Module 2: Istanbul Protocol Standards for Medical Documentation of Torture and Medical Ethics

Page Contents

To familiarize students with the purpose, history, significance of the Istanbul Protocol
To review the overall content of the Istanbul Protocol
To be aware of the limitation and possible misuse of the Istanbul Protocol
To understand Istanbul Protocol standards for procedural safeguards relevant to the medical documentation of torture and ill-treatment
To understand the medical ethical principles relevant to the medical investigation and documentation of torture and ill-treatment
To identify the duties of health professionals in the process of investigating and documenting torture and ill-treatment
Review current, country-specific rules and regulations regarding medical documentation of torture and ill-treatment [to be provided by Instructors]
To identify country-specific challenges in applying international ethical standards to the effective investigation and documentation of torture and ill-treatment

Review of the International Standards for the Effective Investigation and Documentation of Torture and Ill-treatment, the Istanbul Protocol
- Purpose
- History
- International recognition of the Istanbul Protocol
- Overview of Istanbul Protocol content
- Misuse of the Istanbul Protocol
Medical Ethics relevant to the investigation and documentation of torture and ill-treatment
Duties of the health professional
- International codes
- Ethical rules prohibiting torture
- Primary loyalty to the patient
- Dual Obligations
- The treatment of prisoners and detainees
- Issues surrounding examinations of individuals in the presence of security forces
- Abusive medical treatment
- Consent and Confidentiality
- Security
- Involvement of health professionals in torture
- Seeking further information and support
- UN Committee against Torture
Country-specific legal responsibilities of the health professionals for forensic documentation of torture and ill-treatment [to be provided by instructors]
General guidelines for gathering evidence
- The aims and goals of investigation
- The role of health professionals, defense lawyers and NGO workers
- The role of judges and prosecutors
- Documenting the allegations
- The aim of medical documentation
- Types of evidence
- Medical evidence
- Gathering of evidence
- Essential information
- Comparing records

Discuss the value of the Istanbul Protocol for the effective medical investigation and documentation of torture and ill-treatment and its potential for misuse
Compare and contrast international medical ethical standards for torture documentation and country-specific legal responsibilities of the health professionals for forensic documentation of torture and ill-treatment and provide recommendations for any conflicts identified
Discuss international and country-specific strategies to address potential personal risks to health professionals who document torture and ill-treatment
Discuss how health personnel in international and national professional organisations, academics and governmental and non-governmental organisations can work together for the effective investigation and prevention of torture
Discuss the role of alternative (non-governmental) medical reports. Discuss how have they been used internationally and locally and what their effect has been.
Discuss the relationship between health and human rights and whether health professionals have a duty to protect and promote human rights, including freedom from torture and ill-treatment

Group Activity:
- Divide the class into several groups and assign each group with one or more (or all) of the Discussion Topics.
- A facilitator should be identified to moderate the discussion and rapporteur should be identified to record the group’s findings and report them when the class reconvenes.
- After 20-30 minutes of group discussion, the entire class should reconvene
- Rapporteurs should briefly report on their group’s findings
- Open class discussion
Individual Research/Assignment:
- Conduct literature research on the complicity of medical personnel in torture and write a 2-page essay developing a series of country-specific policy recommendations for the government, medical licensing board and national medical association.
- Develop of country-specific list of organisations and bodies relevant to torture and ill-treatment
- If not discussed in class, research the legal status of alternative (non-governmental) forensic medical reports. Indicate how have they been used internationally and locally and what their effect has been.
Journal Entry: (Instructor to assign Write a few paragraphs — no more than a page)
- Respond to one or more of the Discussion Topics
- Do health professionals have a duty to protect and promote human rights? Explain why or why not.
- How can and should health professioinals document torture and ill treatment when they (or their family members) face the risk of reprisals?

The Istanbul Protocol, Chapter II- Relevant Ethical Codes
Medical Investigation and Documentation of Torture: A Handbook for Health Professionals
Trainers’ Guidelines for Health Professionals: Training of Users
Psychological Evaluation of Torture Allegations: An International Training Manual
Action Against Torture: A Practical Guide to the Istanbul Protocol for Lawyers