Disclaimer: This paper represents the author's personal opinion and not necessarily that of Amnesty International:
Submitted to the International Congress for Law and Mental Health in Padua Italy. June 27 2007. see abstract
https://www.ialmh.org/Padua2007/Revised%20Program.doc pp.59
by Ken Agar-Newman RN Email: agarnew@shaw.ca
I am the following:
a Board member of the Victoria Coalition for the Survivors of Torture (VCST).
http://vcst.ca
a General duty nurse in the Cardiovascular Unit at Royal Jubilee Hospital.
http://www.viha.ca/
a Member of Canadian network for the health of survivors of torture and organized violence. (ResCanNet)
http://www.rescannet.2itb.com/ResCanNet111barre.html
a Nursing Coordinator for the Amnesty International Medical Network Canadian Section Anglophone branch.
This paper is my personal opinion and not necessarily the perspective of the organizations I represent.
There is a total ban on torture worldwide, and health-workers’ participation in the process. Dr. Bent Sorensen during his presentation before the US Congressional Human Rights Caucus sums up some basic principles concerning the crime of torture;
1) Torture is one of the worst international crimes
2) It is not an option to grant amnesty for torture
3) There is no statute of limitations against torture.
4) There is no impunity against torture no matter where the crime was committed, where the perpetrator is apprehended, and who the perpetrator is.
5) The sentence must take in account for the gravity of torture (Sorensen).
Unfortunately there continues to be evidence of torture and of the complicity of medical personnel. The reality is that people in power find torture acceptable.
In April of this year the University of Minnesota Human Rights Library, Center for Bioethics web-site posted a new addition to the public record about torture and medical complicity, focusing on US involvement:
(University of Minnesota Center for Bioethics and Human Rights Center. accessed 7 June 2007)
http://www1.umn.edu/humanrts/OathBetrayed/index.html
Miles states in Lancet; “Government documents demonstrate that the US military medical system failed to protect detainees’ human rights, sometimes collaborated with interrogators or abusive guards, and failed to properly report injuries or deaths caused by beatings.” (Miles Abu Ghraib.pp.725)
The UN joint investigation into the situation of detainees at Guantanmo Bay. The UN joint investigation found the following breaches of medical ethics in relation to Principle 1 and 4 of the UN Principles of Medical Ethics:
1) medical records were accessible to interrogators
2) doctors and or other health workers were present and advising during interrogations
3) doctors and or other health workers were present and participating in non-consensual treatment of detainees such as drugging and force-feeding.
4) military policy permits health workers to force feed where it threatens health.
5). health workers were permitting unacceptable standards of quality of healthcare.
6) interrogators used healthcare as a tool to elicit cooperation from detainees.
(UN Joint report. Pp. 31, 33-35, 38)
Impunity also remains a pressing issue. Dr. Miles points out that most of the prison investigations associated with alleged ill-treatment and deaths of detainees by the CIA, US Special Forces, and American Military have been “chartered and performed by personnel belonging to the very institutions whose actions are challenged.” (Miles. Oath Betrayed. Pp. xii)
The UN Committee against Torture also observes a weakness within US maneuvers to bring the guilty parties to justice:
“(We have) concern(s) that the investigation and prosecution of many of these cases, including some resulting in the death of detainees, have led to lenient sentences, including of an administrative nature or less than one year’s imprisonment.” (UN Committee against Torture. Pp 7)
The medical press has published a lot of dialogue on the subject of medical complicity with torture including letters, editorials, and comments. Janofsky urges psychiatrists not to participate in intelligence interrogations on the basis that this will damage the clinical and forensic reputation of psychiatrists (Janofsky). Bloche and Marks suggest ethicists, legal scholars, and civilian professional leaders participate with the US Army, publicly, to address the role of issues around war and medicine generally. (Bloche, M.G. and Marks, J.) Miles in Lancet suggests the initiation of a transparent inquiry encompassing “US military medical services, human rights groups, legal and medical academics and health professional associations jointly and comprehensively” reviewing evidence as part of a reform process (Miles. Abu Ghraib.pp.728). The Editor of Lancet in the same issue urges all doctors to speak out, uniting to support their colleagues and condemning torture and other abuses. (Editor.pp.637-638). Wilks calls for action to confront current breaches of medical ethics including efforts to “map out the ethical boundaries appropriate for doctors acting in areas of dual responsibility at the undergraduate and postgraduate level” (Wilks pp. 430). Hall suggests national medical organizations taking the lead to censure and report doctors complicit in violations. He mentions national medical organizations liaising internationally to facilitate prosecution (Hall pp. 1263). Conversely Tornberg reports that Wilks is citing “recycled unsubstantiated claims found in newspapers and articles”. He is pessimistic that there will be ever one set of ethical guidelines addressing all situations (Tornberg. pp. 1263) . Kiley refers to Miles article and reports that US military wrongdoing is done by a few bad individuals and he expresses faith in the US military Justice system (Kiley.pp. 1851- 1852).
The problem remains;
1) Government sponsored torture and organized violence, with the complicity and or participation of health personnel, is internationally prohibited yet these violations occur with impunity in a significant amount of cases.
2) A higher standard of behaviour is expected of health professionals, than civilians, yet the Principles of Medical Ethics are not enforceable at an inter-government level.
This higher standard is reflected in the principles of beneficence, non-maleficence (above all do no harm), autonomy, justice, dignity and informed consent and these aren’t covered by international conventions.
The UN Committee against Torture has a limited preventative and complimentary role in relation to medical personnel. Rasmussen sums up the following regarding the medical work and the Committee against Torture:
1) encouragement of education about the prohibition of torture with health personnel.
2) encouragement of the prevention of cruel, inhuman and degrading treatment or punishment into medical work.
3) prevention of the medical profession becoming involved in torture.
4) prevention of impunity.
(Rasmussen. Medical aspects of the convention against torture)
Currently the job of regulation of medical personnel is left up to state, provincial, and national regulatory bodies.
A relevant question therefore is the following:
Is it possible to regulate medical personnel at the inter-governmental level so that gaps in regulation of the UN Principles of Medical Ethics, by national and local agencies can be overcome?
The World Medical Association Declaration of Tokyo, according to Amnesty International, is the “strongest statement of the organized medical profession against participation, or tolerance of torture” (AI.pp.156), yet it relies on its moral weight for compliance.
It is the job of national, state and provinicial regulatory bodies to enforce the WMA Declaration of Tokyo and WMA/WHO drafted Principles of Medical Ethics adopted by General Assembly resolution 37/194 of 18 December 1982.
In the early 1980’s an ad hoc international committee of health professionals established an International Commission of Health Professionals. It was conceived as a medical NGO counterpart of the International Commission of Jurists (ICJ) and was to use moral persuasion to change behaviour. Presumably it would have sponsored fact-finding missions on human rights, particularly in relation to harassment, and discuss issues with national authorities and the international community. Subsequently the organization folded due to a lack of money among other things.
In 1990 Dr. Ole Vedel Rasmussen suggested that the WHO ought to compile detailed statistics of the incidence of torture and refer this data to the UN Committee against Torture for action. This suggestion has never been acted on to the extent that Dr. Rasmussen proposed. (Rasmussen.1990)
During the latter part of the 1990’s an international group of experts developed a manual to be used for the medical documentation of torture and in 1999 the Istanbul Protocol was submitted to the UN High Commissioner for Human Rights. It is available on the internet. (AI.pp 157)
On the international nursing regulation front the International Council of Nurses has created a network of nursing regulatory agencies. It is primarily focused as a forum for the exchange of ideas and as a resource bank rather than achieving the ability to regulate.(ICN) ICN believes in “self regulation” and “self governance” by authorities in each country within the specific profession ((personal communication with Dr. Tesfa Ghebrehiwet. ICN)).
In addition there is another idea that was being discussed during the mid-1990’s. The WMA, ICN and others proposed the creation of a UN Special Rapporteur for the Independence and Integrity of Health Professionals. Recently, after a minor revision, the WMA has just reaffirmed the proposal (personal communication with Dr. Otmar Kloiber.WMA.)
The Rapporteur would monitor the role of health professionals working in situations where either their rights to give, or the rights of their patients to receive, treatment are threatened.
The proposed mechanism has no inter-governmental regulatory ability surrounding the UN Principles of Medical Ethics however it will report infractions to other bodies.
(WMA policy statement on the Special Rapporteur)
To fill in the gap in regulation I have developed a proposal that would establish an International Health Professions’ Ethics Committee. It could conceivably compliment the WMA proposal. A draft of the Ethics Committee, supported by the Victoria Coalition for the Survivors of Torture (VCST) has been posted on the VCST web-site:
http://vcst.ca/proposal.htm
The concept is aimed at the WHO level and is concerning the WMA/WHO composed UN Principles of Medical Ethics relevant to the Role of Health Personnel, particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. The proposed committee would be comprised of elected experts and will have the membership of civil society, hopefully with the participation of the World Medical Association, the International Council of Nurses and the World Federation for Mental Health
Their purview would include medically relevant human rights violations connected with torture such as those inherent to the Geneva Conventions, the death penalty, the illegal organ trade, the abuse of women, and breaches against security detainees and prisoners.
The Committee would operate :
•by setting minimum standards by which health workers must practice;
•by supporting national regulating bodies and individual health workers to meet these standards; and
•by acting if these standards are not met.
The Committee would:
•have the power to publicize violations
•compile a registry of health workers and other officials who have breached medical ethics
•have a protective function by focusing international attention on health professionals who are human rights defenders.
• undertake high profile visits to related sites, government officials or members of opposition groups responsible for medically relevant human rights violations.
•Be permitted to raise funds publicly to improve programs.
I propose that the Committee use the WHO constitution to gain access to countries. WHO have responded that they do not have the mandate to look at individual infractions of medical personnel (personnel communication with Allan Rock). No one has said that such a mechanism cannot be devised for WHO however.
Irrespective of whether an Ethics Committee materializes, towards the goal creating an atmosphere of a world without torture and back to my title, a unity of action, I suggest that the health sector form a network similar to the Coalition of International NGO’s Against Torture (CNAT). The CNAT is a coalition of seven NGO’s that work on common issues surrounding torture.
The health sector coalition I’m suggesting could include the 189 nongovernmental organizations in official relations with WHO.
The suggested Coalition of health professional organizations would call on all governments, naming offenders specifically, to safeguard medical ethics. This proposed Coalition must tell the world to stop torture.
In closing, a large coalition of health organizations speaking up against torture reminds me of the following story;
“in the group he reached just such a hand out to a woman whose husband had suffered permanent brain damage as a result of torture and assault. She was wretched and disconsolate, and the hand he reached out to her was a real assistance. He referred back to the hand he had been offered earlier as a link. He described his own as another. “this is a chain, he said, “one link and then another. It will be a great chain. When we eventually shake this chain it will be like thunder. You will hear thunder. The world will stop to listen, humanity will come to its senses and there will be no more torture.” (Schlapobersky, J. Tortue as the Perversion of a Healing relationship. pp. 71)
In this paper I discussed the regulation gap - using the United States as an example. Suggestions in the medical press were highlighted. Next a summary was offered of support of medical ethics in connection with an inter-governmental committee. Finally I suggested further support for medical ethics by the whole health sector.
References
Agar-Newman, Ken. Unpublished paper: the bad guys are winning. Presented at the International Council of Nurses Congress. Copenhagen. June 2001. pp. 1-21
Amnesty International. Combating Torture; a manual for action. Amnesty International Publication. AI Index ACT 40/001/2003. 2003 available off the internet. Accessed June 8 2007.
http://ara.amnesty.org/library/pdf/ACT400012003ENGLISH/$File/ACT4000103.pdf
Bloche, M.G. and Marks, J. Doctors and Interrogators at Guantanamo Bay. NEJM. 353:1. July 7, 2005 pp. 6-8 available on the web: accessed June 9 2007
http://content.nejm.org/cgi/content/full/353/1/6
Bloche, M.G. and Marks, J. When doctors go to war. NEJM. 6 Jan. 2005. 352;1 pp.3-6. downloaded from http://www.jejm.org/ on June 6 2007.
Editorial. How complicit are doctors in abuses of detainees?
Lancet; 21 August 2004. Vol. 364 Issue 9435, p267-638
International Council of Nurses (ICN). ICN's Global Network for Nursing Regulation. Web-site accessed May 31 2007.
http://icn-apnetwork.org/
Janofsky, S. Lies And Coercion: Why Psychiatrists Should Not Participate in Police and Intelligence Interrogations. J Am Acad Psychiatry Law 34:4:472-478 (2006) available on the internet accessed June 9 2007.
http://www.jaapl.org/cgi/content/full/34/4/472
Kiley, Kevin. Correspondence: Military medicine and human rights. Lancet.
November 2004. Vol. 364 Issue 9448, 20 p1851-1852
Hall, Peter. Correspondence; A stain on medical ethics. Lancet. Vol 366. October 8 2005. pp. 1263
Memorandum for Alberto R. Gonzales, counsel to the president, from Jay S. Bybee. Re: standard of conduct for interrogation under 18 U.S.C. 2340A. 1 August 2002. posted at University of Minnesota Center for Bioethics and Human Rights Center Web-site. Archived government documents focusing on medical operations in US prisoner of war facilities in Iraq, Afghanistan and Guantanamo Bay Cuba. Launched April 24 2007 and accessed May 31 2007.
http://www1.umn.edu/humanrts/OathBetrayed/index.html
Miles, Steve H. Abu Ghraib: its legacy for military medicine. Lancet. Vol. 364. August 21 2004. pp. 725- 729.
Miles, Steven H. Authors' reply Lancet, 11/20/2004, Vol. 364 Issue 9448, pp.1852-1852
Miles, Steve H. Oath Betrayed. Torture, medical complicity, and the war on terror. Random House. New York. 2006
Rasmussen, O. V. Medical aspects of Torture - torture types and their relation to symptoms and lesions in 200 victims, followed by a description of the medical profession in relation to torture. Danish Medical Bulletin vol. 37. Supple. No.1 January 1990. Pp. 49.
Rasmussen, O. V. The Medical Aspects of the Convention Against Torture. Torture 16:1. 2006 pp.58-61.
Schlapobersky, J. Torture as the Perversion of a Healing relationship. pp. 51-71. in Health Services for the treatment of torture and trauma survivors. Symposia sponsored by the AAAS Committee on Scientific Freedom and Responsibility. AAAS Publication. Washington D.C. 14 February 1988 and 16 January 1989.
Smidt-Nielsen, K. Participation of health personnel in torture. Torture 1998.8; 91-94. cited by Rasmussen, O. V. The Medical Aspects of the Convention Against Torture. Torture 16:1. 2006 pp.58.
Sorensen, B. Torture: A Global Update and the Need for Assistance for Victims of Torture. Testimony of Professor Bent Sørensen, MD before the US Congressional Human Rights Caucus
Tornberg, David. Correspondence: a stain on medical ethics: Lancet; 10 August 2005. Vol. 366 Issue 9493, pp.1263-1264
United Nations Committee Against Torture (UNCAT). Consideration of reports submitted by states parties under article 19 of the convention. Conclusions and recommendations of the Committee against torture. United States of America. 36th session 18 May 2006. UN index CAT/C/USA/Co/2 . UN publication. Pp. 1-11
United Nations. Joint report: Economic and Social Council. Commission on Human Rights. Sixty-second session items 10 and 11 on the provisional agenda. Situation of detainees at Guantanamo Bay. : The Chairman Rapporteur of the Working Group on Arbitrary Detention, Leila Zerrougui; the Special Rapporteur on the independence of judges and lawyers, Leandro Despouy; the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Manfred Nowak; the Special Rapporteur on freedom of religion or belief, Asma Jahangir, and the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Paul Hunt.
15 February 2006. UN Publication. pp. 1 to 54.
http://news.bbc.co.uk/1/shared/bsp/hi/pdfs/16_02_06_un_guantanamo.pdf
United Nations. Istanbul Protocol: manual on the effective investigation and documentation of torture and other cruel, inhuman or degrading treatment or punishment.. Professional training series no. 8/rev.1. United Nations Publication. Geneva. 2004
United Nations. Principles of Medical Ethics relevant to the Role of Health Personnel, particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. Adopted by General Assembly resolution 37/194 of 18 December 1982. http://www.unhchr.ch/html/menu3/b/h_comp40.htm
University of Minnesota Center for Bioethics and Human Rights Center Web-site. Archived government documents focusing on medical operations in US prisoner of war facilities in Iraq, Afghanistan and Guantanamo Bay Cuba. Launched April 24 2007 and accessed May 31 2007.
http://www1.umn.edu/humanrts/OathBetrayed/index.html
Victoria Coalition for the Survivors of Torture (VCST). The establishment of an International Health Professions’ Ethics Committee. Web-site accessed May 31 2007. http://vcst.ca/proposal.htm
WMA. WMA Proposal for the UN Rapporteur on the Independence and Integrity of Health Professionals. Adopted in Germany November 1997 by the WMA http://www.wma.net/e/policy/h19.htm accessed June 14 2007
Wiesel E. Without conscience.NEJM. 2005; 352:1511-3
http://content.nejm.org/cgi/content/full/352/15/1511 accessed 7 June 2007
Wilks, Michael. A stain on medical ethics. Lancet. Vol 366. 6 August 2005. pp. 429-431.
There is a total ban on torture worldwide, and health-workers’ participation in the process. Dr. Bent Sorensen during his presentation before the US Congressional Human Rights Caucus sums up some basic principles concerning the crime of torture;
1) Torture is one of the worst international crimes
2) It is not an option to grant amnesty for torture
3) There is no statute of limitations against torture.
4) There is no impunity against torture no matter where the crime was committed, where the perpetrator is apprehended, and who the perpetrator is.
5) The sentence must take in account for the gravity of torture (Sorensen).
Unfortunately there continues to be evidence of torture and of the complicity of medical personnel. The reality is that people in power find torture acceptable.
In April of this year the University of Minnesota Human Rights Library, Center for Bioethics web-site posted a new addition to the public record about torture and medical complicity, focusing on US involvement:
(University of Minnesota Center for Bioethics and Human Rights Center. accessed 7 June 2007)
http://www1.umn.edu/humanrts/OathBetrayed/index.html
Miles states in Lancet; “Government documents demonstrate that the US military medical system failed to protect detainees’ human rights, sometimes collaborated with interrogators or abusive guards, and failed to properly report injuries or deaths caused by beatings.” (Miles Abu Ghraib.pp.725)
The UN joint investigation into the situation of detainees at Guantanmo Bay. The UN joint investigation found the following breaches of medical ethics in relation to Principle 1 and 4 of the UN Principles of Medical Ethics:
1) medical records were accessible to interrogators
2) doctors and or other health workers were present and advising during interrogations
3) doctors and or other health workers were present and participating in non-consensual treatment of detainees such as drugging and force-feeding.
4) military policy permits health workers to force feed where it threatens health.
5). health workers were permitting unacceptable standards of quality of healthcare.
6) interrogators used healthcare as a tool to elicit cooperation from detainees.
(UN Joint report. Pp. 31, 33-35, 38)
Impunity also remains a pressing issue. Dr. Miles points out that most of the prison investigations associated with alleged ill-treatment and deaths of detainees by the CIA, US Special Forces, and American Military have been “chartered and performed by personnel belonging to the very institutions whose actions are challenged.” (Miles. Oath Betrayed. Pp. xii)
The UN Committee against Torture also observes a weakness within US maneuvers to bring the guilty parties to justice:
“(We have) concern(s) that the investigation and prosecution of many of these cases, including some resulting in the death of detainees, have led to lenient sentences, including of an administrative nature or less than one year’s imprisonment.” (UN Committee against Torture. Pp 7)
The medical press has published a lot of dialogue on the subject of medical complicity with torture including letters, editorials, and comments. Janofsky urges psychiatrists not to participate in intelligence interrogations on the basis that this will damage the clinical and forensic reputation of psychiatrists (Janofsky). Bloche and Marks suggest ethicists, legal scholars, and civilian professional leaders participate with the US Army, publicly, to address the role of issues around war and medicine generally. (Bloche, M.G. and Marks, J.) Miles in Lancet suggests the initiation of a transparent inquiry encompassing “US military medical services, human rights groups, legal and medical academics and health professional associations jointly and comprehensively” reviewing evidence as part of a reform process (Miles. Abu Ghraib.pp.728). The Editor of Lancet in the same issue urges all doctors to speak out, uniting to support their colleagues and condemning torture and other abuses. (Editor.pp.637-638). Wilks calls for action to confront current breaches of medical ethics including efforts to “map out the ethical boundaries appropriate for doctors acting in areas of dual responsibility at the undergraduate and postgraduate level” (Wilks pp. 430). Hall suggests national medical organizations taking the lead to censure and report doctors complicit in violations. He mentions national medical organizations liaising internationally to facilitate prosecution (Hall pp. 1263). Conversely Tornberg reports that Wilks is citing “recycled unsubstantiated claims found in newspapers and articles”. He is pessimistic that there will be ever one set of ethical guidelines addressing all situations (Tornberg. pp. 1263) . Kiley refers to Miles article and reports that US military wrongdoing is done by a few bad individuals and he expresses faith in the US military Justice system (Kiley.pp. 1851- 1852).
The problem remains;
1) Government sponsored torture and organized violence, with the complicity and or participation of health personnel, is internationally prohibited yet these violations occur with impunity in a significant amount of cases.
2) A higher standard of behaviour is expected of health professionals, than civilians, yet the Principles of Medical Ethics are not enforceable at an inter-government level.
This higher standard is reflected in the principles of beneficence, non-maleficence (above all do no harm), autonomy, justice, dignity and informed consent and these aren’t covered by international conventions.
The UN Committee against Torture has a limited preventative and complimentary role in relation to medical personnel. Rasmussen sums up the following regarding the medical work and the Committee against Torture:
1) encouragement of education about the prohibition of torture with health personnel.
2) encouragement of the prevention of cruel, inhuman and degrading treatment or punishment into medical work.
3) prevention of the medical profession becoming involved in torture.
4) prevention of impunity.
(Rasmussen. Medical aspects of the convention against torture)
Currently the job of regulation of medical personnel is left up to state, provincial, and national regulatory bodies.
A relevant question therefore is the following:
Is it possible to regulate medical personnel at the inter-governmental level so that gaps in regulation of the UN Principles of Medical Ethics, by national and local agencies can be overcome?
The World Medical Association Declaration of Tokyo, according to Amnesty International, is the “strongest statement of the organized medical profession against participation, or tolerance of torture” (AI.pp.156), yet it relies on its moral weight for compliance.
It is the job of national, state and provinicial regulatory bodies to enforce the WMA Declaration of Tokyo and WMA/WHO drafted Principles of Medical Ethics adopted by General Assembly resolution 37/194 of 18 December 1982.
In the early 1980’s an ad hoc international committee of health professionals established an International Commission of Health Professionals. It was conceived as a medical NGO counterpart of the International Commission of Jurists (ICJ) and was to use moral persuasion to change behaviour. Presumably it would have sponsored fact-finding missions on human rights, particularly in relation to harassment, and discuss issues with national authorities and the international community. Subsequently the organization folded due to a lack of money among other things.
In 1990 Dr. Ole Vedel Rasmussen suggested that the WHO ought to compile detailed statistics of the incidence of torture and refer this data to the UN Committee against Torture for action. This suggestion has never been acted on to the extent that Dr. Rasmussen proposed. (Rasmussen.1990)
During the latter part of the 1990’s an international group of experts developed a manual to be used for the medical documentation of torture and in 1999 the Istanbul Protocol was submitted to the UN High Commissioner for Human Rights. It is available on the internet. (AI.pp 157)
On the international nursing regulation front the International Council of Nurses has created a network of nursing regulatory agencies. It is primarily focused as a forum for the exchange of ideas and as a resource bank rather than achieving the ability to regulate.(ICN) ICN believes in “self regulation” and “self governance” by authorities in each country within the specific profession ((personal communication with Dr. Tesfa Ghebrehiwet. ICN)).
In addition there is another idea that was being discussed during the mid-1990’s. The WMA, ICN and others proposed the creation of a UN Special Rapporteur for the Independence and Integrity of Health Professionals. Recently, after a minor revision, the WMA has just reaffirmed the proposal (personal communication with Dr. Otmar Kloiber.WMA.)
The Rapporteur would monitor the role of health professionals working in situations where either their rights to give, or the rights of their patients to receive, treatment are threatened.
The proposed mechanism has no inter-governmental regulatory ability surrounding the UN Principles of Medical Ethics however it will report infractions to other bodies.
(WMA policy statement on the Special Rapporteur)
To fill in the gap in regulation I have developed a proposal that would establish an International Health Professions’ Ethics Committee. It could conceivably compliment the WMA proposal. A draft of the Ethics Committee, supported by the Victoria Coalition for the Survivors of Torture (VCST) has been posted on the VCST web-site:
http://vcst.ca/proposal.htm
The concept is aimed at the WHO level and is concerning the WMA/WHO composed UN Principles of Medical Ethics relevant to the Role of Health Personnel, particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. The proposed committee would be comprised of elected experts and will have the membership of civil society, hopefully with the participation of the World Medical Association, the International Council of Nurses and the World Federation for Mental Health
Their purview would include medically relevant human rights violations connected with torture such as those inherent to the Geneva Conventions, the death penalty, the illegal organ trade, the abuse of women, and breaches against security detainees and prisoners.
The Committee would operate :
•by setting minimum standards by which health workers must practice;
•by supporting national regulating bodies and individual health workers to meet these standards; and
•by acting if these standards are not met.
The Committee would:
•have the power to publicize violations
•compile a registry of health workers and other officials who have breached medical ethics
•have a protective function by focusing international attention on health professionals who are human rights defenders.
• undertake high profile visits to related sites, government officials or members of opposition groups responsible for medically relevant human rights violations.
•Be permitted to raise funds publicly to improve programs.
I propose that the Committee use the WHO constitution to gain access to countries. WHO have responded that they do not have the mandate to look at individual infractions of medical personnel (personnel communication with Allan Rock). No one has said that such a mechanism cannot be devised for WHO however.
Irrespective of whether an Ethics Committee materializes, towards the goal creating an atmosphere of a world without torture and back to my title, a unity of action, I suggest that the health sector form a network similar to the Coalition of International NGO’s Against Torture (CNAT). The CNAT is a coalition of seven NGO’s that work on common issues surrounding torture.
The health sector coalition I’m suggesting could include the 189 nongovernmental organizations in official relations with WHO.
The suggested Coalition of health professional organizations would call on all governments, naming offenders specifically, to safeguard medical ethics. This proposed Coalition must tell the world to stop torture.
In closing, a large coalition of health organizations speaking up against torture reminds me of the following story;
“in the group he reached just such a hand out to a woman whose husband had suffered permanent brain damage as a result of torture and assault. She was wretched and disconsolate, and the hand he reached out to her was a real assistance. He referred back to the hand he had been offered earlier as a link. He described his own as another. “this is a chain, he said, “one link and then another. It will be a great chain. When we eventually shake this chain it will be like thunder. You will hear thunder. The world will stop to listen, humanity will come to its senses and there will be no more torture.” (Schlapobersky, J. Tortue as the Perversion of a Healing relationship. pp. 71)
In this paper I discussed the regulation gap - using the United States as an example. Suggestions in the medical press were highlighted. Next a summary was offered of support of medical ethics in connection with an inter-governmental committee. Finally I suggested further support for medical ethics by the whole health sector.
References
Agar-Newman, Ken. Unpublished paper: the bad guys are winning. Presented at the International Council of Nurses Congress. Copenhagen. June 2001. pp. 1-21
Amnesty International. Combating Torture; a manual for action. Amnesty International Publication. AI Index ACT 40/001/2003. 2003 available off the internet. Accessed June 8 2007.
http://ara.amnesty.org/library/pdf/ACT400012003ENGLISH/$File/ACT4000103.pdf
Bloche, M.G. and Marks, J. Doctors and Interrogators at Guantanamo Bay. NEJM. 353:1. July 7, 2005 pp. 6-8 available on the web: accessed June 9 2007
http://content.nejm.org/cgi/content/full/353/1/6
Bloche, M.G. and Marks, J. When doctors go to war. NEJM. 6 Jan. 2005. 352;1 pp.3-6. downloaded from http://www.jejm.org/ on June 6 2007.
Editorial. How complicit are doctors in abuses of detainees?
Lancet; 21 August 2004. Vol. 364 Issue 9435, p267-638
International Council of Nurses (ICN). ICN's Global Network for Nursing Regulation. Web-site accessed May 31 2007.
http://icn-apnetwork.org/
Janofsky, S. Lies And Coercion: Why Psychiatrists Should Not Participate in Police and Intelligence Interrogations. J Am Acad Psychiatry Law 34:4:472-478 (2006) available on the internet accessed June 9 2007.
http://www.jaapl.org/cgi/content/full/34/4/472
Kiley, Kevin. Correspondence: Military medicine and human rights. Lancet.
November 2004. Vol. 364 Issue 9448, 20 p1851-1852
Hall, Peter. Correspondence; A stain on medical ethics. Lancet. Vol 366. October 8 2005. pp. 1263
Memorandum for Alberto R. Gonzales, counsel to the president, from Jay S. Bybee. Re: standard of conduct for interrogation under 18 U.S.C. 2340A. 1 August 2002. posted at University of Minnesota Center for Bioethics and Human Rights Center Web-site. Archived government documents focusing on medical operations in US prisoner of war facilities in Iraq, Afghanistan and Guantanamo Bay Cuba. Launched April 24 2007 and accessed May 31 2007.
http://www1.umn.edu/humanrts/OathBetrayed/index.html
Miles, Steve H. Abu Ghraib: its legacy for military medicine. Lancet. Vol. 364. August 21 2004. pp. 725- 729.
Miles, Steven H. Authors' reply Lancet, 11/20/2004, Vol. 364 Issue 9448, pp.1852-1852
Miles, Steve H. Oath Betrayed. Torture, medical complicity, and the war on terror. Random House. New York. 2006
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