Expert meeting Torture in healthcare settings (1)

Today, Thursday 13 December 2012 was the first day of the 2-day expert consultation on Torture and other Cruel, Inhuman and Degrading Treatment or Punishment (T & CIDT/P) in healthcare settings. At 8.30 we were expected for coffee/tea at the American University, Washington School of Law. I took a metro and a shuttle bus, but I got off at the wrong department of the University, so I had to walk about half a mile, but anyway I arrived there in time.

At 9 AM the meeting started, and we were welcomed by Juan Mendez, the Special Rapporteur on Torture (www.antitorture.org). He told us that, as a Special Rapporteur, there are 2 opportunities per year to issue a thematic report on issues chosen by the mandate, namely at the Human Right Council and at the Global Assembly. The thematic reports of the Special Rapporteur focus on identified areas of attention, that are most important for the international community to discuss. The thematic reports are meant to underline the academic seriousness of the issues, and create commitment to reform, by setting norms and opening ongoing discussions on development. The thematic reports focus on the grey areas, or outer limits, sometimes because of new developments and sometimes on older and ‘forgotten’ issues.
Juan Mendez and his mandate have decided to produce a thematic report on Torture and other Cruel, Inhuman and Degrading Treatment or Punishment in healthcare settings, and therefore this expert consultation was organized, to provide knowledge and expertise to Juan Mendez, who will write the thematic report of 10.000 words in the next month (which is to be issued in March 2013 at the Human Rights Council).
All participants were asked to contribute our suggestions for reform, not only by addressing problems, but if possible also pointing at solutions.

Unfortunately I can’t make a full summary now, because I’m limited in my time and I need to prepare for tomorrow as well, but I will give a short overview of the issues that were discussed.

The first session was on Compulsory Detention for Medical Conditions. This appeared to be a turbulent session. The first speakers addressed themes like:
• Powerlessness, dependency and vulnerability
• The irony of the invisibility of torture in Health Care settings (that’s not what you would expect from care professionals - obviously the self regulation on monitoring and protection from human rights violations in health care has failed) How to fix the gap?
• About public health policies, which are often based on fear, stigma and discrimination; stereotyping various groups, such as drug abusers and persons with disabilities, leading to disproportionate impact and abuse – sometimes even with the intent to harm the persons who belong to marginalized groups (demonizing)
• How medical procedures are misused for social control,
• About human rights violations in institutions and de-institutionalization into community based care, and the need for inclusion
• And to what extent the law itself contributes to torture : identifying legal manouvres (from stripping legal capacity to guardianship to involuntary commitment and so on) and how the medical profession and law enforcement need to be dislinked; which one to follow: medical expert opinions or human rights law?

We heard about many horrible practices of beating up drug users, putting them into slave labour camps, punishing rape victims, deprivation of food, water, sleep, shelter, privacy and so on (so they fall sick), administering ECT to deliberately induce seizures, injecting haloperidol as punishment, no access to medical treatment, and pushing abortions by misinforming women that their children will be deformed due to the conditions of the mother, bootcamps for children where they are punished for absurd internal rules such as “not smiling to staff, or looking at persons of the other gender, or not taking a coat off”.
The torture definitions were analysed on applicability, and key elements are: pain/suffering, intent and purpose, and state supported/funded/consented.

At some point in this session there was a tough discussion, when someone mentioned “that in some circumstances there is a need for involuntary treatment for persons who are unable to consent and who are a danger to self or others” … and then even: how forced interventions could be a way of “respect” to the user. Tina and I both got upset by this, and we attacked this statement: forced commitment is not care – it’s making life miserable and then the dangers only increase! I emphasized that there are alternatives to forced treatments, such as non violent de-escalation (by dialogue, respectful contact, hope and perspective), and that a person’s ability to consent is not a static black and white thing, but actually it has many grey areas, and is depending on personal social circumstances. It’s also not an issue of the individual rights versus the community’s rights, but actually it’s all connected and the individual and community can help each other (because ideally they all want everyone to be happy). Another world is possible!

The hot discussion wasn’t fully finished, because it was break time. I was really glad to see that we got a lot of support by the other participants. This wasn’t an old-fashioned-minded group, but rather progressive, that’s a real relief :)

The second session was on Denial of Pain Relief, Access to Controlled Medicines.
This was quite a theoretical analysis of the lack of pain relief for many persons, mainly due to the fact that Narcotics Law dominates in the field. The efforts to prevent drug dependency and addiction interfere in a very negative way with the access to pain relief. In this way the governments are blocking the care practices, which could also be called Torture and other Cruel, Inhuman and Degrading Treatment or Punishment.

The presentations were mainly about palliative care, which is care for terminal patients, for example persons suffering from cancer or Aids, and about the provision of pain relief like morphine.
This scope was a kind of disappointing to me, because I know many persons with psychosocial and intellectual disabilities don’t have access to any medical treatment at all, because of Disbelief. I experienced that myself with injuries, and I know about a case where a guy died of broken ribs, after having been to the hospital 3 times, but he was sent away and not believed, because he was perceived as a mental patient who wanted attention. In Eastern Europe I know that there are children in institutions who are so much neglected that they become deformed and it is assumed that this is “part of the mental illness or intellectual disability” – it is said “they don’t get old”, or “they don’t feel pain”. This obviously leads to massive suffering and deaths. I found it a pity that this wasn’t addressed under this topic, so I raised my hand and contributed again. This point was echoed several times by others during the course of the day.

The third session was on Reproductive Rights Violations and Torture and CIDT. In this session again “the problem of medical expertise” was addressed, and the desired focus was on free and informed consent. Again some interesting analysis were made, and I felt good about the general tone of the discussion.

I’m really running out of time now, so I can’t summarize the substance in more detail now.

Anyway, at the end of the day we had a delicious group-dinner at DeCarlo’s, a restaurant close by. The atmosphere was very nice, and it was inspiring to discuss today’s issues in good company. Afterwards 5 of us got in Tina’s car, and after dropping off 2 of them at Georgetown, we went back to the hotel, and I started blogging.

Now I should do a little more preparation on my presentation tomorrow in the session of Persons with Psychosocial and Intellectual Disabilities, and then I will go to sleep. It was an inspiring day.

I also asked Juan Mendez if we could talk about my personal case, and we will do that at some point during these days. Today I didn’t get to it - partially because I was busy meeting other people, and partially because I wasn’t really at ease yet because I couldn’t really estimate my position in all of it, but after a few contributions in the discussion I knew where I relatively stood, and so I got my flow again :)
Tomorrow will be the day for me!