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II. RELEVANT ETHICAL CODES ISTANBUL PROTOCOL

these rights, physicians should pursue appropriate the implications of agreeing and the consequences
means to assure or to restore them.” Individuals of refusing, as well as any reasonable alternatives.
are entitled to appropriate health care, regardless of Before examining patients, health professionals must,
factors such as their race, colour, national, ethnic therefore, explain frankly and in an accessible manner
or social origin, language, age, sex, gender, sexual the purpose of the examination and treatment. Consent
orientation and gender identity, immigration status, obtained under duress or as a result of conveying false
political or other opinion, religion, descent, birth, or partial information to the patient is invalid, and
disability, health status, individual merit, etc. People doctors knowingly acting on it are in breach of medical
accused or convicted of crimes have an equal moral ethics. In addition, the Special Rapporteur on the right
entitlement to appropriate medical and nursing of everyone to the enjoyment of the highest attainable
care. The Declaration emphasizes that the only standard of physical and mental health observed
acceptable criterion for discriminating among patients that guaranteeing informed consent is a fundamental
is the relative urgency of their medical needs. feature of respecting an individual’s autonomy, self-
determination and human dignity in an appropriate
164. When working with children and young people it is continuum of voluntary health-care services. 303
important to remember that: “Organisations have a
duty of care to children with whom they work, are in 167. Torture and ill-treatment, by definition, are crimes
contact with, or who are affected by their work and committed by or with the consent or acquiescence
operations.” 302 The principle of safeguarding children of State officials. State officials often attempt to
includes ensuring that children are protected from conceal these crimes by threatening victims with
harm and are not exposed to risk of harm and that additional torture and ill-treatment if they reveal any
any such risk is reported and addressed immediately. information of abuse to anyone, including evaluating
clinicians. In the context of medico-legal evaluations
2. Informed consent of alleged torture and ill-treatment, informed
consent is imperative. Informed consent requires
165. The most fundamental principle of medical ethics disclosure of all material information – including
is patient autonomy. Autonomy recognizes that the purpose of the evaluation – potential risks and
patients themselves are the best judges of their own benefits, the nature of the evaluation – including
interests. This requires health professionals to adhere the possibility of taking photographs – limits on
to an adult patient’s decisions rather than to the confidentiality – such as any mandatory reporting
views of any person in authority about what would requirements of the clinician – how information
be best for that individual. This is equally true in gathered in the evaluations will be used and stored
the context of clinical evaluations of alleged torture and who will have access to the information.
or ill-treatment that may result in reprisals and the
infliction of severe physical and/or mental harm. In 168. Consent should be confirmed once again at the
cases in which the patient is unconscious or where end of the interview after the disclosure of specific
significant efforts have been made and it is not possible information by the alleged victim and before the
to obtain an individual’s free and informed consent clinical assessment. Informed consent requires that
or to ascertain their will and preferences, including the patients and alleged victims understand the
through the provision of support and accommodations, information provided, with the most important
the standard of “best interpretation of the will and information being thoroughly discussed, which may
preference” should be applied as a last resort. require translation or interpretation, and provide
consent voluntarily. The information provided by the
166. Organizations of health professionals, such as WMA, clinician should be accessible and comprehensible,
WPA and ICN, the Bangkok Rules and the Nelson meaning that, where needed, information should be
Mandela Rules require that doctors and nurses available in accessible means, modes and formats
respect the autonomous decisions of their patients of communication, and reasonable accommodation
and obtain voluntary and informed consent from should be provided, such as supported decision-
patients prior to any examination or procedure. This making. As discussed below in paragraph 273,
means that individuals need to know and understand informed consent should be sought at the outset

302 Keeping Children Safe, The International Child Safeguarding Standards … and How to Implement Them (2014/2020), p. 10.
303 A/64/272, para. 18.

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