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II. RELEVANT ETHICAL CODES ISTANBUL PROTOCOL

Mechanism to Permit Audit of Adherence of States 156. WMA has also established the ethical obligation
to the Declaration of Tokyo recommends support of doctors not to engage in other abusive practices
for doctors and national medical associations in that constitute cruel and degrading treatment and
their efforts to report violations of patients’ health possibly torture, including prolonged solitary
rights and physicians’ professional ethics in custodial confinement, 290 forced body searches, 291 force-feeding
settings. WMA reviews cases of alleged violations of competent individuals, such as hunger strikers, 292
the Declaration of Tokyo and facilitates investigations forced anal examination to substantiate same-sex
by national medical associations of such allegations, activity 293 and female genital mutilation surgery 294
including possible referral to the Special Rapporteur
on torture. 285 The WMA Declaration of Hamburg 157. In addition, when health professionals are in situations
concerning support for medical doctors refusing in which State or military law or government policies
to participate in, or to condone, the use of torture support detention and/or interrogation practices
and other cruel, inhuman or degrading treatment 286 that systematically violate international law and
reaffirms the responsibility of individuals and medical ethics, the health professional must refuse to
organized medical groups worldwide to encourage participate and report the situation to international
doctors to resist torture or any pressure to act contrary authorities. Health professionals who disregard
to ethical principles. It calls upon individual doctors to their ethical obligations may become complicit in
speak out against torture and ill-treatment and urges torture and ill-treatment practices in many ways. 295
national and international medical organizations to
support doctors who resist such pressure. The WMA 3. National codes of health professional ethics
resolution on the responsibility of physicians in the
documentation and denunciation of acts of torture or 158. Ethical principles are also articulated through
cruel or inhuman or degrading treatment establishes national codes. These largely reflect the same core
the duty of physicians to document and denounce values as mentioned above, since medical ethics
acts of torture and ill-treatment and provides that a are the expression of common values among
failure to do so constitutes complicity in such abuse. 287 health professionals. In virtually all cultures and
This duty applies to all physicians – governmental codes, the same basic presumptions occur about
and non-governmental – wherever they encounter duties to avoid harm, help the sick and protect
alleged victims of torture in medico-legal and any the vulnerable and to not discriminate among
other contexts. Other health professionals have the patients on any basis other than the urgency of
same ethical obligation to identify, document and their medical needs. Identical values are present in
report torture. 288 The duty of doctors to document the codes for the nursing profession. A challenging
and report torture and ill-treatment consequently aspect of ethical principles is that they do not,
supports an ethical exception to professional however, provide definitive rules for every dilemma
confidentiality, allowing physicians to report abuses but require some interpretation. When weighing
under limited circumstances. WPA and ICN have ethical dilemmas, it is vital that health professionals
also established similar duties for psychiatrists and bear in mind the fundamental moral obligations
nurses to report torture and ill-treatment. 289 expressed in their shared professional values and

285 Adopted in 2011.
286 Adopted in 1997 and revised in 2017.
287 Adopted in 2003 and revised in 2007, 2008 and 2020.
288 For example, nurses who are aware of abuse and maltreatment should take appropriate action to safeguard the rights of detainees and prisoners. See ICN, “Nurses’ role in
the care of detainees and prisoners”.
289 WPA, Consensus Guidelines for Independent Medical Examinations (March 2015); and ICN, “Nurses’ role in the care of detainees and prisoners”.
290 WMA statement on solitary confinement, adopted in 2014 and revised in 2019.
291 WMA statement on body searches of prisoners, adopted in 1993 and revised in 2005 and 2016.
292 WMA Declaration of Malta on hunger strikers, adopted in 1991 and revised in 1992, 2006 and 2017.
293 WMA resolution on prohibition of forced anal examinations to substantiate same sex-sexual activity, adopted in 2017.
294 WMA statement on female genital mutilation, adopted in 1993 and revised in 2005 and 2016.
295 David H. Hoffman and others, Independent Review Relating to APA Ethics Guidelines, National Security Interrogations, and Torture (Chicago, Sidley Austin, 2015). The
American Psychological Association (APA), the largest association of psychologists in the world, banned the presence of psychologists in national security interrogations, see
American Psychological Association, Council of Representatives, resolution to amend the 2006 and 2013 Council resolutions to clarify the roles of psychologists related to
interrogation and detainee welfare in national security settings, to further implement the 2008 petition resolution, and to safeguard against acts of torture and cruel, inhuman,
or degrading treatment or punishment in all settings, adopted in 2015.

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