Page 188 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

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

(f) Document the presence of all injuries detected, requirements as those conducted in legal settings. In
including those that might be associated with alleged such cases, it would be reasonable for clinicians to
or suspected abuse, with body diagrams (see annex III) follow the Istanbul Principles and note any departures
and photographs if at all possible; from the required elements of these Principles where
applicable. For example, some human rights field
(g) If ill-treatment is alleged or suspected on the basis investigations may not permit sufficient time to
of clinical observations or clinical findings, and on the conduct full and detailed psychological evaluations
condition that informed consent is provided by the and this, therefore, would need to be noted.
alleged victim, the health professional must:
636. Health professionals will need, when assessing the
(i) Make appropriate referrals for further information provided and the clinical findings, to take
consultation, assessment and medico-legal into account that individuals may not disclose the full
evaluation of the alleged or suspected ill-treatment extent of their torture or ill-treatment experiences.
and also for treatment of medical and mental Experiences of sexual torture, in particular, may not
health conditions; be disclosed as discussed in paragraphs 274–276
above and the ability of individuals to recall fully
(ii) Notify the appropriate authorities and inform the details of their experiences may be affected by
individuals of their right to clinical evaluations by many factors including the stress of the situation,
independent, non-governmental clinical experts e.g. if they are in detention (see paras. 342–353
and, to the extent possible, make a referral to a above). Their mental state and reported psychological
specific non-governmental expert; symptoms are also likely to be different if they are
deprived of their liberty. Finally, clinicians who are
(h) Clinicians who have knowledge and experience unfamiliar with recognition and documentation of
applying the Istanbul Protocol and its Principles may physical injuries may underreport physical findings
consider providing an interpretation of the level of compared with more experienced clinicians.
consistency between clinical findings and the alleged
method(s) of injury, as well as an opinion on the 637. Clinical evaluations in non-legal settings should strive
possibility of torture or ill-treatment as defined in to provide all of the information inherent in a full
the Convention against Torture (see paras. 382–385, medico-legal evaluation as described elsewhere in
424–425 and 546–548 above); the Istanbul Protocol. This includes addressing the
relevant clinical history, the allegations or suspicion
(i) Provide a copy of the documentation/evaluation of abuse, physical and psychological symptoms
to the appropriate legal authorities and the patient, if and the findings emerging from a physical and
requested, and/or the patient’s legal representative but psychological examination. The conclusion should
not to law enforcement officials. Health professionals assess the clinical problems and the treatment needs
should keep one copy of the evaluation and as well as steps taken to initiate tests and treatment
documentation for themselves in secure medical files; and referrals for further examination and treatment.
For legal purposes, case information and the
(j) If the health professional is unable to conduct any or circumstances of the evaluation should be included
all components of this evaluation, the clinician should and the clinician’s report should be dated and signed.
indicate the reason(s) for this in the documentation and
pursue alternative approaches;
F. Reporting and regulation
(k) If there is any sign of torture or ill-treatment, the
clinician should make every effort possible, and take all 638. The professional obligation to report torture
measures to avoid that the alleged victim is sent back and ill-treatment is discussed in chapter II (see
to the place where the torture or ill-treatment is alleged paras. 148, 155 and 177–182 above), as well as
or suspected to have taken place. the conditions that may preclude the reporting of
torture and ill-treatment when the alleged victim
635. When independent, non-governmental health does not provide consent. It is also important to be
professionals conduct clinical evaluations of alleged aware of the national laws and regulations regarding
or suspected torture or ill-treatment in non-legal reporting of allegations of torture or ill-treatment.
settings, they do not have the same formal evidentiary Such laws (e.g. criminal procedure codes and

150