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ISTANBUL PROTOCOL II. RELEVANT ETHICAL CODES

killing, widow-burning, trafficking in persons, 2. Statements from international professional
female genital mutilation, conversion therapies to bodies
change sexual orientation, non-consensual gender
reassignment surgeries, forced or coerced pregnancy 154. Many statements from international professional
testing, forced or coercive sterilization, medical bodies focus on principles relevant to the protection of
determinations of gender without consent, and human rights and represent an international medical
unnecessary surgery and treatment on intersex children consensus on these issues. WMA declarations define
without their consent. The Special Rapporteur the ethical duties to which all doctors are held. The
has also recognized certain forms of abuses in guidelines for physicians concerning torture and
health-care settings that may be tantamount to other cruel, inhuman or degrading treatment or
torture or ill-treatment including: force-feeding punishment in relation to detention and imprisonment
hunger strikers, 275 the denial of pain relief, 276 (Declaration of Tokyo), adopted by the World Medical
compulsory detention for medical reasons, such as Assembly, 280 reiterate the prohibition of any form of
compulsory drug detention and “rehabilitation”, medical participation or medical presence in torture
non-consensual medical interventions against persons or ill-treatment. This prohibition is reinforced by
with disabilities, including the non-consensual the aforementioned Principles of Medical Ethics
administration of psychosurgery, electroshocks that specifically refer to the Declaration of Tokyo.
and mind-altering drugs, such as neuroleptics, Doctors are explicitly prohibited from providing
the use of restraint and solitary confinement for information or any medical instrument or substance
both long- and short-term application. 277 that would facilitate ill-treatment. The same rule
is specifically applied to psychiatry in the WPA
153. Health professionals who participate in the monitoring Declaration of Hawaii, 281 which prohibits the misuse
of places of detention, notably as part of national of psychiatric skills to violate the human rights of any
mechanisms for the prevention of torture, 278 have individual or group, and its Declaration of Madrid
a particular role in addressing health issues related on ethical standards for psychiatric practice. 282
to torture and ill-treatment; in assessing the health The International Conference on Islamic Medicine
system in detention, for example through an analysis made a similar point in its Declaration of Kuwait, 283
of medical files and records and discussions with which bans doctors from allowing their special
the health-care staff in places of detention; and knowledge to be used “to harm, destroy or inflict
in evaluating the impact of general conditions of damage on the body, mind or spirit, whatever the
detention (hygiene, nutrition, access to showers, military or political reason”. Similar provisions are
overcrowding etc.) on the health of the detained made for nurses in the position statement on nurses’
population. This medical expertise enhances the role in the care of detainees and prisoners. 284
quality of monitoring that is conducted by the
visiting mechanisms. In this perspective, health 155. Health professionals also have a duty to support
professionals may provide a substantial contribution colleagues who denounce human rights violations
to the application of norms and standards – especially related to torture. Failure to do so risks not only an
on the provision of, and access to, health care and infringement of patient rights and a contravention
on ethical practices for those working in places of the declarations listed above, but also brings the
of detention – and recommendations to the State health professions into disrepute. This is elaborated by
authorities addressing health issues in detention that other WMA policies supplementing the Declaration
may amount to torture and/or ill-treatment. 279 of Tokyo. For example, the WMA Recommendation
on the Development of a Monitoring and Reporting

275 OHCHR, “Force-feeding is cruel and inhuman – UN experts urge Israel not to make it legal”, press release, 25 June 2014.
276 The WMA resolution on the access to adequate pain treatment (2011, revised 2020) highlights the problem of the vast majority of the world population having no access to
or inadequate pain treatment. The resolution urges health professionals and Governments to ensure adequate pain treatment for all and to establish effective monitoring and
compliance mechanisms.
277 A/HRC/22/53, para. 89 (b).
278 Pursuant to the Optional Protocol to the Convention against Torture.
279 The Association for the Prevention of Torture, “Visiting places of detention: what role for physicians and other health professionals?” (Geneva, 2008), pp. 6–7.
280 Adopted in 1975 and revised in 2005, 2006 and 2016.
281 Adopted in 1977 and updated in 1983.
282 Approved by the WPA General Assembly in 1996 and revised in 1999, 2002, 2005 and 2011.
283 Adopted in 1981, otherwise known as the Islamic code of medical ethics.
284 Adopted by ICN in 1998 and revised in 2006 and 2011.

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