Policy Tag: Rehabilitation

Adopted by the 64th General Assembly, Fortaleza, Brazil, October 2013 and
reaffirmed with minor revisions by the 224th WMA Council, Kigali, Rwanda, October 2023

 

PREAMBLE

The World Medical Association notes with grave concern the continued use of torture in many countries throughout the world.

The WMA reaffirms its total condemnation of all form of torture, and other cruel, inhuman or degrading treatment or punishment, as defined by the United Nations Convention Against Torture (CAT, 1984). Torture is one of the gravest violations of international human rights law and has devastating consequences for victims, their families and society as a whole. Torture causes severe physical and mental injuries and is a crime absolutely prohibited under international law.

The WMA reaffirms its policies adopted previously, namely:

The medical evaluation is an essential factor in pursuing the documentation of torture and the reparation of victims of torture. Physicians have a critical role to play in gathering information about torture, documenting evidence of torture for legal purposes, as well as supporting and rehabilitating victims.

The WMA recognizes the adoption, in December 2012, by the UN Committee Against Torture of the General Comment on the Implementation of article 14 of Convention against Torture relating to the right to reparation of victims of torture. The General Comment outlines the right of rehabilitation as an obligation on States and specifies the scope of these services. The WMA welcomes in particular:

  • The obligation of State parties to adopt a “long-term and integrated approach and ensure that specialized services for the victim of torture or ill treatment are available, appropriate and promptly accessible”, without making access to these services dependent on the victim pursuing judicial remedies [1].
  • The recognition of the right of victims to choose a rehabilitation service provider, be it a State institution, or a non-State service provider, which is funded by the State.
  • The recognition that State parties should provide torture victims with access to rehabilitation programs as soon as possible following an assessment by qualified independent healthcare professionals.
  • The references to measures aimed at protecting health and legal professionals who assist torture victims, developing specific training on the Istanbul Protocol for health professionals, and promoting the observance of international standards and codes of conduct by public servants, including medical, psychological and social service personnel [2].

The WMA notes that since the adoption of the General Comment on the Implementation of article 14, important developments have taken place in the practice of rehabilitation and in monitoring State compliance with their obligations:

 

RECOMMENDATIONS

  1. The WMA emphasizes the vital function of reparation for victims of torture and their families in rebuilding their lives and achieve redress and the important role of physicians in rehabilitation.
  2. The WMA encourages its member associations to work with relevant agencies – governmental and non-governmental – acting for the reparation of victims of torture, in particular in the areas of documentation and rehabilitation, as well as prevention, and to use the revised Istanbul Protocol and the global rehabilitations standards in doing so.
  3. The WMA encourages its members to support agencies that are under threat of – or subjected to – reprisals from state parties due to their involvement in the documentation of torture, rehabilitation and reparation of torture victims.
  4. The WMA calls on its members to use their medical experience to support torture victims in accordance with article 14 of the UN Convention against Torture, including by helping them to become active agents in their own rehabilitation process through survivor explicit programs.
  5. The WMA calls on its member associations to support and facilitate data collection at the national level, using established indicators for the right to rehabilitation, to monitor the implementation of the State’s obligation to provide rehabilitation services.

 

[1] Paragraph 13 of the General Comment
[2] Paragraph 18 of the General Comment
[3] Global Impact Data – IRCT

Adopted by the 42nd World Medical Assembly, Rancho Mirage, CA., USA, October 1990
and revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and by the 67th WMA General Assembly, Taipei, Taiwan, October 2016 

 

Injuries are the leading cause of death and disability in children and young adults, destroying the health, livelihoods and lives of millions of people each year. Causes of injury include, among others, acts of violence against oneself or others, traffic crashes, falls, poisonings, drowning, and burns. Yet many injuries are preventable. Injury control should be recognized as a public health priority requiring coordination among health, transportation and social service agencies in each country. Physician participation and leadership through medicine, education and advocacy is necessary to ensure the success of such injury control programmes.

As the World Health Organization states in Injuries and Violence: The Facts, the rate of injury is far from uniform around the world. Indeed, about 90% of injury-related deaths occur in low- and middle-income countries. Within countries, injury rates vary by social class as well. The impoverished face more dangerous living and working conditions than the more affluent. For example, buildings in poorer communities are more likely to be older and in need of repair. Poor communities are also plagued by much higher rates of homicide. What’s more, people living in poverty also have less access to quality emergency care and rehabilitation services. Greater attention must be given to these root causes of injuries.

The World Medical Association urges National Medical Associations to work with appropriate public and private agencies to develop and implement programmes to prevent and treat injuries. Included in the programmes must be efforts to improve medical treatment and rehabilitation of injured patients. Research and education on injury control must be increased, and international cooperation is a vital and necessary component of successful programmes.

National Medical Associations should recommend that the following basic elements be incorporated in their countries’ programmes:

EPIDEMIOLOGY

The initial activity of such programmes must be the acquisition of more adequate data on which to base priorities, interventions and research. An effective injury surveillance system should be implemented in each country to gather and integrate information. A consistent and accurate system for coding injuries must be implemented by hospitals and health agencies. There should also be international uniformity in the coding of injury severity.

PREVENTION

Injury prevention requires education and training to teach and persuade people to alter their behaviour in order to reduce their risk of injury. Laws and regulations based on scientifically sound methods of preventing injuries may be appropriate for effecting changes in behaviour (for example, the use of seatbelts and protective helmets). These laws must in turn be strictly enforced. An effective injury surveillance system as mentioned above will help determine how to target further preventive efforts. Urban and traffic planning should support safe environments for the residents.

BIOMECHANICS

A better understanding of the biomechanics of injury and disability could inform the development of improved safety standards and regulations of products and their designs.

TREATMENT

Injury management at the scene of the occurrence must be enhanced by an effective system of communication between first responders and health professionals at hospitals to facilitate decision-making. Rapid and safe transportation to the hospital should be provided. An experienced team of trauma practitioners should be available at the hospital. There should also be adequate equipment and supplies available for the care of the injured patient, including immediate access to a blood bank. Education and training of medical practitioners in trauma care must be encouraged to assure optimal technique by an adequate number of physicians at all times.

REHABILITATION 

Trauma victims need continuity of care emphasizing not only survival but also the identification and preservation of residual functions. Rehabilitation to restore biological, psychological and social functions must be undertaken in an effort to allow the injured person to achieve maximal personal autonomy and an independent lifestyle. Where feasible, community integration is a desirable goal for people chronically disabled by injury. Rehabilitation may also require changes in the patient’s physical and social environment.

Adopted by the 49th WMA General Assembly, Hamburg, Germany, November 1997,
reaffirmed by the 176th WMA Council Session, Berlin, Germany, May 2007
And reaffirmed with minor revision by the 207th WMA Council session, Chicago, United States, October 2017

PREAMBLE

1.     On the basis of a number of international ethical declarations and guidelines subscribed to by the medical profession, physicians throughout the world are prohibited from countenancing, condoning or participating in the practice of torture and other cruel, inhuman or degrading treatment or punishment for any reason.

2.     Primary among these declarations are the World Medical Association’s International Code of Medical Ethics, Declaration of Geneva, the Declaration of Tokyo (1975), the Resolution on the Responsibility of Physicians in the Documentation and Denunciation of Acts of Torture or Inhuman or Degrading Treatment (2003) and the Resolution on Physician Participation in Capital Punishment(1981); as well as the Standing Committee of European Doctors’ Statement of Madrid (1989); the Nordic Resolution Concerning Physician Involvement in Capital Punishment; and, the World Psychiatric Association’s Declaration of Hawaii.

3.     However, none of these declarations or statements addresses explicitly the issue of what protection should be extended to physicians if they are pressured, called upon, or ordered to take part in torture and other cruel, inhuman or degrading treatment or punishment. Nor do these declarations or statements express explicit support for, or the obligation to protect, doctors who encounter or become aware of such procedures.

RESOLUTION

4.     The World Medical Association (WMA) hereby reiterates and reaffirms the responsibility of the organised medical profession:

4.1  To encourage physicians to honour their commitment as physicians to serve humanity and to resist any pressure to act contrary to the ethical principles governing their dedication to this task;

4.2  To support physicians experiencing difficulties as a result of their resistance to any such pressure or as a result of their attempts to speak out or to act against such inhuman procedures; and,

4.3  To extend its support and to encourage other international organisations, as well as the constituent members of the World Medical Association (WMA), to support physicians encountering difficulties as a result of their attempts to act in accordance with the highest ethical principles of the profession.

4.4  To encourage physicians to report and document any acts of torture and other cruel, inhuman or degrading treatment or punishment they are aware of.

5.     Furthermore, in view of the continued employment of such inhumane procedures in many countries throughout the world, and the documented incidents of pressure upon physicians to act in contravention to the ethical principles subscribed to by the profession, the WMA finds it necessary:

5.1  To protest internationally against any involvement of, or any pressure to involve, physicians in acts of torture and or other forms of cruel, inhuman or degrading treatment or punishment;

5.2  To support and protect, and to call upon its constituent members NMAs to support and protect, physicians who are resisting involvement in such inhuman procedures or who are documenting and reporting these procedures, or who are working to treat and rehabilitate victims thereof, as well as to secure the right to uphold the highest ethical principles including medical confidentiality;

5.3  To publicize information about and to support physicians reporting evidence of torture and to make known proven cases of attempts to involve physicians in such procedures; and,

5.4  To encourage its constituent members to take action so that physicians are held accountable before the law in case of complicity in acts of torture and other cruel, inhuman or degrading treatment or punishment;

5.5  To encourage its constituent members to ask corresponding academic authorities to teach and investigate in all schools of medicine and hospitals the consequences of torture and its treatment, the rehabilitation of the survivors, the documentation of torture, and the professional protection described in this Declaration.