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ISTANBUL PROTOCOL II. RELEVANT ETHICAL CODES

that they implement them in a manner that reflects ethical principles are also recognized by WPA and
the basic duty to avoid harm to their patients. 296 ICN and apply to psychiatrists and nurses. 298

161. In cases of alleged torture or ill-treatment, the
C. Application of ethical principles best interests of the patient or alleged victim are
in clinical evaluations of torture often consistent with the purpose of the clinical
and ill-treatment evaluation, namely the effective documentation of
torture and ill-treatment, which may corroborate
159. The codes of conduct of health professional share an individual’s allegations of abuse.
a number of core principles. The ethical principles
most relevant to clinical evaluations of alleged or 162. The ethical obligation of beneficence is reflected
suspected cases of torture or ill-treatment are to in many WMA declarations, which make clear
act in the best interests of patients (beneficence), that doctors must always do what is best for the
“do no harm” (non-maleficence), respect the patient, including persons accused or convicted of
decisions of patients (autonomy) and maintain the crimes. This duty of beneficence is also expressed
confidentiality of information shared in encounters through the notion of professional independence,
with health professionals. In recent years, WMA requiring doctors to adhere to good and accepted
and the Nelson Mandela Rules have established the medical practices despite any pressure that might be
ethical obligation for doctors and other medical applied. The WMA International Code of Medical
personnel to document and report acts of torture Ethics emphasizes doctors’ duty to provide care
and ill-treatment under certain circumstances. While in full professional and moral independence, with
these ethical principles may be mutually reinforcing compassion and respect for human dignity. 299 It also
and supportive of a clinical evaluation of alleged contains the duty to refuse to use medical knowledge
torture or ill-treatment, they may conflict and thus to violate human rights, even under threat. WMA
present a challenge for health professionals. The standing policy, such as the Declaration of Tokyo or
present section reviews the application of core ethical the Declaration of Seoul on professional autonomy
principles in clinical evaluations of cases in which and clinical independence, 300 is unambiguous that
torture or ill-treatment is alleged or suspected. doctors must insist on being free to act in patients’
interests, regardless of other considerations, including
1. Beneficence and non-maleficence the instructions of employers, prison authorities
or security forces. Similar principles are prescribed
160. The duty of doctors to act in the best interests of the for nurses in the ICN Code of Ethics for Nurses.
patient and not to harm them has been recognized
for centuries in a number of codes, including the 163. Another way in which the duties of physicians is
Charaka Samhita, a Hindu code dating from the expressed by WMA is through its recognition of
first century A.D., the Declaration of Kuwait, the patient rights. Its Declaration of Lisbon on the
Prayer of Maimonides and the Hippocratic Oath. rights of the patient 301 recognizes that every person
The WMA Declaration of Geneva 297 is a modern is entitled, without discrimination, to appropriate
restatement of the Hippocratic values reflecting four health care and reiterates that doctors must always
foundational principles – beneficence, non-maleficence, act in a patient’s best interest. According to the
confidentiality and respect for patient autonomy. It Declaration, this includes efforts by doctors and other
is a promise by which doctors undertake to make the persons or bodies involved in the provision of health
health of their patients their primary consideration and care to uphold patients’ rights, including autonomy
vow to devote themselves to the service of humanity and justice. The Declaration states in its preamble:
with conscience and dignity. These foundational “Whenever legislation, government action or any
other administration or institution denies patients

296 This is recognized by WMA in the regular (minimum every 10 years) review of its policies to ensure that they remain sufficiently detailed and clear to guide physicians’
decision-making. Updates clarify language and seek to address matters that were not covered by earlier drafts.
297 Adopted in 1948 and revised in 1968, 1983, 1994, 2005, 2006 and 2017.
298 WPA, Declaration of Hawaii (1983) and Declaration of Madrid; and ICN, ICN Code of Ethics for Nurses (adopted in 1953 and last revised in 2012).
299 Adopted in 1949 and revised in 1968, 1983 and 2006.
300 Adopted in 2008 and revised in 2018.
301 Adopted in 1981, revised in 1995, 2005 and 2015.

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