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Module 9 Answers

  1. Answer: A, B, C, E, F

    Expert medical reports and testimony can be of value in all of the contexts listed with the exception of D. As the Istanbul Protocol makes clear, a medical evaluation does not exclude the possibility that the alleged torture took place. Medical evaluations should not be used to “prove” that law enforcement officials, or any other alleged perpetrator, is innocent of alleged acts or torture and ill treatment.

  2. Answer: A

    The purpose of written reports and oral testimony is to assess claims, document evidence of torture and ill-treatment, and effectively communicate this evidence to adjudicators. Clinical evaluations are often critical in enabling adjudicators to make accurate and just decisions in medico-legal cases by providing an assessment of the degree of consistency between allegations of torture and ill treatment and physical and psychological evidence.

  3. Answer: F

    All of the items listed may represent relevant qualifications.

  4. Answer: A

    Qualifying as a medical expert depends on relevant knowledge and skills for both physical and psychological evidence of torture. Physicians who are not psychiatrists may qualify as experts on psychological evidence of torture and ill treatment as symptoms of depression and anxiety are common in general populations and many primary care physicians can acquire the knowledge and skills to diagnose these conditions and initiate appropriate care. The diagnosis of trauma-related disorders such as PTSD requires more specific training and experience for all clinicians, including psychiatrists, psychologists and clinical social workers.

  5. Answer: B

    The evaluating clinician should review the alleged victim’s affidavit (declaration) and any relevant medical or legal materials that the alleged torture victim has presented to the court, as it generally includes information that may be compared with the clinician’s evaluation. Any discrepancies that may arise should be pursued with the individual and/or the individual’s attorney to a point of clarity. Adjudicators often interpret inconsistent testimony as a lack of credibility on behalf of the alleged torture victim, when, in fact, such inconsistencies are often related to the presence of psychological, cultural, linguistic or other factors.

  6. Answer: E

    All of the items listed are true.

  7. Answer: E

    All sources of information listed above can and should be used to corroborate allegations of torture and ill treatment as long as the medical evaluator deems them to be relevant and credible.

  8. Answer: A

    Adjudicators are often unaware of the complexities of effective documentation of torture and ill treatment and their decisions may be influenced by pre-existing prejudice. Clinicians can and should take the opportunity to educate adjudicators on physical and psychological evidence of torture and ill treatment, i.e. explaining likely causes of inconsistencies, the sensitivity and specificity of physical findings and diagnostic tests, the utility and limitations of psychological instruments and diagnoses, the significance of historical evidence, etc.

  9. Answer: A

    First evaluations may be less convincing in a court of law than those conducted by clinicians with extensive experience. It is therefore advisable to conduct one’s first evaluation(s) under the supervision or of a more experienced evaluator.

  10. Answer: A

    Historical information may be very useful in corroborating an individual’s allegations of torture because it indicates first-hand knowledge of the alleged experience.

  11. Answer: B

    Istanbul Protocol guidelines include recommendations for care when they are clinically indicated. This is a professional duty independent of the immediate objectives of the legal team.

  12. Answer: A

    The clinician’s interpretation of findings and conclusions on the possibility of torture and ill treatment should be based on all categories of corroborating evidence, including physical and psychological evidence, historical information, and any other relevant resource materials.

  13. Answer: F

    All of the considerations listed support the credibility of an individual’s allegations or torture and ill treatment and, if relevant, may be included in the clinician’s written reports and oral testimony. Note that inconsistencies that are attributable to an individual’s torture experience may, in fact, support an individual’s allegations of abuse, rather than undermine it.

  14. Answer: B

    Credibility is not an all-or-nothing concept – there is a continuum between the absolute truth and the complete fabrication of events, with at least three points in-between: a) a mixture of falsehood and truth; b) conscious or subconscious exaggeration – saying that the ill-treatment was more frequent and more severe than actually happened; and c) genuine errors arising from mistakes and misunderstandings. Clinicians should try to identify potential reasons for exaggeration or fabrication, keeping in mind that fabrications may require detailed knowledge about trauma-related symptoms and findings that individuals rarely possess.

  15. Answer: H

    Inconsistencies may result from a number of factors that may be directly related to the torture and ill treatment or to the psychological and/or neurological symptoms that result from torture and ill treatment. Interview conditions and cross cultural factors may be significant factors as well. Clinicians should be familiar with such factors to effectively explain any inconsistencies observed.

  16. Answer: A

    Adjudicators and cross-examining attorneys may dismiss the medical expert’s findings on the basis of “hear-say” evidence, i.e. that the medical expert is stating a fact that was simply reported to him or her. A statement qualifying the veracity of testimony is therefore advisable.

  17. Answer: B

    While PTSD and MDD are common among survivors of torture, the diagnosis of either one is not cause-specific. Experiences other than torture and ill treatment also may be the cause of these diagnoses or sub-threshold symptoms.

  18. Answer: E

    All of the guidelines listed are relevant considerations for oral testimony by medical experts.

  19. Answer: E

    It is common in medico-legal contexts for the clinician to be asked whether psychological symptoms were caused by the alleged torture and ill-treatment or other traumatic experiences that may have occurred before or after the alleged events. Clinicians should note temporal relationships between the onset of symptoms and the alleged torture and ill-treatment and subsequent trends in psychological symptoms in relation to external stressors. They should also consider content-specific symptoms that may relate to the alleged torture and ill-treatment such as: the content of nightmares, triggers for intrusive recollection, reliving experiences, and avoidance reactions.

  20. Answer: B

    In court, the finding of credibility is a legal matter that is the responsibility of the judge. The expert witness is one resource that the judge draws upon to make that determination. The clinician need not feel the compulsion to make that determination for the judge, and, indeed, judges may resent an expert who tries to do so. What the clinician can do is address any observed inconsistencies and answer the questions of the attorneys and the judge as thoroughly and professionally as possible, along with his/her opinion about credibility, and let the judge arrive at his/her own conclusion.