Interpreting Evidence of Torture.

The Istanbul Protocol provides a scheme for giving evidence of signs of torture. This scheme does not conform with the principles of logical inference, revolving as it does round the concept of 'consistency'. The shortcomings of the Protocol are explained using the evidence given in the recent case of KV(Sri Lanka) and the logical approach to such evidence explained.

From Nuremberg to Guantanamo Bay: Uses of Physicians in the War on Terror.

Seventy years after the Nuremberg Doctors' Trial, health professionals and lawyers working together after 9/11 played a critical role in designing, justifying, and carrying out the US state-sponsored torture program in the CIA "Black Sites" and US military detention centers, including Abu Ghraib, Bagram, and Guantanamo Bay, Cuba. We analyze the similarities between the Nazi doctors and health professionals in the War on Terror and address the question of how it happened that health professionals, including doctors, psychologists, physician assistants, and nurses, acted as agents of the state to utilize their medical and healing skills to cause harm and sanitize barbarous acts, similar to (though not on the scale of) how Nazi doctors were used by the Third Reich.

Are healthcare professionals working in Australia's immigration detention centres condoning torture?

Australian immigration detention centres are in secluded locations, some on offshore islands, and are subject to extreme secrecy, comparable with 'black sites' elsewhere. There are parallels between healthcare professionals working in immigration detention centres and healthcare professionals involved with or complicit in torture. In both cases, healthcare professionals are conflicted between a duty of care to improve the health of patients and the interests of the government. While this duality of interests has been recognised previously, the full implications for healthcare professionals working in immigration detention have not been addressed. The Australian Government maintains that immigration detention is needed for security checks, but the average duration of immigration detention has increased from 10 weeks to 14 months, and detainees are not informed of the progress of their application for refugee status. Long-term immigration detention causes major mental health problems, is illegal in international law and arguably fulfils the recognised definition of torture. It is generally accepted that healthcare professionals should not participate in or condone torture. Australian healthcare professionals thus face a major ethical dilemma: patients in immigration detention have pressing mental and physical health needs, but providing healthcare might support or represent complicity in a practice that is unethical. Individual healthcare professionals need to decide whether or not to work in immigration detention centres. If they do so, they need to decide for how long and to what extent restrictive contracts and gagging laws will constrain them from advocating for closing detention centres.

The kindest cut? Surgical castration, sex offenders and coercive offers.

The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) have conducted visits and written reports criticising the surgical castration of sex offenders in the Czech Republic and Germany. They claim that surgical castration is degrading treatment and have called for an immediate end to this practice. The Czech and German governments have published rebuttals of these criticisms. The rebuttals cite evidence about clinical effectiveness and point out this is an intervention that must be requested by the sex offender and cannot occur without informed consent. This article considers a number of relevant arguments that are not discussed in these reports but which are central to how we might assess this practice. First, the article discusses the possible ways in which sex offenders could be coerced into castration and whether this is a decisive moral problem. Then, it considers a number of issues relevant to determining whether sex offenders are harmed by physical castration. The article concludes by arguing that sex offenders should not be coerced into castration, be that via threats or offers, but that there is no reason to think that this is occurring in the Czech Republic or Germany. In some cases, castration might be useful for reconfiguring a life that has gone badly awry and where there is no coercion, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment are mistaken about this being degrading treatment.

The Istanbul protocol (manual on the effective investigation and documentation of torture and other cruel, inhuman or degrading treatment or punishment): implementation and education in Israel.

All victims of violence encountered in our emergency rooms and clinics need to be recognized and documented as such. Although there has been progress in the implementation of rules concerning (domestic) violence against women, children and the elderly, the management of cases where patients have been subjected to violence while under the custody of legal enforcement agencies, or patients who have been victims of torture, is still not sufficiently standardized. We describe the Istanbul Protocol of the United Nations, an excellent tool that can help physicians and health professionals recognize and treat cases of torture or institutional violence.

Prison overcrowding and ill-treatment: sentence reduction as a reparation measure. A view from Latin America and Europe.

INTRODUCTION: In recent years mass protest movements have taken to the streets in many countries across the world. Despite strong international and domestic legal protections for the right to freedom of peaceful assembly and other fundamental human rights, entire assemblies are frequently labelled violent and less lethal weapons are used to disperse them. METHODS: This article examines the weapons often used by police against public assemblies. Focusing on striking weapons (batons), chemical irri-tants, kinetic impact projectiles and stun grenades, the article uses examples from various countries to illustrate how these weapons are being used and the associated human rights and health impacts. Re-sults: Worrying trends identified include the use of dangerous or untested equipment, such as thermal foggers to deploy chemical irritants; the use of inherently abusive weapons, such as whips or sjam-boks; and the increasing use of certain types of munitions, specifically indiscriminate kinetic impact projectiles. DISCUSSION: The article seeks to support medical and legal professionals becoming more familiar with the weapons being used in the countries they practice in, the effects of those weapons, and clinical aspects in the presentation and care of those exposed.

Ill-treatment in the Chilean prison system - an analysis of reports presented by the National Institute of Human Rights (INDH) and their handling by the legal actors.

INTRODUCTION: Prisons in Latin America are often described as violent and lawless places. This article analyses the Chilean case. We want to find out how complaints of ill-treatment are investigated if the victim is in prison. Our hypothesis is that the response to the phenomenon, both in the prose-cution of the perpetrators and in the protection of its victims, does not take into consideration the guidelines established in international standards, especially those contained in the Istanbul Proto-col. METHODS: We analysed a total of 124 complaints of ill-treatment filed by the Chilean National Human Rights Institute (INDH). RESULTS: An excessive amount of time elapses between the alleged ill treatment, the filing of complaints, the use of protective measures, and the termination of the cases. There are serious deficiencies in the investigations carried out by the Public Prosecutor's Office, and therefore, most of the complaints are not clarified and end up being shelved. We conclude that, through both the actions of the judges and the prosecutors in the processing of the complaints, when it comes to investigating acts of ill-treatment inside Chilean prisons, the standards of the Istanbul Protocol are not met.

Presence of Inmates with Mental Health Problems in Detention and Correctional Centers in the Republic of Kosovo.

BACKGROUND: Conventions adopted by the United Nations and Council of Europe pay special importance to the treatment of prisoners with mental health problems. Their treatment is close-ly related to respect for human dignity, and the prohibition of torture, cruel and degrading treatment or punishment. The Eu-ropean Court of Human Rights, in many cases, has ruled that the detention of a mentally-ill person can raise issues under Ar-ticle 3 of the European Convention on Human Rights and that the lack of adequate medical care can result in treatment in con-travention of this article. The Republic of Kosovo is not a mem-ber of the United Nations and Council of Europe. However, it has incorporated in its Constitution a number of Conven-tions adopted by the United Nations and Council of Europe. Also, Kosovo has adopted a legal framework which prohibits torture, cruel and degrading treatment or punishment in ac-cordance with the international human rights standards. The Constitution also provides that human rights and fundamen-tal freedoms guaranteed by the Constitution shall be interpret-ed in accordance with the case law of the European Court of Human Rights. METHODS: Review of Ombudsperson's, Committee for the Prevention of Torture, Prison Health Department of Kosovo Ministry of Health reports, as well as reports of the NGOs in Kosovo.

[Doctors of the dictatorship: physicians and human rights violations in Brazil (1964-1985)]. / Doutores da ditadura: médicos e violação dos direitos humanos no Brasil (1964-1985).

The article discusses the participation of doctors in the Brazilian military dictatorship (1964-1985). It identifies the main ways in which these doctors contributed with their technical and scientific knowledge and their institutional positions to the repression of the regime's opponents. The authors argue that this collaboration was not casual but strategic, organized, and systematic in assisting interrogations and practices of physical and psychological torture, as well as in covering up human rights violations. The article points out that this collaboration between doctors and the authoritarian regime violated all professional codes of ethics and international conventions for the protection and promotion of human rights, as well as the Hippocratic Oath. The primary historical sources on which the article is based are documents from the Brasil Nunca Mais Project, the final report of the National Truth Commission (CNV), and reports from states truth commissions. It concludes that the scant civil, criminal, and professional punishment of doctors involved in the regime's violence, protected by the 1979 Amnesty Law and other legal provisions, characterizes an incomplete rupture with the authoritarian legacies of the past, with consequences for the present and future of Brazilian democracy.

O artigo aborda a participação de médicos na ditadura civil militar brasileira (1964-1985) e identifica as principais formas pelas quais esses médicos contribuíram com seus conhecimentos técnicos e científicos e suas posições institucionais para a repressão aos opositores do regime. Os autores argumentam que essa colaboração não foi eventual, mas estratégica, organizada e sistemática na assessoria a interrogatórios e práticas de tortura física e psicológicas, assim como no encobrimento de violações de direitos humanos. O artigo chama a atenção para que essa colaboração de médicos com o regime autoritário transgrediu códigos de ética profissionais e as convenções internacionais de proteção e promoção dos direitos humanos, assim como o Juramento de Hipócrates. As principais fontes históricas que embasam o artigo são os documentos do Projeto Brasil Nunca Mais e do relatório final da Comissão Nacional da Verdade (CNV), assim como relatórios de comissões estaduais da verdade. Conclui que a exígua punição civil, criminal e profissional aos médicos envolvidos com a violência do regime, protegidos pela Lei da Anistia de 1979 e outras provisões legais, caracteriza o rompimento incompleto com os legados autoritários do passado, com consequências para o presente e o futuro da democracia brasileira.

Circumcision of male infants as a human rights violation.

Every infant has a right to bodily integrity. Removing healthy tissue from an infant is only permissible if there is an immediate medical indication. In the case of infant male circumcision there is no evidence of an immediate need to perform the procedure. As a German court recently held, any benefit to circumcision can be obtained by delaying the procedure until the male is old enough to give his own fully informed consent. With the option of delaying circumcision providing all of the purported benefits, circumcising an infant is an unnecessary violation of his bodily integrity as well as an ethically invalid form of medical violence. Parental proxy 'consent' for newborn circumcision is invalid. Male circumcision also violates four core human rights documents-the Universal Declaration of Human Rights, the Convention on the Rights of the Child, the International Covenant on Civil and Political Rights, and the Convention Against Torture. Social norm theory predicts that once the circumcision rate falls below a critical value, the social norms that currently distort our perception of the practice will dissolve and rates will quickly fall.

Medical forensic examination of detained immigrants: is the Istanbul Protocol followed?

INTRODUCTION: Maltreatment and torture during custody is still an important problem in many countries. Both national and international regulations and the Istanbul Protocol are of great importance in terms of elimination of maltreatment and torture. In this study, we evaluated whether examinations for custody of immigrants were performed in accordance with the Istanbul Protocol. METHOD: We retrospectively evaluated reports of forensic examinations for custody of 100 immigrants in Van-Çaldiran Government Hospital in 2009. Data about nationality, age, gender, examination date, referring department, examination findings and departments to which the reports were submitted were collected. RESULTS: Fifty percent of the immigrants were Iranian and they were aged between 11 and 62 years. Ninety-nine immigrants were men and one was woman. Data about history of arrest were missing in forensic reports about all immigrants. Data about signs of trauma were present only for seven immigrants. Ninety-three immigrants were reported to have no signs of trauma. None of the immigrants underwent psychiatric examination. All forensic reports were found to be submitted to the police personally. Whether the immigrants were examined before or after the custody was not clear in the reports. CONCLUSION: Evaluation of the data showed that none of the forensic examinations were performed in accordance with the Istanbul Protocol. It can be recommended that the protocol should be incorporated into the curricula for undergraduate, graduate and in-service training programmes in order to improve relevant forensic practices.

Pain as a fact and heuristic: how pain neuroimaging illuminates moral dimensions of law.

In legal domains ranging from tort to torture, pain and its degree do important definitional work by delimiting boundaries of lawfulness and of entitlements. Yet, for all the work done by pain as a term in legal texts and practice, it has a confounding lack of external verifiability. Now, neuroimaging is rendering pain and myriad other subjective states at least partly ascertainable. This emerging ability to ascertain and quantify subjective states is prompting a "hedonic" or a "subjectivist" turn in legal scholarship, which has sparked a vigorous debate as to whether the quantification of subjective states might affect legal theory and practice. Subjectivists contend that much values-talk in law has been a necessary but poor substitute for quantitative determinations of subjective states--determinations that will be possible in the law's "experiential future." This Article argues the converse: that pain discourse in law frequently is a heuristic for values. Drawing on interviews and laboratory visits with neuroimaging researchers, this Article shows current and in-principle limitations of pain quantification through neuroimaging. It then presents case studies on torture-murder, torture, the death penalty, and abortion to show the largely heuristic role of pain discourse in law. Introducing the theory of "embodied morality," the Article describes how moral conceptions of rights and duties are informed by human physicality and constrained by the limits of empathic identification. Pain neuroimaging helps reveal this dual factual and heuristic nature of pain in the law, and thus itself points to the translational work required for neuroimaging to influence, much less transform, legal practice and doctrine.

Neglect of medical evidence of torture in Guantánamo Bay: a case series.

BACKGROUND: In the wake of the September 11, 2001 attacks on the US, the government authorized the use of "enhanced interrogation" techniques that were previously recognized as torture. While the complicity of US health professionals in the design and implementation of US torture practices has been documented, little is known about the role of health providers, assigned to the US Department of Defense (DoD) at the US Naval Station Guantánamo Bay, Cuba (GTMO), who should have been in a position to observe and document physical and psychological evidence of torture and ill treatment. METHODS AND FINDINGS: We reviewed GTMO medical records and relevant case files (client affidavits, attorney-client notes and summaries, and legal affidavits of medical experts) of nine individuals for evidence of torture and ill treatment and documentation by medical personnel. In each of the nine cases, GTMO detainees alleged abusive interrogation methods that are consistent with torture as defined by the UN Convention Against Torture as well as the more restrictive US definition of torture that was operational at the time. The medical affidavits in each of the nine cases indicate that the specific allegations of torture and ill treatment are highly consistent with physical and psychological evidence documented in the medical records and evaluations by non-governmental medical experts. However, the medical personnel who treated the detainees at GTMO failed to inquire and/or document causes of the physical injuries and psychological symptoms they observed. Psychological symptoms were commonly attributed to "personality disorders" and "routine stressors of confinement." Temporary psychotic symptoms and hallucinations did not prompt consideration of abusive treatment. Psychological assessments conducted by non-governmental medical experts revealed diagnostic criteria for current major depression and/or PTSD in all nine cases. CONCLUSION: The findings in these nine cases from GTMO indicate that medical doctors and mental health personnel assigned to the DoD neglected and/or concealed medical evidence of intentional harm.

Detained and drugged: a brief overview of the use of pharmaceuticals for the interrogation of suspects, prisoners, patients, and POWs in the US.

Using medical literature citations, Congressional hearings, and declassified documents this paper examines the uses of pharmaceuticals in the interrogation of vulnerable populations. From the use of IV relaxants on criminal suspects during the 1920s to the Global War on Terror, the nexus of drugs, testing, and interrogations will be explored in both the domestic and international contexts.

Documentation of torture and the Istanbul Protocol: applied medical ethics.

The so-called Istanbul Protocol, a Manual on the Effective Investigation and Documentation of Torture and other Cruel, Inhumane or Degrading Treatment or Punishment was adopted by the United Nations soon after its completion in 1999 and since then has become an acknowledged standard for documenting cases of alleged torture and other forms of severe maltreatment. In 2009 the "Forum for medicine and human rights" at the Medical Faculty at the University Erlangen-Nuremburg has provided the first German edition of this manual. The article traces back the development of the protocol taking into account the general background as well as the factual occasion of its initiation. The main ethical and legal principles of the manual are introduced as well as the projects for implementing the rules provided in the protocol that have been carried out so far. From this the urgent need for implementation of the Istanbul Protocol guidelines also in Europe and in German-speaking countries and here not exclusively but especially within asylum procedures becomes clear.