July 4 juillet 8:30 – 12:15
(extended session)
Room NCDH–200
Chair: Thomas Wenzel , University Hospital for Psychiatry, Vienna
Rarely have medical ethics been abused as systematically as in the case of the NS reign of terror in Europe. In addition to the well-known human experiments, murder, ill-treatment and torture of alleged mentally handicapped patients became a far-spread practice with several centers, including Vienna`s “Spiegelgrund” hospital, serving as focal points in the networks of destructive “medical” practices. The rationalisations that permitted this special form of “Euthanasia” are discussed on the background of the continuous suffering of present day child survivors in the present situations. Legal measures taking into account the protection and compensation of survivors constitute a neglected issue that links present and past threats to survivors.
This paper will review the principles and good practices in service delivery that the Canadian Center for Victims of Torture has developed over the years. It will also review the concept and components of Psychosocial Trauma and it will build on it to provide a context to illustrate different levels at which torture operates: At the level of the individual, the family and the community. A consistent approach to the issue of torture following the same format will also be analyzed.
Torture has been understood as a legally “correct” method of sanction or criminal persecution not only in modern totalitarian governments, but also in European history. Practical or “humanitarian” reasoning required that physicians participate in torture. This reasoning also provided physicians with excuses, in spite of their contradiction with the basic concept of medical ethics: not to cause intentional suffering or harm to the patientThe understanding of historical arguments to support such an–as we would say nowadays–abuse of medicine is much different from the modern arguments used in the support of torture or other debatable practices, such as the death penalty and mutilating punishment. Recent international legislation stressed the univerality of human rights in spite of regional laws, but usually focuses on areas outside the scope of professional conduct. The Nuremberg trials set a special example, and while it has not always been followed in recent years, it might be used to understand the basic reasoning. Trust in the patient-doctor relationship can be a direct victim of the condonement of such lack of establishment of practices.
In a study conducted by our group, diagnostic practices and
perceptions of disorders related to governmental torture in different countries
were gathered by questionnaire. Research appears to have a high importance in
the perception of many treatment facilities, though means are targeted and not
sufficiently funded in regard to primary treatment concerns. Psychiatric
symptoms are listed as important in most centers, and a majority of centers
supplyservices in this regard, although regional needs reflect specific common
physical forms of torture in some countries. In many countries, the continued
threat lurking behind day-to-day work is an aggravating factor that extends
persecution from the direct victims to physicians and other health care
specialists, creating a treatment structure that differs from those in
economically rich countries. Training, as a factor of mutual support, and
quality control would strengthen strategies that support the treatment and
prevention of sequels to social violence.
The paper is written on the basis of experiences at BRCT.
BRCT is the first and only organization of its kind in Bangladesh providing
treatment, legal aid and rehabilitation services to victims of torture
perpetrated by the members of law enforcing agencies. Torture not only affects a
victim, but also affects the members of the family in the form of secondary
traumatization.
To cope with the situation BRCT conducts a home visit
program. During the home visit BRCT counselors and related persons visit the
victim’s house and meet with the victim’s family members and relatives as a
part of the psychosocial counseling. The home visit is a unique method used to prevent the effects of
secondary traumatization on the family members of the torture victims. Several
statistics and important case studies will show the effectiveness of the home
visit as a
preventive approach to secondary traumatization of the victims of torture in
Bangladesh.
For some decades now, refugees who have experienced persecution and tortureare requesting hosting countries to show flexibility and a capacity of adaptation to face their needs.
Canada, as a country that offers immigration and asylum, welcomes a great number of refugees. These people from different backgrounds have specific needs connected to their past. Official health and social services have little or nothing to offer to these refugees, leaving non-governmental organizations (NGO) to responde to their suffering. In 1983, CCTV began in Toronto. Since then, the ResCan–Canadian network for the health of survivors of torture and organized violence has grown to 12 agencies that are intended to provide therapeutic services to this group.
In Montreal, with a provincial mandate, the RIVO began in the 90’s offering therapeutic services and sensibilization-training, while conducting research. Although government support is virtually non-existent, RIVO’s services are frequently used by both formal health and social systems, and also by other authorities. Its network design allows it to face support and training demands while ensuring essential support to their workers.
The government by military dictatorship that was instituted
in Chile from 1973 to 1990 was associated with massive human rights violations.
At the same time and as consequence, a struggle for the protection and
vindication of human rights was conducted at national and international levels.
This paper reviews this movement of human rights solidarity, reaching across
several continents, and specifically the contribution of the health and legal
professions to this movement. Medical techniques and, above all, medical language, de-politicized
and stretched to the limits of its metaphors, were used by the medical and
health professions in the service of victims. The spirit of solidarity with the
legal, in particular, and other professions materialized in concrete projects of
victim support and human rights promotion.
The indictment of general Augusto Pinochet for crimes
committed against foreign and Chilean citizens represents a major step in the
effective utilization of universal and national legal instruments for the
protection and promotion of human rights across the globe. However, vigilance
must be exercised to the dangers of the application of human rights legislation
under double standards or for nationalistic purposes.
In order to evaluate the phenomenon of prison suicides, a study was conducted using the case notes of all suicides having occured in Austrian prisons between 1947 and 2000, as documented by the Ministry of Justice. All personal records of all known cases were taken from the archive of each prison. Although some of the records were no longer available, the necessary information for this study was obtained. All records included the suicide verdict. In 1975, there was an important legislational reform of the criminal law in Austria. One of the major aims of this reform was the reduction of the total inmate population. Certain former offenses were no longer punishable, and suspended sentences could be more readily imposed. The average daily inmate population decreased significantly, providing penal institutions with more room, especially single-cells, per inmate. Furthermore, the education of the prison security staff was improved, and prison officers began to cooperate with the psychological staff. The psychological, psychiatric and social work staffs were increased, and better therapeutic treatment facilities were implemented. It was, therefore, expected that the incidence of suicide in jails and prisons would decrease. Method: We calculated the time dependent suicide rate/100,000 inmates per year using a Poisson-regression-model and defining different dummy-variables. Furthermore, we investigated different parameters, chosen from the case records, to determine if single-cell use has an effect on prison suicide rates. Results: (1)The only dummy-variable of significance was the year 1975 (p<0.001), meaning that between 1947 and 1975 we have a stable suicide rate. After 1975, the suicide rate increases steadily and significantly. (2) Suicide in single cells has increased significantly among prisoners on remand over the last 25 years (p< 0.05). (3) Seventy percent of suicides occured in single cells. Conclusion: The increased provision of single cells after 1975, seen as an improvement and privilege in modern times, has to be regarded as isolation and deprivation (N.B.: in former times single cells were used as severe punishment.)
In the modern condition of “the age of refuge”, Canada
has become a major country for refugee resettlement. Among these refugees are an
increasing number of people who have survived torture and organized violence. In
response, psychosocial services dedicated to meet the needs of this
population were first established in Toronto, in 1983. Ten years later, 12
centers and programs for survivors have formed the Canadian Network for Health
and Human Rights of Survivors of Torture and Organized Violence. The presentation will discuss the development
of the Canadian model of care through an examination of the centers’ origins,
mandates, structure, clientele and programs of service. The data presented is
based primarily on a survey conducted in 2001. Similarities and dissimilarities
within the range of service delivery in programs across Canada are included as
are the issues identified by the centers as significant for their current
activity. The changing context in which this work is conducted will be analyzed
and implications for the future design of appropriate interventions will be
drawn.
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