What is Torture? This might seem to be a simple question but the sliding slope of mistreatment and abuse makes defining torture a complex legal issue. Torture is defined by the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (UNCAT) June 1987. Article 1 (1) in the following way: “For the purposes of this Convention, the term "torture" means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity.” The definition of Torture by the Torture Abolition and Survivors Support Coalition International (TASSC) is as follows:

1. Medical Whistleblower
December 2008
Medical Whistleblower’s
Volume 3 Issue 12
Canary Notes
Inside this issue:
Physical Torture 1
What is Torture?
Psychological Torture 2
Sleep Deprivation 3 What is Torture? This might seem to be a
simple question but the sliding slope of mis-
Threats
treatment and abuse makes defining torture a
complex legal issue. Torture is defined by
Rape and Sexual 4
Abuse the United Nations Convention against Torture
and Other Cruel, Inhuman or Degrading Treat-
The World Medical 5-6
Association ment or Punishment (UNCAT) June 1987.
Article 1 (1) in the following way:
Countries who signed 7
& ratified ―For the purposes of this Convention, the term
"torture" means any act by which severe pain
Psychological Research 7 or suffering, whether physical or mental, is in-
How do governments 8 tentionally inflicted on a person for such pur-
poses as obtaining from him or a third person
Amnesty Interna- 8
tional
information or a confession, punishing him for
an act he or a third person has committed or is
Cruel and Degrading
suspected of having committed, or intimidating
Disappearances 9 or coercing him or a third person, or for any reason based on discrimination of any kind,
Human Subjects when such pain or suffering is inflicted by or at the instigation of or with the consent or
acquiescence of a public official or other person acting in an official capacity.‖
Physicians for Human 10
Rights The definition of Torture by the Torture Abolition and Survivors Support Coalition Inter-
national (TASSC) is as follows:
Physical Torture
Physical Torture is any action or technique, or combination that would result in severe
physical pain when inflicted upon a human being. Severe physical pain means a level
“The clarity of what of pain that a person would not voluntarily accept for himself or herself. Physical torture
you ought to do gives
includes but is not limited to the following:
you courage.”
– Wangari Maathai Electric shock Beatings
Near asphyxiation Stress positions
Rape or sexual abuse Dog attacks
Burning

2. Page 2 Medical Whistleblower’s Canary Notes Volume 3 Issue 12
Psychological Torture
Non-physical methods can be used to cause psychological suffering. The effects of psychological torture are
not immediately apparent unless they alter the behavior of the tortured person, so it is often overlooked or
denied. Physical torture is the inflicting of severe pain or suffering on a person. In contrast, psychological tor-
ture is directed at the psyche with calculated violations of psychological needs, along with deep damage to
psychological structures and the breakage of beliefs underpinning normal sanity. Torturers often inflict both
types of torture in combination to compound the associated effects. Torture can include extreme stressors,
rape, sexual abuse, mock execution, shunning, violation of deep-seated social or sexual norms and taboos,
and extended solitary confinement. Many torturers around the world use methods designed to have a maxi-
mum psychological impact, while leaving only minimal physical traces. For survivors, torture often leads to
lasting mental and physical health problems. It is important to remember that it is possible to induce severe
psychological pain, suffering, and trauma with no externally visible effects. Often torturers prefer methods
that, while unpleasant, leave victims alive and unmarked. A victim with no visible damage may lack credibility
when telling tales of torture. Mental torture, however can leave scars just as deep and long-lasting as physi-
cal torture. Torture can include electrical shock, asphyxiation, heat, cold, noise, and sleep deprivation (which
leaves little evidence), beatings, and can even involve horrific mutilation or death. The severe mental pain
and suffering of those who have been subjected to sexually humiliating acts can constitute cruel or inhuman
treatment and also be considered a psychological form of torture. The definition of Mental Torture by the
Torture Abolition and Survivors Support Coalition International (TASSC) is any action or technique, or any
combination thereof, which might result in severe mental trauma or harm when inflicted upon a human be-
ing. This includes but is not limited to the following:
Death threat or threats of immediate and severe physical
pain
Mock executions
Rape or sexual abuse
Extended disruption of food and sleep
Extended solitary confinement
Extended sensory deprivation
Extended sensory disruption or overload
Use of hallucinogenic or other mentally disruptive drugs
Threats against family members
Secret detention or "disappearances" of a loved one
Forced observance, by hearing or watching, of the mental and/or physical torture or murder of another.
Forcible participation in the mental or physical torture of others.
Severe mental trauma or harm means a level of fear or trauma that a person would not voluntarily accept
for himself or herself, or which results in prolonged mental suffering afterwards.
Note: There are countless ways to inflict mental trauma or harm such as the use of psychotropic, mind-
altering, or other drugs for the purpose of decreasing resistance or gaining information or the exploitation
of phobias, psychopathology, or physical vulnerability . Some methods may appear innocuous, but are in
fact devastating.

3. Page 3 Medical Whistleblower’s Canary Notes Volume 3 Issue 12
Disruption of Sleep and Meals:
Sleep Deprivation and withholding food and water con-
stitutes, at a minimum, cruel and degrading treat-
ment. Depending on the age and health of the prisoner,
the duration of the disruption, and the other techniques
being used in this combination, in most cases this will
also constitute mental and/or physical torture. US Fed-
eral courts have repeatedly found sleep deprivation to
violate both the Eighth and Fourteenth Amendments.
The Supreme Court has held that a confession obtained
by depriving a prisoner of sleep for thirty-six hours vio-
lated the individual’s right to due process. See Ashcraft
v. Tennessee, 322 U.S. 143, 154 (1944); see also Ashcraft v. Tennessee, 327 U.S. 274 (1946); see generally
United States ex rel. Wade v. Jackson, 256 F.2d 7 (2d Cir. 1958) (depriving arrestee of sleep for twenty-two
hours contributed to violations of due process rights).
Threats:
Universal Declaration of Human
The international courts have agreed that threats, including threats to a third Rights
person, are prohibited conduct constituting cruel or inhuman treatment. Article 1-
[ Campbell v. United Kingdom — 4 Eur. Ct. H.R. 293 (ser. A) ¶ 26(Feb. 25 “All human beings are born free
1982), available at http://www.worldlii.org/eu/cases/ECHR/1982/1.html] and in
and equal in dignity and rights.
some cases part of a pattern of mental abuse and torture. [Urrutia v. Guate-
They are endowed with reason
mala, Inter-Am. Ct. H.R., (Ser. C) No. 103, ¶¶ 93-94] The European Court of
and conscience and should act
Human Rights found that threats can trigger ―long-term symptoms of anxiety
towards one another in a spirit of
and insecurity, diagnosed as post-traumatic stress disorder and requiring
treatment by medication,‖ and can even be by themselves to constitute tor- brotherhood”
ture.‖ [Akkoç v. Turkey. App. nos. 22947/93 and 22948/93, 116-17 (Oct. 10,
2000)]. Under US law, threats of imminent death or severe physical pain or
suffering to the individual or others, are explicitly banned as forms of mental torture that can lead to long-term
harm under the Torture Act and are war crimes under the War Crimes Act (2003). When there are credible
verbal threats of the use of deadly force it can be considered to be cruel and unusual treatment that ―shocks
the conscience‖ in violation of the Fifth and Fourteenth Amendments. For instance, US Federal appeals
courts have found that pointing a loaded weapon at a civilian without a legiti-
mate law enforcement purpose violated the Fourteenth Amendment.
[Hawkins v. Holloway, 316 F.3d 777, 787 (8th Cir. 2003)] (holding that
―threatening deadly force a as means of oppressing those employed in his
department‖ elevated ―his conduct to the arbitrary and conscience shocking
behavior prohibited by substantive due process‖); [Robinson v. Solano
County, 278 F.3d 1007, 1014 (9th Cir. 2002)].

4. Page 4 Medical Whistleblower’s Canary Volume 3 Issue 12
Rape, Sexual Abuse and Humiliation:
Article 5- Rape, of course, will always constitute physical and mental torture. Religious, cultural,
and sexual humiliation including, but not limited to, forced nakedness and other sexual
“No one shall be subjected abuse, such as unwanted touching, forced nudity, and forced masturbation is always,
to torture or to cruel, at the very least, cruel and degrading. Sexual abuse and humiliation fall within the
definition of mental torture. In the legal case Raquel Martin Mejía v. Perú, Case
inhuman or degrading
10.970, Report No. 5/96, Inter-Am. C.H.R. 157, OEA/ser.L/V/II.91, doc. 7 rev. (1996).
treatment or punishment”
The court announced that rape constituted torture if it was: ―1) an intentional act
through which physical and mental pain and suffering is inflicted on a person; 2) com-
mitted with a purpose; and 3) committed by a public official or by a private person act-
ing at the instigation of the former.‖
Rape not only is an unspeakable infringement of human rights, but often leaves deep
and lasting psychological scars. The international human rights, criminal justice, and
humanitarian law communities, including the International Criminal Court (ICC), the ad
hoc international criminal tribunals, regional human rights courts, and the UN human
rights bodies, are uniform in their designation of rape as a violation of human rights
and a crime. Perhaps most significantly, the International Criminal Court statute con-
siders rape, including sexual violence, a war crime and, if used systematically against
a civilian population, a crime against humanity. The ICC statute also establishes that
rape is a ―grave breach‖ of the Geneva Conventions and may constitute a crime
against humanity. Rape by a state agent will almost always be torture as well. The
Fourth Geneva Convention considers rape as an act of torture and a war crime. Both
the European Court of Human Rights and the Inter-American Court of Human Rights
have characterized rape as inhumane treatment, and the Inter-American Court later
“I know what few U.S. determined that rape is a form of torture and thus a violation of Article 5.2 of the
citizens know: what it is
American Convention on Human Rights. The European Court of Human Rights also
to be an innocent civil-
ian, and to be accused, found that rape can constitute a violation of Article 3 of the European Convention,
interrogated, and tor- which prohibits torture. The court found that ―rape of a detainee by an official of the
tured, to have my own
government eschew my State must be considered to be an especially grave and abhorrent form of ill-treatment
claims for justice and given the ease with which the offender can exploit the vulnerability and weakened re-
actively destroy my sistance of his victim.‖ Aydin v. Turkey, 1997-VI Eur. H.R. Rep. 1866, ¶¶ 80-88 ¶
character because my
case causes political 83.(1997). Incidents of penetration with a foreign object clearly constitute rape under
problems for them. I domestic law such as the War Crimes Act. Military Commissions Act of 2006, Pub. L.
know what it is to wait in
No. 109-366, 120 Stat. 2600 (amending 18 U.S.C.§ 2441) (2006). Sexually degrading
the dark for torture, and
what it is to wait in the acts have historically been used in combination with other methods to break down a
dark for the truth. I am detainee. Forced nakedness and sexual humiliation violate human dignity and can
still waiting.‖
lead to long-term psychological harm. Sexual humiliation and stripping a detainee of
Sister Diana Ortiz his clothes adds to his sense of vulnerability and are ―intended to cause . . . feelings of
humiliation and inferiority.‖

5. Volume 3 Issue 12 Medical Whistleblower’s Canary Notes Page 5
The World Medical Association Declaration of Tokyo
The World Medical Association Declaration of Tokyo. Guidelines for Physicians Concerning Tor-
ture and other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention
and Imprisonment
Adopted by the 29th World Medical Assembly, Tokyo, Japan, October 1975,
and editorially revised at the 170th Council Session, Divonne-les-Bains, France,
May 2005 and the 173rd Council Session, Divonne-les-Bains, France, May 2006
PREAMBLE
It is the privilege of the physician to practise medicine in the service of humanity, to preserve and
restore bodily and mental health without distinction as to persons, to comfort and to ease the
suffering of his or her patients. The utmost respect for human life is to be maintained even under
threat, and no use made of any medical knowledge contrary to the laws of humanity.
For the purpose of this Declaration, torture is defined as the deliberate, systematic or wanton
infliction of physical or mental suffering by one or more persons acting alone or on the orders of
any authority, to force another person to yield information, to make a confession, or for any other
reason.
DECLARATION
1. The physician shall not countenance, condone or participate in the practice of torture or
other forms of cruel, inhuman or degrading procedures, whatever the offense of which the victim
of such procedures is suspected, accused or guilty, and whatever the victim's beliefs or motives,
and in all situations, including armed conflict and civil strife.
2. The physician shall not provide any premises, instruments, substances or knowledge to fa-
cilitate the practice of torture or other forms of cruel, inhuman or degrading treatment or to dimin-
ish the ability of the victim to resist such treatment.
3. When providing medical assistance to detainees or prisoners who are, or who could later be,
under interrogation, physicians should be particularly careful to ensure the confidentiality of all
personal medical information. A breach of the Geneva Conventions shall in any case be reported
by the physician to relevant authorities. The physician shall not use nor allow to be used, as far
as he or she can, medical knowledge or skills, or health information specific to individuals, to fa-
cilitate or otherwise aid any interrogation, legal or illegal, of those individuals.
4. The physician shall not be present during any procedure during which torture or any other
forms of cruel, inhuman or degrading treatment is used or threatened.
5. A physician must have complete clinical independence in deciding upon the care of a person
for whom he or she is medically responsible. The physician's fundamental role is to alleviate the
distress of his or her fellow human beings, and no motive, whether personal, collective or politi-
cal, shall prevail against this higher purpose.
6. Where a prisoner refuses nourishment and is considered by the physician as capable of
forming an unimpaired and rational judgment concerning the consequences of such a voluntary
refusal of nourishment, he or she shall not be fed artificially. The decision as to the capacity of
the prisoner to form such a judgment should be confirmed by at least one other independent
physician. The consequences of the refusal of nourishment shall be explained by the physician
to the prisoner.
7. The World Medical Association will support, and should encourage the international commu-
nity, the National Medical Associations and fellow physicians to support, the physician and his or
her family in the face of threats or reprisals resulting from a refusal to condone the use of torture
or other forms of cruel, inhuman or degrading treatment.

6. Page 6 Medical Whistleblower’s Canary Notes Volume 3 Issue 12
The World Medical Association Declaration, Hamburg, Germany, 11/ 1997
World Medical Association Declaration Concerning Support for Medical Doctors Refusing
to Participate in, or to Condone, the Use of Torture or Other Forms of Cruel, Inhuman or
Degrading Treatment
PREAMBLE
1. On the basis of a number of international ethical declarations and guidelines subscribed to by the medical profession, medi-
cal doctors throughout the world are prohibited from countenancing, condoning or participating in the practice of torture or other
forms of cruel, inhuman or degrading procedures for any reason.
2. Primary among these declarations are the World Medical Association's International Code of Medical Ethics, Declaration of
Geneva, Declaration of Tokyo, and Resolution on Physician Participation in Capital Punishment; the Standing Committee of
European Doctors' Statement of Madrid; the Nordic Resolution Concerning Physician Involvement in Capital Punishment; and,
the World Psychiatric Association's Declaration of Hawaii.
However, none of these declarations or statements addresses explicitly the issue of what protection should be extended to
medical doctors if they are pressured, called upon, or ordered to take part in torture or other forms of cruel, inhuman or degrad-
ing treatment or punishment. Nor do these declarations or statements express explicit support for, or the obligation to protect,
doctors who encounter or become aware of such procedures.
RESOLUTION
4. The World Medical Association (WMA) hereby reiterates and reaffirms the responsibility of the organised medical profes-
sion:
i. to encourage doctors to honour their commitment as physicians to serve humanity and to resist any pressure to act con-
trary to the ethical principles governing their dedication to this task;
ii. to support physicians experiencing difficulties as a result of their resistance to any such pressure or as a result of their at-
tempts to speak out or to act against such inhuman procedures; and,
iii. to extend its support and to encourage other international organisations, as well as the national member associations
(NMAs) of the World Medical Association, to support physicians encountering difficulties as a result of their attempts to act in
accordance with the highest ethical principles of the profession.
iv. Furthermore, in view of the continued employment of such inhumane procedures in many countries throughout the world,
and the documented incidents of pressure upon medical doctors to act in contravention to the ethical principles subscribed to
by the profession, the WMA finds it necessary:
v. to protest internationally against any involvement of, or any pressure to involve, medical doctors in acts of torture or other
forms of cruel, inhuman or degrading treatment or punishment;
vi. to support and protect, and to call upon its NMAs to support and protect, physicians who are resisting involvement in such
inhuman procedures or who are working to treat and rehabilitate victims thereof, as well as to secure the right to uphold the
highest ethical principles including medical confidentiality;
vii. to publicise information about and to support doctors reporting evidence of torture and to make known proven cases of at-
tempts to involve physicians in such procedures; and,
viii. to encourage national medical associations to ask corresponding academic authorities to teach and investigate in all
schools of medicine and hospitals the consequences of torture and its treatment, the rehabilitation of the survivors, the docu-
mentation of torture, and the professional protection described in this Declaration.

7. Volume 3 Issue 12 Medical Whistleblower’s Canary Page 7
Countries To the Convention Against Torture
Article 3-
“Everyone has the right to
life, liberty and
security of person”
Map of the world with
parties to the Conven-
Psychological Research on Torture tion against Torture
shaded dark green,
In two very important psychological research studies, the Stanford prison states that have signed
experiment, and the Milgram experiment, it was found that the people re-
spond to authority figures and will participate in torture. In the acceptance
but not ratified the treaty
of torture there are is a sliding scale of stages of personal acceptance of in light green, and non-
torture and these include: parties in grey.
Reluctant or peripheral participation:
Official encouragement: Many people will follow the direction of an authority
figure (such as a superior officer) in an official setting (especially if presented
as mandatory), even if they have personal uncertainty. The main motivations
for this appear to be fear of loss of status or respect, and the desire to be seen
as a "good citizen" or "good subordinate".
Peer encouragement: This is when people begin to accept torture as neces-
sary, acceptable or deserved, or to comply from a wish to not reject peer group
beliefs.
Dehumanization: This means people seeing victims as objects of curiosity
and experimentation, where pain becomes just another test to see how it af-
fects the victim.
Disinhibition: This is when socio-cultural and situational pressures may cause torturers to undergo a lessen-
ing of moral Inhibitions and as a result act in ways not normally countenanced by law, custom and con-
science.
Milgram, Stanley (1963). "Behavioral Study of Obedience". Journal of Abnormal and Social Psychology 67:
371–378. doi:10.1037/h0040525. PMID 14049516.
http://content.apa.org/journals/abn/67/4/371. Full-text PDF.

8. Page 8 Medical Whistleblower’s Canary Volume 3 Issue 12
How do Governments Respond to Torture?
Torture becomes established as part of internally acceptable norms un-
der certain circumstances, it’s us often becomes institutionalized and
self-perpetuating over time. Many perpetrators of torture are coerced
by their superiors. It can be:
1.Carried on in silence (official denial)
2. Semi-silence (known but not spoken about)
3. Openly acknowledged in public (in order to instill fear and obedience).
Amnesty International
Amnesty International researches human rights abuses worldwide and releases re-
ports– in order to increase transparency and bring world attention to the problem. It
Amnesty International
also organizes a huge grassroots movement to call attention to actions of govern-
USA website http://
ments and individuals involved in abuses. Amnesty International argues that torture
www.amnestyusa.org
and ill-treatment are repugnant, abhorrent, and immoral. Amnesty International asserts
+1 212 807 8400
that evidence extracted by torture can be unreliable and that the use of torture cor-
rupts institutions which tolerate it. People will say or do anything to escape the situa- 5 Penn Plaza - 16th floor,
tion, including untrue ―confessions" and implication of others without genuine knowl- New York, NY 10001
edge, who may well then be tortured in turn. Torture has often been sponsored by USA
governments. In addition, individuals or groups may inflict torture on others for the
same reasons as those acting in an official capacity. The Amnesty International Secretariat is responsible for
the majority of the organization's research and leads the campaigning work, based in London, UK. Tele-
phone: +44-20-74135500 Fax number: +44-20-79561157 Address:1 Easton Street, London, WC1X
0DW, UK
Cruel and Degrading Treatment
Cruel and degrading treatment is any action or technique, or combination
thereof, that would degrade or humiliate a human being, or result in personal
misery. This category may include mental and physical abuse that would not
quite amount to torture. Note: Today this category should include forcing a
devout Muslim man to wear a woman's underpants on his head, or depriving a
prisoner of bathing and toilet privileges. Many of these actions, if repeated or
prolonged, or combined with other actions could constitute mental or physical
torture.

9. Newsletter Title Volume 3 Issue 12 Page 9
Disappearances
"Ghost Prisoners": Holding any person prisoner in
secret detention without access to families, advo-
cates, lawyers or the International Red Cross con-
stitutes mental torture both for the prisoners, their
families and loved ones. Under such conditions,
other forms of mental and physical torture become
almost inevitable. Secrecy always results in the
abuse of power. International Committee of the Red
Cross ICRC 1100 Connecticut Ave., N.W., Suite
500, Washington, D.C. 20036, 202-587-4600, Fax:
202-587-4696 http://www.icrc.org/ Torture is at the
heart of the deadly politics of national security. http://
www.icrc.org/ Report on High Value Detainees in CIA custody http://www.nybooks.com/icrc-report.pdf
Human Subjects Protection
Human subjects should be protected and any medical research involving
the use of Human Subjects should have a reviewed and approved investi-
gation plan guided by experts in clinical medicine, public health, bioethics,
and international human rights law who reviewed and approved the investi-
gation plan. The medical research plan should also be guided by the rele-
vant process provisions of Title 45 of the US Code of Federal Regulations
and complied with the Declaration of Helsinki, as revised in 2000. For fur-
ther information consult the World Med. Association, Declaration of Hel-
sinki: Ethical Principles for Medical Research Involving Human Subjects,
World Medical Association Doc. 17.C (1964, am. 1975, 1983, 1989, 1996,
and 2000), available at http://www.wma.net/e/policy/b3.htm.
The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent
organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of
war and internal violence and to provide them with assistance. It directs and coordinates the
international relief activities conducted by the Movement in situations of conflict. It also
endeavours to prevent suffering by promoting and strengthening humanitarian law and universal
humanitarian principles.

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information only. The information provided by the Medial
Dr. Janet Parker DVM Whistleblower Canary Notes does not constitute legal or
P.O. Box C professional advice nor is it conveyed or intended to be con-
Lawrence, KS 66044 veyed in the course of any adviser-client discourse, but is
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Supporting the Emotional Health of All Whistleblowers and medical aspects of these issues .
and their Friends, Supporters and Families.
Physicians for Human Rights
Physicians for Human Rights (PHR) mobilizes health
professionals to advance the health and dignity of all
people through actions that promote respect for, pro-
tection of, and fulfillment of human rights. PHR has a
Medical Evidence of Torture track record of more than 20 years documenting tor-
by US Personnel and Its ture around the world, including in Turkey, Chile,
Impact: A Report by Chechnya, Kosovo, Israel, India, and Chiapas, Mex-
Physicians for Human Rights
ico. PHR has extensive expertise in evaluating survi-
June 2008
vors of torture as well as experience with prisoner health issues. PHR was one of
the lead initiators and authors of the Istanbul Protocol on the investigation and
Physicians for Human Rights documentation of torture, adopted as an official document by the United Nations in
2 Arrow Street, Suite 301 1999. PHR has repeatedly called for an end to the use of the ―enhanced‖ tactics by
all US personnel, an end to all health professional participation in interrogations, a
Cambridge, MA 02138
full Congressional investigation of the use of psychological and physical torture by
Tel. (617) 301.4200
the US Government, and accountability for perpetrators. PHR has successfully or-
Washington Office ganized and mobilized thousands of health professionals and helped to secure the
1156 15th Street, Suite leadership of the major health professional associations to develop ethical guide-
1001 lines related to interrogation that protect against medicine and science being em-
Washington, DC 20005 ployed to aid the abuse of prisoners. PHR’s work contributed to the adoption of ethi-
cal standards by the American Medical Association, the World Medical Association,
Tel. (202) 728.5335
and the American Psychiatric Association prohibiting direct participation of physi-
www.physiciansforhumanrights
cians in interrogations. PHR has helped move the American Psychological Associa-
tion (APA) to prohibit the involvement of its members in the Central Intelligence
Agency’s ―enhanced‖ interrogation techniques and has supported a movement
within the APA to end the direct participation of psychologists in interrogations.