A number of international ethical standards deal directly with the obligations of health professionals with regard to torture and other ill-treatment. The World Medical Association’s 1975 Declaration of Tokyo, Guidelines for Medical Doctors Concerning Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention and Imprisonment, contains an unequivocal prohibition on any form of active or passive participation of a doctor in torture or other ill-treatment. According to the Tokyo Declaration:
- The doctor shall not countenance, condone or participate in the practise of torture or other forms of cruel, inhuman or degrading procedures, whatever the offence of which the victim of such procedure is suspected, accused or guilty, and whatever the victim’s belief or motives, and in all situations, including armed conflict and civil strife.
- The doctor shall not provide any premises, instruments, substances or knowledge to facilitate the practise of torture or other forms of cruel, inhuman or degrading treatment or to diminish the ability of the victim to resist such treatment.
- The doctor shall not be present during any procedure during which torture or other forms of cruel, inhuman or degrading treatment are used or threatened.
Tokyo Declaration was revised in 2006 to include the provision that:
The physician shall not use nor allow to be used, as far as he or she can, medical knowledge or skills, or health information specific to individuals, to facilitate or otherwise aid any interrogation, legal or illegal, of those individuals.
Principles of medical ethics apply not only to doctors, but to all health care professionals. Nurses may also find themselves faced with patients who are survivors of torture or other ill-treatment, and the Position Statement on Nurses’ Role in the Care of Prisoners and Detainees, of the International Council of Nurses, has stressed the fundamental obligation of the nurse to restore the health and alleviate the suffering of the patient, including prisoners, and to protect them from abuse and ill-treatment. Similarly, the World Psychiatric Association has issued specific guidance which prohibits any participation of psychiatrists in torture (Declaration of Madrid 1996).
‘Participation’ in torture refers to some action at the time of the abuse or later, or by omission. It includes evaluating an individual’s capacity to withstand ill-treatment; being present at, supervising or inflicting ill-treatment; resuscitating individuals for the purposes of further ill-treatment; providing medical treatment on the instructions of those likely to be responsible for torture (rather than on the basis of clinical judgement); or providing professional medical knowledge or individuals’ personal health information to torturers. Omission includes the deliberate withholding of medical treatment so as to aggravate suffering intentionally or neglecting evidence. The failure to report cases of ill-treatment or torture that a health professional has noted is, at the least, acquiescence in torture, and the falsifying of medical notes or reports is a form of complicity in the abuse.