Medical ethics

Introduction

Background ↓
Questions and Answers ↓

The Proposal:  Edited March 2012: VCST Oversight Committee March 2012 v1.2 (PDF)

There is no specialized comprehensive inter-governmental regulation of health professional standards of practice when state, provincial, or national bodies are unable (or unwilling) to exercise their mandate.

This proposal articulates a way to operationalize the WHO/WMA designed UN Principles of Medical Ethics (1982) through the formation of a group of experts, under the auspices of WHO, that would collate and compile relevant practice standards of ethics, support regulatory agencies from state, provincial, military and national bodies, and initiate interventions when education or investigations, hearings, and censure are required.

The scope of the proposed Oversight Committee is narrow, focusing incompetence related to torture and cruel inhumane and degrading treatment or punishment, due to the need to focus on the worst violations. It is designed to partner government and civil society so that there is collaboration regarding expertise and funding. It would rely on the UN Committee Against Torture, the International Criminal Court and the constitution of the World Health Organization to gain access to countries. It would not duplicate the functions of these international bodies.

The Oversight Committee would raise the international standard of practice related to torture and abuse. Isn’t it finally time for psychologists and other health care workers to practice human rights protection in every prison, detention facility and health care establishment with the help they sometimes need.

Background

1980’s: the International Commission of Health Professionals was established.

1990: WHO to compile statistics of the incidence of torture and refer data to the UN Committee against Torture for action.

Options

National, state and provincial regulatory bodies to enforce UN Principles of Medical Ethics;The UN Committee on Economic, Social and Cultural Rights is available for Oversight issues;ICN – network of nursing regulatory agencies – exchanges of ideas – resource bank. “self regulation” and “self governance”; andWMA – “we are interested in doctors”.

Vision

To establish a more comprehensive oversight mechanism that addresses the gaps in regulation;
To partner civil society and governments – expertise and funding;
To partner WHO, UNCAT, the ICC and the Oversight Committee – Statute, Legislation, Law.

Goals Key Points

Torture and abuse are internationally prohibited yet they occur increasingly and with impunity;
A higher standard is expected of health professionals yet the UN Principles of Medical Ethics are not enforceable at an inter-government level; and
Health workers are crucial to torture prevention, detection and treatment yet some are still involved.

Chronology

2001 – Met with:
ICN’s policy consultant,
IRCT Secretary General,
UN Rapporteur against Torture,
Amnesty International Medical Coordinator, and
representatives from the UK Medical Foundation.

2007
Presented the concept to the International Academy of Law and Mental Health Congress in Italy.
Dr Genefke suggested that the OC incorporated penalties.
Dr. Sorenson, former member of the UNCAT, suggested that the OC utilize the legal authority of the Convention Against Torture.

2008
Consulted the Rapporteur for Health for All  Prof. Paul Hunt – Ken Agar-Newman
Consultation workshop at the IX Congress of Social Psychology for Liberation, San Cristobal de las Casas, Chiapas – Alvaro Moreno

2009
Concept presented at the International Academy of Law and Mental Health Congress in New York – Peter Golden.
Concept presented at the American Psychological Association Annual meeting during a panel discussion about anti-torture initiatives – Ken Agar-Newman

2010
Concept to be presented at the American Psychologists for Social Responsibility Conference in Boston – Ken Agar-Newman

2012
Dr Jean Maria Arrigo expresses her endorsement for the Proposal.
She states:

` `We are not the cause of (Torture), but state-sponsored torture cannot proceed
far with out us (health professionals).`
Dr Arrigo is a former member of the American Psychological Association (APA)
task force on interrogation. She is an independent scholar and an expert on the ethics
of military intelligence.
www.democracynow.org/2007/8/20/apa_interrogation_task_force_member_dr

Dr Trudy Bond also endorses the Proposal. Dr Bond has filed a number of
complaints with licensing boards and the APA regarding individual psychologists
participating in torture and abuse at the American run Guantanamo Bay facility.
www.law.berkeley.edu/8309.htm

2013
Peter Golden is slated to present the proposal at the 33rd International
Congress of Law and Mental Health in Amsterdam.
www.ialmh.org/template.cgi

For Example other initiatives – Finances
$CAN 160 Million: WHO immunization work.
$CAN 18 Million: CRNBC (Regulates nurses in a province – 42, 000 nurses in BC.
$CAN 7.6 Million: IRCT yearly expenses.
$CAN 56 Million: AI (IS) yearly expenses.
$CAN 45 Million: HRW.

Finances
Contributions from individual health workers (1.1 million nurses + 8 million physicians),
Funds raising from Foundations and Governments and others.

– Have asked Executive Board member of WHO for North America, Dr Karen Dodds, for an opinion and she informed me that she has asked her colleague Bersabel Ephrem, to consult with colleagues at WHO. She has consulted the Canadian Department of International Affairs, to consider
“where (the proposal’s focus) is best directed; if it is, indeed, to WHO”. Personal communication 23 November 2009

Dr K. Dodds is also Assistant Deputy Minister Health Policy Branch Health Canada

Questions and Answers about the proposal

Why would you want this Committee when the IGO enforcement system has been shredded? Bringing an IGO body into the matter is like bringing the cart before the horse. You simply can not have effective regulation without domestic effective national licensing.

The international system is far from shredded. There are problems with the enforcement system and that’s why we are suggesting improvements. The trend set by economic agendas is a more globalized world. Economic and environmental disaster aside, it’s just a matter of time when globalized overall oversight regulation will occur within the larger practice and ethical boundaries.
A lack of effective national licensing in some countries concerning torture and CID is the very reason we want to add an IGO enforcement system into the mix.

Do I understand you proposal right, that you would like to set up a system that works almost in parallel with the UN Special Rapporteur system?

We are not a parallel system nor redundant to either the ICC or the UN SR system.

The oversight regulatory committee is proposed to be a special committee within WHO legitimized by existing articles of WHO. It would complement the UN SR system. It would be legally legitimized by the UN CAT and the UN Committee against Torture as they interpret the UN CAT (which is international law) in relation to each country. They would be asked to stress the requirement of participation with each state party.
Regulation consists of: licensure, registration credentialing, and accreditation. The Oversight committee would deal with oversight in relation to these processes with regard to torture and CID issues. They will focus on regulation of the regulatory agencies that exist on the state, provincial and national level.

  • Existing regulatory structures and the professions, INGO’s and GO’s, will be relied upon to be responsible for direct regulation, standards of practice, and position statements. They will be held in account to the Proposed Committee when oversight is required. Best practices, competency in differentiated practice roles, co-regulation in conjunction with public protection, and standardization will be facilitated.
  • The Proposed Committee regulates (through oversight) the regulatory agencies through legislation elaborated by WHO. For example the WHO operates as a supranational regulatory agency already, with rule-making powers delegated to it by national governments. For example:

WHO constitution – Article 2
(a) to act as the directing and coordinating authority on international health work;
(j) to promote co-operation among scientific and professional groups which contribute to the advancement of health;
(k) to propose conventions, agreements and regulations, and make recommendations
with respect to international health matters and to perform such duties as may be assigned thereby to the Organization and are consistent with its objective;
(o) to promote improved standards of teaching and training in the health, medical and related professions.

Article 66
The Organization shall enjoy in the territory of each Member such legal capacity as may be necessary for the fulfillment of its objective and for the exercise of its functions.
Article 67
(a) The Organization shall enjoy in the territory of each Member such privileges and immunities as may be necessary for the fulfillment of its objective and for the exercise of its functions.
(b) Representatives of Members, persons designated to serve on the Board and technical and administrative personnel of the Organization shall similarly enjoy such privileges and immunities as are necessary for the independent exercise of their functions in connection with the Organization.
(Who Constitution. 2006)

www.who.int/governance/eb/who_constitution_en.pdf

Traditionally WHO has operated unobtrusively focusing on populations– this traditional character will be the preferred modi operandi.

  • Standards of practice established by the profession and the Proposed Committee in conjunction with public input (torture survivors, NGO’s and Governments) within legislation refined by WHO. Where there are gaps – the Proposed Committee intervenes through comments, recommendations, and interventions. Interventions may include hearings involving individual health workers. Regulatory agencies will be expected to carry out decisions of hearings conducted by the Proposed Committee

The proposed committee does not exist to duplicate the work of the ICC. If ICC mandated crimes are discovered – they would be referred to the ICC. Central to that remit of the proposed committee is the principle of complementarity (also used with the ICC). The principle of complementarity defines the relationship between the proposed committee and national and state regulatory jurisdictions.

“In essence (the principle) defers to individual nation states the primary responsibility for investigating and prosecuting- the most serious practice (infractions) of international concern”.

(Jensen, Rod. COMPLIMENTING COMPLEMENTARITY: THE PRINICPLE OF COMPLEMENTARITY IN THE ROME STATUTE OF THE INTERNATIONALCRIMINAL COURT (Notes accompanying his presentation)

http://www.isrcl.org/Papers/Jensen.pdf

Another consideration of the proposed committee is extradition obstacles that arose in the case of the ICC, when a country’s constitution blocks extradition of a national to a foreign state. The way that the ICC uses to circumvent this obstacle is that “surrender” is legally different than “extradition”. This distinction reflects a conceptual difference between principles; “that transfer to another equal sovereign state is fundamentally different from transfer to (an international body) established under international law, with the involvement and consent of the state concerned.” “When the constitutions prohibited extradition to foreign jurisdictions they clearly contemplated national not international jurisdiction.”
In the worse case, if there is little hope of summoning the health worker to the proposed committee for an interview, when the health worker travels to a supportive country – the legal principle of surrender will be used.
(Human Rights Watch. May 8 2001. The Compatibility of the ICC Statute with Certain Constitutional Provisions around the Globe)
www.hrw.org/campaigns/icc/docs/final_nopaper.pdf

I thought Health Professionals Organisations don’t have the mandate to do these interventions and often don’t receive access. Its seems to me even Novak wasn’t able to enter Guantanamo.

On the contrary Novak’s report (UN Economic and Social Council, 2006, Situation on detainees at Guantanomo Bay) was highly perceptive, (even now as we have more information) and extremely useful to the international and domestic community. It was remarkable because as you know he never set foot in the US due to a potential compromise of mandate. At the time the US dismissed it as hearsay – but it didn’t work!
See the the UN Report on Guantanamo:

http://www.cbsnews.com/htdocs/pdf/ungitmo021506.pdf

Last year in fact his interpretation of the 2009 situation at Guantanamo was used by Dr. Steven Reisner at the American Psychological Association (APA) convention in June to explain graphically to officials why psychologists shouldn’t be at this site – Ken Agar-Newman was at that convention and the effect of Manfred Novak’s opinion, as international law, was immense.
CCR Press Release. August 2009. UN Special Rapporteur on Torture urges APA act on own policies.

http://ccrjustice.org/newsroom/press-releases/un-special-rapporteur-torture-urges-american-psychological-association-act-o