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

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