 
•  “A
 medical
 doctor
 has
 the
 same
 obliga0ons
 
towards
 pa0ents
 with
 mental
 illness
 as
 toward
 
any
 other
 pa0ent”.
 
•  “The
 doctor’s
 primary
 role
 as
 healer
 of
 
pa0ents
 should
 not
 be
 undermined
 by
 serving
 
as
 the
 agent
 of
 the
 greater
 society
 except
 in
 
instances
 of
 danger
 to
 the
 public”.
 
 
WMA
 on
 Mental
 illness…..
 

 The
 discrimina0on
 associated
 with
 psychiatry
 
and
 the
 mentally
 ill
 should
 be
 eliminated.
 
 

 This
 s0gma
 onen
 discourages
 people
 in
 need
 
from
 seeking
 psychiatric
 help
 thereby
 
aggrava0ng
 their
 situa0on
 and
 placing
 them
 
at
 risk
 of
 emo0onal
 or
 physical
 harm.
 
 
WMA
 on
 Mental
 Illness……
 

 A
 
 doctor
 should
 never
 use
 his
 or
 her
 
professional
 posi0on
 to
 violate
 the
 dignity
 or
 
human
 rights
 of
 any
 individual
 or
 group
 
 

 and
 should
 never
 allow
 his/her
 personal
 
desires,
 needs,
 feelings,
 prejudices
 or
 beliefs
 
to
 interfere
 with
 the
 treatment.
 
 
WMA
 on
 Mental
 Health…
 

 Neither
 should
 a
 doctor
 take
 advantage
 of
 his/
her
 professional
 posi0on
 or
 the
 vulnerability
 
of
 a
 pa0ent
 to
 abuse
 his/her
 authority.
 
Other
 WMA
 Guidelines
 and
 
Statements
 
WMA
 Statement
 on
 Adolescent
 Suicide
 (1991)
 

 “The
 health
 care
 of
 adolescents
 is
 best
 achieved
 when
 
doctors
 provide
 comprehensive
 services
 including
 both
 
medical
 and
 psychosocial
 evalua0on
 and
 treatment.”
 

 “Doctors
 should
 be
 trained
 to
 iden0fy
 early
 signs
 and
 
symptoms
 of
 physical,
 emo0onal
 and
 social
 distress
 of
 
adolescent
 pa0ents
 and
 the
 signs
 and
 symptoms
 of
 
psychiatric
 disorders
 that
 may
 contribute
 to
 suicide…”.
 
WMA
 Ethical
 
 Guidelines
 on
 Research
 
involving
 Human
 Subjects
 
•  Was
 first
 adopted
 at
 the
 Annual
 general
 
Assembly
 of
 the
 World
 Medical
 Associa0on
 
held
 in
 Helsinki,
 Finland
 in
 1964.
 
•  So
 is
 also
 known
 as
 the
 Declara0on
 of
 Helsinki
 
(DoH).
 
•  Will
 be
 50
 years
 old
 in
 2014
 
DoH
 
•  October 2011 – Process to revise started.
•  Consultations have been held with global
ethics experts and stakeholders at regional
workshops in Brazil, Belgium, South Africa,
Japan and the final meeting will be held in
Washington DC on 26th August, 2013.
•  The final draft will be presented for approval
at the Annual General Meeting in Brazil in
October, 2013.
DoH
 
•  The Declaration is addressed primarily to
doctors.
•  The WMA however encourages other
participants in medical research involving
human subjects to adopt these principles.”
 
DoH
 

 Global
 consensus
 that
 the
 category
 
“vulnerable
 popula0ons”
 includes
 among
 
others
 :
 
•  Conflict
 and
 Post-­‐conflict
 communi0es
 
•  The
 Mentally
 ill
 
•  The
 Poor
 

 
 
What
 is
 new?
 
“Medical research involving a disadvantaged
or vulnerable population or community is only
justified if
1. The research can not be carried out in a
non-vulnerable population.
2. This population or community stands to
benefit from the knowledge, practices or
interventions that result from the research.”

 
 
 Thank
 you
 for
 listening………!