A Viewpoint in this week's edition of The Lancet discusses how the 1975 Declaration of Tokyo, on Medical Ethics and Torture, could be further revised to make it more relevant to the world today — making sure that physicians who are complicit in torture of prisoners are held to account. The Viewpoint is written by Dr Steven Miles, Center for Bioethics, University of Minnesota, MN, USA, and Dr Alfred Freedman, New York Medical College, USA.
Medical complicity with torture and abuse of prisoners is common in the roughly 100 countries that practise torture. Physicians devise ways to keep physical scars to a minimum, certify prisoners as fit for abuse, monitor vital signs during mistreatment, and give approval to intensify abuse. A third to half of torture survivors report physicians overseeing the abuse; this number does not include those who do not see physicians being accomplices of the abuse and those who die of torture that a physician, either willingly or under coercion, certifies as death by natural causes. Many more physicians are complicit with abusing prisoners than work in programmes to treat torture survivors.
The World Medical Association's (WMA) Declaration of Tokyo has been a landmark event in medical ethics. It was passed in 1975, and has undergone several revisions. The declaration condemns medical participation in torture, and cruel, inhuman, or degrading treatment, or any act to diminish the ability of the victim to resist such treatment. It serves as a template for many medical codes. Although the WMA updated the Declaration of Tokyo in 2006, a revised version might further clarify medical roles and duties in countries where prisoners are abused.
The authors propose four manners in which the code should be revised. First, it should incorporate authoritative definitions of torture and cruel, inhuman, and degrading treatment, to harmonise this medical ethics code with international law and, thereby, communicate the accountability of physicians to international law. Second, a revision of the Declaration of Tokyo should incorporate some of the good ideas recently endorsed by various clinical societies — for example, a death certificate should be publicly posted for every death in custody, as is currently mandated for prisoners of war by a Geneva Convention. False or non-issued death certificates conceal torture. Third, a revision of the Declaration of Tokyo must commend ways for holding physicians professionally and criminally accountable for abetting abuse of prisoners — including those who flee the country where the abuse occurred and attempt to obtain a licence to practice elsewhere. Finally, a revision of the Declaration of Tokyo should be readable by a person with 12 years of education — the current version needs advanced collegiate-grade reading skills, with its average sentence containing more than 30 words.
The authors conclude: "The medical community is key to the campaign against torture. Governments that practice torture need complicity of prison medical personnel. Furthermore, a profound link exists between domestic torture and worldwide medical solidarity against torture. A physician community that acquiesces to abuses by its members undermines its credibility in protesting against foreign medical communities or colleagues who abet torture. Accordingly, physicians and their societies must act on their duty to promote prisoners' wellbeing, access to prisons, skills at identifying abuse, and membership of civil society."
An accompanying Editorial says: "The global community still has much work to do in the field of human rights", and refers to "a gloomy start to the year for human rights." It focuses on a Jan 13 report, Health in Ruins, by Physicians for Human Rights (PHR), detailing their December factfinding visit to Zimbabwe. The Editorial says: "For the cholera epidemic in Zimbabwe (just over 2000 deaths so far), PHR found a death rate of 5%, well above the usual 1% if treatment had been available. But the report also details other health-care crises, including anthrax and tuberculosis, and lack of availability of antiretroviral drugs for HIV... All that is against a background of systematic murders, beatings, and torture of opposition-party supporters. It is no surprise that PHR calls for the International Criminal Court to investigate the health crisis in Zimbabwe as a crime against humanity. This is not a glib call. The report's preface is signed by, no less, Richard Goldstone (former UN Chief Prosecutor at the International Criminal Tribunals for Yugoslavia and Rwanda), Mary Robinson (former UN High Commissioner for Human Rights), and Archbishop Desmond Tutu of South Africa."
The Editorial concludes: "The situation in Zimbabwe highlights how breakdown in a country has destroyed health-care provision there. Health professionals worldwide need to remain vigilant to help to prevent human rights abuses and refuse to participate in such abuses. A year from now, will we be writing any differently?"
Dr Steven Miles, Center for Bioethics, University of Minnesota, MN, USA T) +1 612 624 9440 E) miles001@umn.edu
Lancet Press Office T) +44 (0) 20 7424 4949 E) pressoffice@lancet.com
For full Viewpoint and Editorial see: http://press.thelancet.com/torture.pdf
Journal
The Lancet