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Given that torture has been reported in 141 countries in the last five years, a conference to help health professionals identify, record and report it is always, shamefully, relevant.
But the event, co-hosted by the BMA and the charities Amnesty International and Freedom from Torture, also comes as doctors absorb the chilling findings of a US report which showed widespread medical participation in human rights abuses.
The US Senate Select Committee on Intelligence report, published last December, confirms what many had suspected. The line between medical care and interrogation was systematically and deliberately breached by the CIA and US medical personnel in detention facilities during what has come to be known as ‘the war on terror.’
Medical personnel, whose binding professional obligation is to promote the wellbeing of those in their care, systematically abused their position.
The report is not an easy read. Medical personnel were involved in supervising waterboarding sessions, reviving detainees when they were rendered unconscious. One attending medical officer described these interrogations as ‘a series of near-drownings.’ Medical personnel ‘cleared’ detainees for ‘enhanced interrogation’ techniques and were involved in rectal feeding that was medically unnecessary.
Among the most troubling of the report’s revelations was that the CIA contracted with two psychologists to operate and assess all their ‘enhanced interrogation’ techniques.
We know that, globally, this is the tip of a very dark iceberg. Worldwide, the routine state use of torture is endemic. Amnesty International has reported on the use of torture in 141 countries during the last five years. Despite the international prohibition on all forms of torture or inhuman and degrading treatment, as set out in the Universal Declaration of Human Rights, in many parts of the world it continues with almost complete immunity for its perpetrators.
The prohibition in the Universal Declaration is taken up and reinforced in the binding obligations on medical professionals only to use medical skills and knowledge for therapeutic purposes. Any non-therapeutic participation by medical professionals in torture or interrogation is strictly prohibited under international law. It is also a gross violation of medical ethics.
We know that, properly resourced and supported, independent forensic health professionals can play an important role in preventing torture. They can identify and support those who have been subject to torture. They can provide vital forensic evidence. They can assist in reporting torture and other forms of abuse to relevant authorities.
Unfortunately, all too often, forensic health professionals struggle to maintain their clinical and ethical independence. Professionally isolated and poorly supported, frequently working in coercive institutions, they can lose sight of their primary professional obligations.
Addressing these problems is a significant challenge. Torture plays a central role in policing and public security operations by military and police forces across the globe. We know that in too many jurisdictions, political, judicial and administrative authorities systematically downplay the widespread use of torture and other ill-treatment. Forensic health professionals are under-resourced and sidelined.
Take Mexico, one of Amnesty’s focus countries in its current Stop Torture campaign. Although since 2003 Mexico has committed to implement an adapted form of the Istanbul Protocol – the UN manual on investigating and documenting torture – in most cases of torture the relevant medical and psychological evaluation is not undertaken, and where it is performed it falls short of the standards established in the Protocol.
Our conference on 20 January will bring together domestic and international experts in forensic medicine and in health and human rights. It will hear from both the survivors of torture and those health professionals who work with them. It will explore the ethical dilemmas confronted by forensic health professionals as they work to balance their obligations to patients and to the criminal justice system.
But it will also look forward. It will seek ways to support forensic professionals, ways of building professional networks and providing resources to overcome professional isolation and institutional neglect. No it won’t be easy. But it is hard to imagine a greater perversion of medical skills and knowledge than their direct involvement in the destruction of human minds and bodies. The challenge could not be more urgent.
Julian Sheather is BMA deputy head of ethics
More information about the conference
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