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ISTANBUL PROTOCOL IV. GENERAL CONSIDERATIONS FOR INTERVIEWS

“physical and psychological findings, historical possibility of whether the clinical findings that they
information, photographic findings, diagnostic test observe were caused by the infliction of the severe
results, knowledge of regional practices of torture, physical and/or mental pain or suffering alleged.
consultation reports etc.”, as stated in annex IV.
The clinician’s opinion on the possibility of torture 385. In addition to providing a conclusion on the possibility
or ill-treatment is expressed using the same levels of torture or ill-treatment, clinicians should reiterate
of consistency as those used for interpretation the current symptoms and disabilities and the
of findings. Because of the capacity of children, likely effects on social functioning and provide any
clinicians should take into account that: “The recommendations for further evaluations and care
threshold at which treatment or punishment may for the individual. As noted in annex IV, medico-legal
be classified as torture or ill-treatment is therefore reports may also include a statement of truthfulness of
lower in the case of children, and in particular in the clinician’s medico-legal report, a statement of any
the case of children deprived of their liberty.” 415 restrictions on the evaluation, the clinician’s identifying
information and signature, and any relevant annexes.
383. Ultimately, it is the overall evaluation of all clinical
findings and not the consistency of one finding in 3. Self-infliction and simulation
particular that is important in assessing allegations
of torture or ill-treatment. When physical and 386. The question of self-inflicted injuries (or self-infliction
psychological evidence are documented in a single by proxy, i.e. by someone else) and the simulation of
report by one examiner, the conclusion on all of physical or psychological symptoms may be raised
the clinical evidence should be the highest level of in medico-legal settings. Clinicians and adjudicators
consistency reported. Similarly, when considering a alike should understand that the Istanbul Protocol
conclusion on physical and psychological evidence is a useful tool for corroborating specific allegations
that are reported in separate clinical evaluations, of abuse with relevant clinical findings, such as
the conclusion on all of the clinical evidence physical and psychological evidence. If the clinician
should be the highest level of consistency reported suspects fabrication, another clinician should
in either of the separate clinical evaluations or, if conduct additional interviews. Documentation of
confirming the same conclusion, it could be higher. the possibility of self-infliction or simulation should
be noted with the agreement of both clinicians
384. Medico-legal evaluations that fail to assess and in the interpretation of findings and conclusion.
provide an opinion on the possibility of torture or Clinicians do not have a duty, however, to consider
ill-treatment are not consistent with the Istanbul these possibilities in the absence of an evidentiary
Principles and should be considered deficient. Clinical foundation since judicial decisions are based on the
opinions on the possibility of torture or ill-treatment existence and weight of evidence and not hypothetical
are sometimes contested in medico-legal settings. It possibilities in the absence of supporting evidence.
is important to understand that clinical opinions on
the possibility of torture are based on the probability 4. Reliability of clinical evidence and credibility
that the totality of clinical evidence was caused by
the alleged torture or ill-treatment as defined by the 387. In medico-legal cases, lawyers, prosecutors and
Convention against Torture or other applicable legal adjudicators are often concerned with the credibility
definitions. 416 Causation is expressed in terms of of an alleged victim or suspect. Credibility
consistency rather than judicial standards of proof determinations are often used by such legal experts
(e.g. “more likely than not” or “beyond a reasonable to weigh the veracity of an individual’s claims and
doubt”) to avoid the conflation of clinical opinions often have a significant effect on judicial decisions.
with judicial determinations. Clinicians routinely Judicial determinations of an individual’s credibility
consider the cause of the symptoms of their patients. vary among States, but generally include a number
In the case of medico-legal evaluations of torture or of factors – clinical evidence representing only
ill-treatment, clinicians have the necessary knowledge one of these factors. Legal experts sometimes ask
and experience to formulate an opinion on the clinicians for their opinions on the credibility

415 A/HRC/28/68, para. 33. See, also, ibid., para. 17.
416 In some countries, the definition of torture may vary from that of the Convention against Torture and adjudicators may request or require clinicians to opine on whether torture
occurred or not. In such circumstances, clinicians may consider explaining the limits of their expertise and the ethical obligations to work within the limits of their professional
competence.

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