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VII. HEALTH PROFESSIONALS DOCUMENTING TORTURE AND ILL-TREATMENT ISTANBUL PROTOCOL

report torture and ill-treatment and obtain the 5. Non-disclosure
necessary professional knowledge and skills
to fulfil these obligations. Lack of necessary 619. Victims of torture do not necessarily disclose their
training does not in any way diminish the ethical torture experiences readily or at a first appointment
obligations of the health professional to effectively and circumstances such as the presence of others
document and report torture and ill-treatment. or fear of reprisals may make them even less likely
to do so. The health-care professional should
3. Lack of time, heavy workload and inadequate develop skills in facilitating disclosure, pay attention
number of health professionals to cues of further torture experiences, especially
sexual torture (see paras. 274–276 above), that the
615. Just as in cases of domestic violence, sexual assault, person may find difficult to disclose initially, and
child abuse and other forms of violence, insufficient explore such cues as they present in the review of
time is not an acceptable reason not to conduct an bodily systems and in the full examination. 525
evaluation in cases of alleged or suspected torture or
ill-treatment. A clinical evaluation may be condensed 6. Vicarious trauma and burnout
and still be consistent with the Istanbul Principles.
Health professionals should take the necessary 620. As discussed in paragraphs 300 and 302 above,
time for an effective evaluation and schedule a health professionals who are unaware of the way
follow-up appointment or refer to another health in which they indirectly experience the trauma of
professional with adequate knowledge and skills if others may react in a way that is neither healthy
the evaluation cannot be completed in a single visit. for themselves nor effective for the alleged victim.
Professional wellness and effective evaluations require
616. Health professionals should document all the knowledge and mitigation of vicarious trauma. This
findings and information detected during clinical is especially true for clinicians who work alone,
encounters and clinical evaluations, as well as with limited collegial support, and are subject to
the conditions, such as examination time and high levels of stress at work and heavy workloads.
environment, as stated in paragraph 270 above,
while respecting confidentiality and privacy.
D. Implementing ethical obligations
4. Lack of adequate professional space
or conditions 621. As discussed in paragraphs 159–172 above,
all health professionals who encounter alleged
617. Evaluations conditions can be challenging, for example victims of torture or ill-treatment, regardless of
the lack of privacy, the physical conditions of the the primary purpose of the contact or the context
interview setting and the person being restrained. in which the encounter occurs, must respect their
As mentioned in paragraphs 315 and 354 above core ethical obligations even in the face of real or
and annex I, all evaluations should be conducted in perceived obligations to third parties. The non-
privacy and without limitations or restrictions. If maleficence obligation may imply in extreme cases
this cannot be achieved, any limitations on privacy that, due to risks for the alleged victim, no further
should be documented in the clinician’s report. steps regarding identification, documentation,
evaluation and reporting should be taken. At the
618. In order to fulfil their professional obligation to same time, the ethical obligation to document
document and report torture and ill-treatment, and report is critical in preventing the passive
health professionals should take steps to request – if complicity of health professionals in these crimes.
possible, in writing – that the authorities provide an
appropriate environment and conditions, equipment, 622. The duty to document and report torture and
time and human resources. In addressing the ill-treatment may be particularly challenging in settings
authorities in these situations, health professionals in which health professionals are under a real or
can refer to international and scientific standards. perceived pressure from third parties, such as a State
Keeping a copy of such correspondence is advised. employer, that conflicts with their ethical duties. In
instances in which the alleged torture or ill-treatment

525 Faculty of Forensic and Legal Medicine of the Royal College of Physicians, Quality Standards for Healthcare Professionals.

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