S-1996-02-1996_OVE

L’ASSOCIATION MEDICALE MONDIALE. INC ASOCIACION MEDICA MUNDIAL, INC
THE WORLD MEDICAL ASSOCIATION. INC.
B. P. 63 • 01212 FERNEY.VOLTAIRE Cedex, France
28, avenue des Alpes – 01210 FERNEY-VOLTAIRE, France
Telephone: 045040 75 75
Fax: 04 50 40 59 37
October 1996
Cable Address:
WOMEDAS, Ferney-Voltaire
10.140
Original: English
WORLD MEDICAL ASSOCIATION DECLARATION
FAMILY VIOLENCE
Adopted by the 48th General Assembly
Somerset West, Republic of South Africa, October 1996
PREAMBLE
PREAMBLE
Recalling the previous World Medical Association Declaration of Hong Kong on the Abuse of
the Elderly (10.25) and the World Medical Association Statement on Child Abuse and Neglect
(17.W), 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 by
addressing 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 which 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.
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 system
(legal, medical, etc.) affected. In many families where partner battering occurs, for example,
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there may be child and/or abuse of older people as well, eften 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 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 as well.
Although the causes of family violence are complex, a number of contributing factors are
known. These includes 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.
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 th.
about current or past victimization. Physicians should inquire about violence routinely, as w
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 which 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,
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.
RECOMMENDATIONS
1. The World Medical Association recommends that national medical associations adopt the
following guidelines for physicians:
a) All physicians should receive adequate training in the medical, sociological,
psychological and preventive aspects of all types of family violence. This would incl_
medical school training in the general principles, specialty-specific information durflllll
residency training, and continuing medical education about family violence. Trainees
must receive adequate training in the role of gender, power, and other issues of family
dynamics in contributing to family violence.
b) Physicians should know how to take an appropriate and CUlturally sensitive history of
current and past victimization.
c) 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.
d) 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.
e) Physicians should be aware of social, community and other services of use to victims of
violence, and refer to and use these routinely.
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f) Physicians should be acutely aware of the need for maintaining confidentiality in cases
of family violence. as well as knowledgeable about adequate case documentation and
any local or national reporting requirements.
g) Physicians should be encouraged to participate in coordinated community activities
which seek to reduce the amount and impactof family violence.
h) 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.
2. 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.
3. National medical associations should encourage and facilitate research to understandthe
e prevalence, risk factors, outcomes, and optimal care for victims of family violence.
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