Doctors Urged to Document Cases of Torture

New guidance to doctors to become much more actively involved in documenting cases of torture they come across, have been approved by the World Medical Association. At its annual General Assembly in Copenhagen which ended at the weekend, the WMA decided that physicians had an obligation to document cases of torture in a professional way when examining victims of torture and consulting their medical files. Based on the guidance given in the Istanbul Protocol for medical and legal experts on how to determine whether or not a person has been tortured, this documentation could then be used for submission to judicial and administrative bodies.

Amending its advice issued four years ago, the WMA said that the absence of documenting and denouncing such acts might be considered as a form of tolerance and of non-assistance to the victims.

Dr Jon Snaedal, President of the WMA, said: 'Doctors are in a key position to witness and report acts of torture, and by documenting and providing information about what they see, they can become a powerful voice in helping the struggle against torture.

'This is the first time the WMA has explicitly obliged doctors to document cases of torture of which they become aware. By doing so we hope that doctors around the world will put pressure on those who perpetrate such acts to stop such degrading treatment'.

Brita Sydhoff, Secretary General of the International Rehabilitation Council for Torture Victims, told the meeting: 'Doctors, with their specific expertise and direct access to victims, play a crucial role in establishing the evidence needed to prove that torture has occurred. Many practitioners are unaware of how to recognise symptoms of torture - and of their responsibility to report their findings. A particular challenge in documenting torture is that torture methods are often designed to induce maximum impact while leaving minimum detectable signs.

'Add to this that victims are often detained until their physical injuries have healed, and it becomes clear that documenting consequences of torture is no easy task.

'I have no doubt that the proposed changes to the WMA guidance today will help strengthen the fight against impunity for perpetrators of torture. By adopting these changes, the WMA will significantly bolster the crucial role
that medical doctors can play in the fight against torture.'

The amended guidance urges national medical associations to promote the training of physicians on the identification of different modes of torture and in recognising the physical and psychological symptoms following specific forms of torture. However physicians should observe informed consent and avoided putting individuals in danger while documenting signs of torture and ill-treatment.

The WMA's guidance is in line with the Istanbul Protocol which states: '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.'