Top UN Expert on Torture Demands an End to Abuses in Health Care

A few of the many people like them across the world have told their stories:

Now, the international community is listening.

In a landmark new report presented today to the United Nations Human Rights Council, the UN Special Rapporteur on Torture Juan Mendez says that severe abuses in health care settings amount to cruel, inhumane, and degrading treatment—and even torture. The Open Society Foundations and the Campaign to Stop Torture in Health Care welcome this conclusion, which places immediate legal obligations on governments to end such abuses.

Responsible for interpreting international understandings of torture, the Special Rapporteur’s report is the first systematic examination of torture and ill-treatment committed in health care contexts. The report says that abuse cannot be justified by claims of “medical necessity,” and it underscores the fundamental need for free, full, and informed consent by patients to any and all medical procedures.

The Special Rapporteur highlights examples of forced treatments that can constitute torture and ill-treatment:

  • Forced sterilization of women, transgender, and intersex people, and forced abortion—a violation disproportionately suffered by those women who face systemic discrimination, like ethnic minorities, women with disabilities, and women living with HIV.
  • Forced treatment and involuntary commitment of people with psychosocial (mental) disabilities, and the use of restraints, and solitary confinement.
  • Forced detention of drug users in inhumane facilities under the guise of treatment. Detention itself often results in painful drug withdrawal, and many facilities mandate so-called therapies—often overseen by non-medical personnel—which include beatings, shock therapy, and rigorous manual labor.

The Special Rapporteur also sees this risk in the denial of care, highlighting:

  • Denial of essential pain relief medications, including lack of access to oral morphine, due to policies that prioritize strict drug control regulations over patient care, or inadequate domestic provision of medications.
  • Denial of opioid substitution therapy for drug users, including those instances in which criminal confessions are extracted under the pains of drug withdrawal.
  • Denial of reproductive services like abortion, which can encompass needless and difficult requirements for accessing abortion services, and the denial of information or intentional misinformation to women to influence their reproductive health decisions.
  • Denial of a range of health services for people who face discrimination like sex workers, drug users, and LGBT people. For example, drug users may be denied HIV treatments under the discriminatory assumption that they will not properly manage their medications.

And the Special Rapporteur notes some ways in which health workers can use their status and access to sensitive information as a means of discrimination and harassment, including:

  • Public disclosure of the HIV status of sex workers and the inclusion of the names of drug users on government registries, which violate privacy and patient confidentiality, and subject people to public abuse.
  • Delays in care, unwarranted and intrusive physical examinations, and verbal harassment of patients by health practitioners.

Given these findings, the Special Rapporteur makes urgent demands on states to investigate abuse and to review domestic laws that allow for human rights violations in health care settings. He calls on states to implement mechanisms to monitor and prosecute wrongdoing, to educate health care personnel, and to discontinue international funding for drug detention facilities if contributions do not mandate safeguards.

For the Open Society Foundations, our grantees, and advocates around the world, this report is a powerful new tool for fighting torture in health care. With one exception—in which the report seems to confusingly allow narrow instances of involuntary commitment, contrary to the Convention on the Rights of Persons with Disabilities—this report carefully frames key international obligations that will make a lasting difference in stopping torture in health care. It has the potential to impact courts of law, government bodies, public education, health-worker training, and much more.

This groundbreaking international recognition of torture in health care is an important step toward making the stories of those like Hilma, Vlad, and Venta the narratives of a sad—but distant—history.

11 Comments

hAY QUE DETENER LA TORTURA EN LOS CUIDADOS DE LA SALUD.

Healthcare workers have licenses to practice. Thus licensing boards must be the implementors of non-torture in healthcare. EMTs are licensed too. Patients having had surgeries need real pain medications in ordeer to heal faster.Drug treatments in prison hospitals perhaps or outside venues. Forced sterilization for any reason whereby patients are not aware of nor have consented to is criminal -putting aside uterine,cervical,fallopian tube cancers where removal is necessary in order to save a life. Forced labor camps of any sort banned internationally since that is the very gist of human rights. OSF is doing the work for those whose human rights,rights to have adequate palliative care,drug treatments.HIV treatments and whose consent to that before was not asked- now must ask for it.

Many states within America have passed legislation that require a woman to have medically unneccessry and invasive procedures (transvaginal ultrasounds, before and/or after abortion; being forced to watch the ultrasound and to listen to the fetal heartbeat) before having an abortion. Since these are laws authored by the state,offers the woman no personal benefit, incur an additional expense, are degrading and designed to humiliate the woman and thus may cause emotional and physical pain,does this not constitute torture? Also, some states have legislated that women must go to 'reproductive counseling centers' which are nothing more than a cover for a (conservative) religious institution to try to convince a woman to continue with the pregnancy. What of the women who are atheists or subscribe to a different religion rather than the one represented by the conservative religion at the reproductive center?
The access to abortion and even, to contraception, is being restricted by many states and this may, in many cases, cause severe physical and emotional harm to the girl or woman. Many state legislators have sought to deny a woman an abortion even in the cases of rape, incest or threat to the woman's life. Abortion is legal in the United States (Roe v. Wade), yet, states are making access to abortion difficult or impossible to obtain. Does this not consitute a human rights abuse as a denial of care?

Spring: Thanks very much for your insightful comment. Indeed -- and unfortunately -- the abuses detailed in my blog and the SRT's report are just the tip of the iceberg. There are innumerable abuses in health care that are extremely serious and should be stopped immediately, including infringements on sexual and reproductive health and rights occuring in the USA. As the SRT notes in his report, his list is far from exhaustive and is intended to demonstrate the diversity and intensity of the problem not provide a comprehensive description of the situation. We hope that the framework of Torture in Health Care will be useful in your and other's advocacy on health-related violations.

It is sad and unfortunate that people with health issues and or vulnerable groups should be treated like sub-humans. Health care should be regarded as part and parcel of human Rights, people in need of such cares should be availed of same- it is only Right and Human.

In Brazil we have many cases of HIV, however, between the indigenous population of these cases are silenced, people are left to their own fate.
This is a case of denunciation against the positions of the Brazilian State in relation to the indigenous population.

This is indeed a landmark report and a milestone in addressing tremendous abuses that take place under the guise of health care. We particularly welcome the report’s stance on forced sterilization as “an act of violence, a form of social control, and a violation of the right to be free from torture and cruel, inhuman, or degrading treatment,” which should be outlawed in all circumstances. The report also importantly recognizes the particular vulnerability of marginalized groups, considered undesirable and “unfit to bear children” and faced with a power imbalance when interacting with health providers. Significantly, the report cites FIGO’s (International Federation of Obstetrics and Gynecology) recent progressive guidelines (http://www.opensocietyfoundations.org/voices/against-her-will-putting-en...) and goes one step further to address forced sterilization of transgender and intersex persons. It is time for all people to enjoy their reproductive rights no matter their gender.

The presentation of the report to the UN and interactive dialogue is available at: http://webtv.un.org/live-now/watch/22nd-regular-session-of-the-human-rig....

Terrific post.

This groundbreaking report joins a growing body of resources and tools advocating for palliative care and pain relief as human rights. At the 17th session of the Human Rights Council in June 2011, a panel discussion on “Access to Palliative Care: A Neglected Component of the Right to Health” was held with palliative care experts from India, Africa, and Latin America with opening remarks from the former President of Uruguay. The panel discussion focused on human rights mechanisms to address global challenges that hamper access to pain and palliative care treatment. The report “Access to Palliative Care: A Neglected Component of the Right to Health”
can be accessed here: http://www.opensocietyfoundations.org/reports/access-palliative-care-neg...

One of life's worst nightmares is being tortured by other people one's life is at the mercy of. The so-called war on drugs and terror is just a front for torture without end. Forced psychiatric medications torture their users and are more addictive then street drugs. Drug treatment is laced with torture called "Confrontation therapy." I experienced group therapy as a teen-ager where the other girls in my group beat me up and verbally abused me. There is NO EXCUSE for torture, either human or animal!

AS A YOUNG WOMAN, I WAS SEXUALLY ABUSED BY SO MANY DOCTORS I LOST COUNT. A DR LOVE, KID YOU NOT, DID A VAGINAL EXAM FOR A SORE THROAT. ANOTHER DR. INSISTED I AND A FEMALE FRIEND, TURN OUR BACKSIDES TO HIM AND SPREAD OUR LEGS, SO HE COULD CHECK FOR SKIN CANCER, YET DIDN'T WITH OUR HUSBANDS. ONE DR STROKED MY CLITORIS AS HE GAVE ME A VAGINAL EXAM TO GET BIRTH CONTROL PILLS. WAS THAT ENTIRELY NECESSARY? I YELLED "STOP THAT!" THE REQUIRED NURSE IN THE ROOM DID NOTHING. IT'S GREAT BEING OLD. MENOPAUSE IS TRULY WOMAN'S LIBERATION!!! I WALK PAST PADS AND TAMPONS, THINKING "FREE AT LAST"! I HOPE YOUNG WOMEN HAVE THE COURAGE TO REPORT THAT KIND OF ABUSE TO AUTHORITIES, WHO OF COURSE, WILL BELIEVE THE LYING DOCTOR. TRY ANYWAY.

I have witnessed many women who consult gynaecologists being forced to undergo invasive u/sound checks. These checks are very expensive and sometimes are unnecessary. The doctors are after money from these unsuspecting mothers/girls. Are these checks mandatory during the diagnosis? Please advise.Does this amount to human rights abuse as sometimes are not consensual?

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