WMA-and-Torture
PDF Upload
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………!