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

was perpetrated in the institution in which the alleged 2. Implicit and explicit bias
victim is being held, this may expose the victim to a
very high risk. Under such circumstances, the health 625. Explicit biases are conscious thoughts directed
professional’s ethical obligations of acting in the towards a specific group of individuals and are
best interests of the individual, not doing harm and easily recognized by the holder of those beliefs or by
respecting autonomy and confidentiality may conflict others during routine interactions. 526 Implicit biases
with the ethical obligation to document and report are unconscious thoughts that are directed towards
torture and ill-treatment and to prevent harm to others. a specific group of individuals. The unconscious
nature of implicit bias makes it quite pervasive,
623. Even in such conflicting situations, health professionals even among health-care professionals working with
should never ignore cases and the suspicions of torture groups such as victims of torture or ill-treatment,
or allegations presented. Health professionals who particularly those who are in custody. It is important
suspect torture or ill-treatment, regardless of the setting to recognize and mitigate implicit and explicit bias
or purpose of a clinical encounter, should always: in working with patients, clients and alleged victims,
to avoid acting upon such biased conceptions.
(a) Seek to obtain informed consent and disclose any
mandatory reporting obligation; 3. Limited opportunities for referral

(b) Document and report torture and ill-treatment in 626. Referral options may be limited due to lack of
accordance with the Istanbul Principles when informed experts to refer to, resistance in the system to refer
consent for a clinical evaluation and reporting cases, economic hindrances, as well as problems
is provided; of access and adequate standards with regard to
transfer and examinations in health facilities. This
(c) Consider, in the absence of informed consent, all makes the initial documentation of torture or
ethical obligations and only consider breaches in ill-treatment all the more urgent and necessary.
confidentiality under the conditions provided for in
paragraphs 177–178 above;
E. Guidance and procedures
(d) Document patterns of abuse anonymously and
report such patterns of abuse to international and 627. All clinicians should do their utmost to fulfil their
national human rights institutions; ethical obligation to document and report torture
and ill-treatment in all settings. The Istanbul Protocol
(e) Consider the need for referrals, either for treatment and its Principles should be considered the principal
purposes or for further documentation by other framework within which to fulfil this obligation.
clinicians.
1. Clinical evaluations in legal contexts
1. Real or perceived obligations to third parties
628. Chapters IV, V and VI and annexes I–IV provide
624. As discussed in paragraphs 173–182 above, detailed guidance on clinical evaluations of torture
dilemmas arising from real or perceived obligations and ill-treatment in legal contexts. Several key points
to third parties, such as State employers or a on this guidance are included here only to highlight
military chain of command, may compromise a differences between clinical evaluations in legal and
health professional’s respect for core ethical duties. non-legal contexts. Health professionals should refer
Whatever the circumstances of their employment, to chapters IV, V and VI and annexes I–IV to ensure
health professionals cannot be obliged by contractual that their clinical evaluations in legal contexts are
or other considerations to compromise their consistent with the standards of the Istanbul Protocol.
professional ethical obligations or independence.
629. When an individual alleges the crime of torture or
ill-treatment, the State has a duty to investigate the

526 Chloë FitzGerald and Samia Hurst, “Implicit bias in healthcare professionals: a systematic review”, BMC Medical Ethics, vol. 18, No. 1 (2017).

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