Doctors should be trained and supported to have independent clinical opinion as well as on the circumstances leading to the clinical condition and not based on duress by authority. Doctors' independence should be promoted by clinical or medical associations and bodies, by the judiciary, by civil society, media etc.
Patient records should be kept confidential.
Doctors should be identifiable by the patients and not treat those who are blindfolded etc.
Interviews and examination should not happen in the presence of a 3rd party, especially if they have the power to influence what the person says.
No drug or procedure should be prescribed by the doctor unless it has a clinical basis.
As a policy, doctors should learn to ask for the cause or explanation for any injury and also correlate different injuries and illnesses.
If doctors have reason to suspect torture, they should bring it to the notice of the authorities. If this is not an option, it can be shared with a national body. In the absence of a reliable support at the national level it can be brought to the attention of international bodies that monitor torture.
National medical associations have a crucial role to ensure that no doctor feels that he or she is functioning unsupported in an ethical vacuum. Professional medical bodies should regularly put out statements that they oppose torture, mentioning what constitutes torture, ensure that medical education curriculum looks at these issues and has clear guidelines on what a doctor can or cannot do. They can also provide helplines for doctors and confidential counselling on what course of action they can take.
Doctors who have participated in torture should be penalised and suspended to send a message to the medical fraternity that there is a zero tolerance to torture.
Healthcare personnel can demand rehabilitation centers for torture victims in India that are free from police, judicial or political influence, well resourced, have well trained human resources, have good documentation facilities, are linked to trained healthcare facilities.
Doctors who work with victims/or survivors of torture and those who work with prisons, the law, detention centres etc. should be regularly assessed for their own mental health, prejudices etc.
Keep one copy of the patients with the HCP and give one copy to them. In the event that the victim dies or is further tortured or silenced in other ways, this documentation can come in handy.
The first step n seeing a patient would be to offer medical care to the person and referral if required. If the HCP feels that the person can go back to further torture, then it is well within his or her right to ask for admission either in his or her hospital or at a referral hospital. This also gives the opportunity to get accurate history without the presence of the police. Immediate and long term need for counseling and psychological/psychiatric support can be a valid reason for admission and referral. That the person’s life is in danger is enough reason for a HCP to intervene as part of his or her professional duties and responsibilities.
A detailed baseline medical examination of a person is important and this should be insisted. If a doctor is seeing a person for the first time after the torture, it should be a matter of routine to ask for baseline medical examination notes or reports. If this is not available or not done, it should be documented and can be a valuable evidence for the victim.
Adequate documentation of history as well as the clinical findings. A copy to be maintained with the doctor and one copy for the person/family/lawyer. Photographs are important and HCP providers should be trained in basic visual documentation skill.
Informing senior police officials or prison authorities
Identify pattern of torture as well as document if similar clinical picture and history is being observed with more than one patient.
Involve and inform other colleagues and hospital authorities.
Ensure that there is documentation process that also includes torture even in a general hospital setting, especially if the person is brought by a police.
Inform the local medical/nursing councils so that they can be part of the process either to be part of team that visits the prison/police station to offer their independent observation, or to issue statements to other HCP not to participate in torture, as well as what amounts to torture.
Write to national and international human rights bodies either independently, or if concerned about safety, as part of an NGO that works on these issues, lawyers, doctors/nurses associations etc.
If comfortable enough, give factual information about the issue to media. This should not put the person in prison or the HCP at aggravated risk. Anonymous tipping off can help some journalists do a more investigative enquiry with consent.
If required to give evidence in a court of law, the HCP should view it as part of his or her patient responsibilities rather than a burden to be avoided. Involvement of HCP in challenging custodial torture will go a long way in holding the system accountable. It can also ensure reparation for victims/survivors of custodial torture
Reach out to prison doctors to offer support and contacts with agencies or bodies that can challenge torture by police.
The role of the HCP in identifying, preventing and managing torture should be essential part of medical/nursing curriculum. Trained HCP are more likely to pick up torture than those who have never heard of it.
HCP and healthcare institutions should move beyond clinical care to also identify and fulfil their social responsibilities. Participating in training police and prison officials, monitoring visits, talking to people in custody as well as their family/lawyers can go a long way in challenging established ways of functioning of police. HCP should also participate in preparing updated police and prison manuals focusing in issues related to personal hygiene, nutrition (including their opinions on force feeding of people in custody who choose to fast), overcrowding, sanitation, water, ventilation, sunlight, pandemic response, treatment protocols etc.
Publishing papers, case discussions, seminars, panel discussions, morbidity/mortality audits can create a culture of talking about torture without any exceptionality clauses. The idea that some people can be tortured is deeply ingrained in society and HCP. This has to be challenged by locating it in the framework of medical ethics and human rights.
Any efforts to highlight custodial torture that involves naming individual victims can only be done with their consent and after having explained to them the possible consequences. The family and lawyer of the person in custody could also be consulted.
The doctors notes and reports documenting history and clinical assessment of torture should not be handed over to the police. This is confidential to the person. The doctor owes confidentiality to the victim and this should be displayed prominently in the hospital/clinic.
The interpretation of history and examination and a final opinion of the doctor can make or break a victims testimony. THe doctor should give opinion on whether findings are consistent with torture or unrelated. However this opinion should not come from ignorance, inability to put all the evidence together or under duress or fear of reprisal. If the doctor is unable to make a conclusion it would be good to ask for a second opinion rather than give a wrong opinion.
The healthcare system should hold doctors who give false/incorrect/incomplete reports regarding torture which leads either to more torture or denial of justice to a person in custody, accountable.
As part of medical/nursing curriculum and forensic training, there should be regular visits to different police stations and prisons to create a sense of responsibility among HCP to understand and also look out for torture in their regular clinical practice. This is also important when people who have been released from custody come to the HCP with acute or chronic torture related signs and symptoms.
If a person has health related complications or disability following torture, the healthcare system should be able to demand an attender for the person if he ir she is admitted. Expecting or allowing prison officials or police to organise a carer or attender can be counter-productive to the care of the patient, especially if he is in psychological distress.
In cases of conflict between the role of doctor as investigating officer (forensic doctor) and treating doctor or other ethical conflicts, there should be helplines of medical bodies that should be available that protect the doctor legally without violating medical ethics.
In the event that a person who has been tortured dies or is brought dead or disappears, the HCP should have clear protocols on post mortem, who the reports/clinical notes should be shared with, issues of confidentiality etc.
The medico-legal report should stand scrutiny for state, national or international legal procedures, for lobbying and advocacy, for research and for requesting protection.
- carindiachapter
Kommentare