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Initiated: September 2002
Adopted by the WMA General Assembly, Helsinki 2003
and amended by the WMA General Assembly, Copenhagen, Denmark,
October 2007
The World Medical Association,
- 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,
- 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,
- Considering Article 5 of that Declaration which proclaims
that no one shall be subjected to torture or cruel, inhuman
or degrading treatment,
- 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,
- 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,
- Considering the Declaration of Hawaii, adopted by the World
Psychiatric Association in 1977,
- Considering the Declaration of Kuwait, adopted by the International
Conference of Islamic Medical Associations in 1981,
- 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…",
- 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,
- 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,
- 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,
- 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,
- 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,
- 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
- 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
- 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,
- 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,
- 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,
- 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,
- 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, report
or denounce acts of torture or inhuman or degrading treatment
of which they are aware,
Recommends that National Medical Associations
- 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.
- 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.
- Disseminate to physicians the Istanbul Protocol.
- 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.
- Promote awareness of the correlation between the examination
findings, understanding torture methods and the patients' allegations
of abuse;
- Facilitate the production of high-quality medical reports
on torture victims for submission to judicial and administrative
bodies;
- Attempt to ensure that physicians observe informed consent
and avoid putting individuals in danger while assessing or documenting
signs of torture and ill-treatment;
- 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.
- Support the adoption in their country of ethical rules and
legislative provisions:
9.1 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; depending
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.
9.2 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.
9.3 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
- 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 examined
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."
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