- The primary purpose of a medical evaluation of torture and ill treatment is to assess the degree to which physical and psychological findings correlate with individual allegations of abuse.
- True
- False
- Which of the following will aid clinicians in earning the trust of individuals who have experienced torture and ill treatment?
- Active listening
- Meticulous communication
- Courtesy, genuine empathy and honesty
- Explaining what to expect in the evaluation
- Being mindful of the tone, phrasing and sequencing of questions (sensitive questions should be asked only after some degree of rapport has been developed)
- All of the above
- Clinicians planning to conduct a medical evaluation for physical or psychological evidence of torture and ill treatment should schedule adequate time:
- About 30 minutes
- About 1 hours
- About 2 to 4 hours
- More than 6 hours
- Which of the following is not a procedural safeguard according to the Istanbul Protocol?
- It is mandatory that detainees undergo a preliminary medical examination at the time of detention; a further examination and evaluation should be made upon their release.
- The officials who supervise the transportation of the detainee should be responsible to the public prosecutors and not to other law enforcement officials.
- The medical examination for detainees should be free of charge.
- Forensic medical services should be under the authority of the police or prison system.
- Detainees have the right to obtain a second or alternative medical evaluation by a qualified physician during his/her detention.
- Clinicians must balance two important requirements in the course of interviewing individuals who allege torture and ill treatment: 1) the need to obtain a detailed accurate account of events, and 2) the importance of respecting the needs of the person being interviewed.
- True
- False
- The gender of the examining clinician should always be the same as the interviewee.
- True
- False
- Which of the following are not accurate statements about the use of interpreters for medical evaluations of torture and ill treatment?
- As a rule, family members should not be used
- In cases of alleged sexual assault of a woman it is advisable to use a female interpreter if the interviewee does not express a gender preference
- The age of the interviewer does not matter
- Interviewers should make eye contact with and speak directly to the interviewee
- There may be difficulties when the interviewee and the interpreter are from different, ethnic, religious, social, and/or political backgrounds
- When a physician is involved in the torture of an individual, he or she may have difficulty trusting the examining clinician. This is an example of:
- Transference
- Counter-transference
- A reaction formation
- Traumatic delusion
- After listening to the audiotape of the 1996 National Public Radio interview with Sr. Diana Ortiz, consider which of the following emotional reactions that an interviewer is likely to have:
- Anger
- Helplessness
- Fear
- Shame
- Guilt
- All of the above
- After listening to the audiotape of the 1996 National Public Radio interview with Sr. Diana Ortiz, identify interview considerations that the interviewer did not adequately address:
- Comfort and privacy
- Empathy
- Appropriate use of open-ended and closed questioning
- Allowing the interviewee to have some control over the interview process
- All of the above
- Before a forensic interview begins, the clinician must inform the interviewee of any limits on the confidentiality of the information he or she provides.
- True
- False
- As a clinician who provides care to survivors of torture and/or conducts medical evaluations of alleged victims of torture and ill treatment, what strategies do you consider to be effective in managing and limiting secondary trauma and “burn out?”
- Debriefing with colleagues and seeking counseling if needed
- Discussing your emotional reactions with the survivor/alleged victim
- Limiting your exposure to traumatic cases
- Awareness to, reflection on and modulation of your emotional reactions to interviews with survivors of torture and ill treatment
- All of the above
- Initially, interview questions should be open-ended, allowing a narration of the trauma with minimal interruptions.
- True
- False
- The accuracy of information obtained in a medical evaluation can be improved by:
- Clarifying details
- Summarising key points periodically
- Scheduling a follow-up interview to address outstanding questions or any inconsistencies
- Using cognitive techniques such as “You were telling me about being suspended; can you tell me what happened just before that?”
- All of the above
- Which of the following may affect an individual’s ability to recall and recount torture and ill treatment?
- Disorientation during torture, blindfolding, drugging, and lapses of consciousness
- Neurological or psychological memory disturbances
- Feelings of guilt or shame
- Cultural differences in the perception of time
- Lack of trust in the examining clinician and/or interpreter
- Fear of reprisals
- Lack of privacy during the interview
- All of the above
- Which of the following are appropriate steps for clinicians to take to assess inconsistencies?
- Ask the individual for further clarification
- Identify other sources of corroborating information
- Identify possible reasons for exaggeration or fabrication
- Schedule an additional interview to discuss inconsistencies
- Refer the individual to another clinician for a second opinion
- All of the above
- In medical evaluations of torture and ill treatment it is not appropriate to ask questions about prior political activities and/or social beliefs and attitudes?
- True
- False
- In obtaining information on specific methods of torture and ill-treatment, the clinician should note for each form of abuse: body position, methods of restraint, nature of contact, the duration, frequency, and anatomical location of the alleged abuse, and the subsequent effects of the alleged abuse, i.e. pain, bleeding, loss of consciousness, disabilities, etc.
- True
- False
- The ethical principles of beneficence and non-malfeasance require that clinicians’ conclusions regarding torture and ill treatment be consistent with the least harmful legal outcome.
- True
- False
- In the course of documenting medical evidence of torture and ill-treatment, physicians have an ethical duty of identifying and making appropriate referrals for medical and social needs.
- True
- False
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- Preface
- Introduction
- 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
- 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
- Torture
- Module 2: Istanbul Protocol Standards for Medical Documentation of Torture and Medical Ethics
- The Istanbul Protocol
- An Overview of the Istanbul Protocol
- 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
- Documenting the allegations
- Module 2 Presentation: Istanbul Protocol Standards for Medical Documentation of Torture and Medical Ethics
- Self-Assessment and Quiz
- 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
- 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
- Preliminary Considerations
- 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
- Module 4 Presentation: Torture Methods and their Medical Consequences
- Self-Assessment and Quiz
- Module 5: Physical Evidence of Torture and Ill-Treatment
- Module 6: Psychological Evidence of Torture and Ill-Treatment
- Module 7: Case Example #01
- Module 8: Case Example #02
- Module 9: Report Writing and Testifying in Court