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Module 1 Answers
The Istanbul Protocol
Toolkits > Istanbul Protocol Model Medical Curriculum > Module 2: Istanbul Protocol Standards for Medical Documentation of Torture and Medical Ethics

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

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Objectives

  • 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

Content

  • 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

Discussion Topics

  • 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

Teaching Formats

  • 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?

Primary Resources

  • 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

Section Contents

  1. The Istanbul Protocol
    • About the Istanbul Protocol
    • Brief History
    • International Recognition of the Istanbul Protocol
  2. An Overview of the Istanbul Protocol
    • Legal Investigation of Torture
    • General Considerations for Interviews
    • Physical Evidence of Torture
    • Psychological Evidence of Torture
    • Interpretation of Findings and Referrals
    • Misuse of the Istanbul Protocol
    • Procedural Safeguards for Detainees
  3. Medical Ethics
    • Introduction
    • Duties of the health professional
    • International Codes
    • Ethical rules directly prohibiting involvement in 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 other health professionals in torture
    • Seeking further information and support
    • Country-specific legal responsibilities of health professionals for forensic documentation of torture and ill-treatment
  4. General Guidelines for Gathering Evidence and Documenting Findings
    • The aims and goals of investigation
    • Multidisciplinary approach to documentation
    • Role of the health professional in the team
    • Role of the lawyer in the team
    • Role of the NGO member in the team
    • Role of judges and prosecutors
  5. Documenting the allegations
    • The aim of medical documentation
    • Types of evidence
    • Medical evidence
    • Gathering of evidence
    • Essential information
    • Quality of information
    • Comparing records
  6. Module 2 Presentation: Istanbul Protocol Standards for Medical Documentation of Torture and Medical Ethics
  7. Self-Assessment and Quiz
    • Module 2 Answers
Module 1 Answers
The Istanbul Protocol
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  • Istanbul Protocol Model Medical Curriculum

    • Preface
      • Copyright and Acknowledgements
      • Resources
      • Glossary
    • Introduction
      • Curriculum Materials
      • Summary of Content
      • How to Use These Educational Resources
    • Module 1: International Legal Standards (Overview)
      • Torture
        • What is Torture
        • Purpose of Torture
        • History of Torture
        • Other Definitions
        • Cruel Inhuman & Degrading Treatment & Punishment (CID)
        • Prohibition of Torture in International Law
        • The United Nations Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment 1984
        • Torture in the World Today
        • Country-Specific Legal Standards and Torture Practices
        • The Perpetrators
        • Common Situations for Torture Allegations
        • Where Does Torture and Ill-treatment Occur?
        • Obligation to Investigate and Bring Justice
        • Formal Inspection of Detention Facilities
        • Official Complaints to Human Rights Bodies and Other Organizations
        • Recently Released Detainees
        • NGO Information Gathering
        • Late Allegations
      • Prevention and Accountability
        • Prevention
        • Accountability
        • Reparation
      • International Supervisory Machinery and Complaints Procedures
        • The Human Rights Committee
        • The UN Committee against Torture
        • Regional Mechanisms
        • Other monitoring mechanisms
        • The UN Special Rapporteur on Torture and other Cruel, Inhuman and Degrading Treatment or Punishment
        • International criminal courts and tribunals
        • The International Committee of the Red Cross (ICRC)
      • Safeguards Against Torture for Those Deprived of Their Liberty
        • Notifying people of their rights
        • Use of officially recognized places of detention and the maintenance of effective custody records
        • Avoiding incommunicado detention
        • Humane conditions of detention
        • Limits on interrogation
        • Access to a lawyer and respect for the functions of a lawyer
        • Access to a doctor
        • The right to challenge the lawfulness of detention
        • Safeguards for special categories of detainees
      • Module 1 Presentation: International Legal Standards
      • Self-Assessment and Quiz
        • Module 1 Answers
    • Module 2: Istanbul Protocol Standards for Medical Documentation of Torture and Medical Ethics
      • The Istanbul Protocol
        • About the Istanbul Protocol
        • Brief History
        • International Recognition of the Istanbul Protocol
      • An Overview of the Istanbul Protocol
        • Legal Investigation of Torture
        • General Considerations for Interviews
        • Physical Evidence of Torture
        • Psychological Evidence of Torture
        • Interpretation of Findings and Referrals
        • Misuse of the Istanbul Protocol
        • Procedural Safeguards for Detainees
      • Medical Ethics
        • Introduction
        • Duties of the health professional
        • International Codes
        • Ethical rules directly prohibiting involvement in 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 other health professionals in torture
        • Seeking further information and support
        • Country-specific legal responsibilities of health professionals for forensic documentation of torture and ill-treatment
      • General Guidelines for Gathering Evidence and Documenting Findings
        • The aims and goals of investigation
        • Multidisciplinary approach to documentation
        • Role of the health professional in the team
        • Role of the lawyer in the team
        • Role of the NGO member in the team
        • Role of judges and prosecutors
      • Documenting the allegations
        • The aim of medical documentation
        • Types of evidence
        • Medical evidence
        • Gathering of evidence
        • Essential information
        • Quality of information
        • Comparing records
      • Module 2 Presentation: Istanbul Protocol Standards for Medical Documentation of Torture and Medical Ethics
      • Self-Assessment and Quiz
        • Module 2 Answers
    • Module 3: Interview Considerations
      • Preliminary Considerations
        • Purpose of Medical Evaluations
        • Interview Settings
        • Trust
        • Informed Consent
        • Confidentiality
        • Privacy
        • Empathy
        • Objectivity
        • Safety and Security
        • Procedural Safeguards for Detainees
        • Risk of Re-traumatisation
        • Gender Considerations
        • Interviewing Children
        • Cultural and Religious Awareness
        • Working with Interpreters
        • Transference and Counter-Transference Reactions
      • Conducting Interviews
        • Types of questions
        • Cognitive Techniques
        • Summarising and clarifying
        • Difficulties Recalling and Recounting
        • Assessing Inconsistencies
      • Interview Content
        • Identification and Introduction
        • Psychosocial History (Pre-Arrest)
        • Past Medical History
        • Summary of Detention(s) and Abuse
        • Circumstances of Detention(s)
        • Prison/Detention Place Conditions
        • Allegations of Torture and Ill-treatment
        • Review of Symptoms
        • Psychosocial History (post-arrest)
        • Assessments of Physical and Psychological Evidence
        • Physical Examination
        • Closing
        • Indications for Referral
      • Module 3 Presentation: Interview Considerations
      • Self-Assessment and Quiz
        • Module 3 Answers
    • Module 4: Torture Methods and their Medical Consequences
      • Introduction
      • Torture Methods
        • Beatings/Falanga
        • Ear Trauma
        • Eye Trauma
        • Restraint, Shackling and Positional Torture
        • Suspension
        • Crushing and Stretching Injuries
        • Burning
        • Electrical injuries
        • Asphyxiation
        • Violent Shaking
        • Sexual Assault
        • Sexual Humiliation
        • Prolonged Isolation and Sensory Deprivation
        • Sleep Deprivation
        • Temperature Manipulation
        • Sensory Bombardment
        • Threats of Harm
      • Psychological Consequences of Torture
        • Introduction
        • The Paradox of Psychological Consequences of Torture
        • The Psychological Consequences of Torture
        • Social, Political and Cultural Context
        • Risk factors for Trauma and Torture-Related Disorders
        • Psychological Symptoms
      • Module 4 Presentation: Torture Methods and their Medical Consequences
      • Self-Assessment and Quiz
        • Module 4 Answers
    • Module 5: Physical Evidence of Torture and Ill-Treatment
      • Physical Evidence of Torture
        • Medical history
      • The Physical Examination
        • Dermatologic Evaluation
        • Head and Neck
        • Chest and Abdomen
        • Musculoskeletal System
      • Neurological Examination
        • Head Trauma and Post-traumatic Epilepsy
        • Nerve Damage
      • Examination of Women
        • Examination Following a Recent Assault
        • Examination After the Immediate Phase
        • Follow-up
        • Genital Examination of Women
      • Genital Examination of Men
      • Perianal Examination
      • Medical Photography
        • Assessment for Referral
      • Diagnostic Tests
      • Module 5 Presentation: Physical Evidence of Torture and Ill-Treatment
      • Self-Assessment and Quiz
        • Module 5 Answers
    • Module 6: Psychological Evidence of Torture and Ill-Treatment
      • The Central Role of the Psychological Evaluation
        • Conducting the Psychological Evaluation
        • Psychological Findings and Diagnostic Considerations
        • Components of the Psychological/Psychiatric Evaluation
      • Children and Torture
        • Introduction
        • Developmental Considerations
        • Clinical Considerations
        • Role of the Family
      • Apendix I: Sample Psychological Evaluations
        • Psychological Evaluation #1
        • Psychological Evaluation #2
      • Apendix II: ICD-10
      • Module 6 Presentation: Psychological Evidence of Torture and Ill-Treatment
      • Self-Assessment and Quiz
        • Module 6 Answers
    • Module 7: Case Example #01
      • Introduction
      • Preliminary Considerations
      • Materials
      • Module 7 Presentation: Case Example #01
      • Self-Assessment and Quiz
        • Module 7 Answers
    • Module 8: Case Example #02
      • Introduction
      • Preliminary Considerations
      • Materials
      • Module 8 Presentation: Case Example #02
      • Self-Assessment and Quiz
        • Module 8 Answers
    • Module 9: Report Writing and Testifying in Court
      • Written Reports
        • General Considerations
        • Content of Written Reports
        • Conclusions
        • Inconsistencies
      • Providing Testimony in Court
      • Appendix: Court Testimony Guidelines and Maxims
      • Module 9 Presentation: Report Writing and Testifying in Court
      • Self-Assessment and Quiz
        • Module 9 Answers
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