A global organization of physicians developed and passed a declaration stating that doctors should not “countenance, condone, or participate” in torture or cruel, inhuman, or degrading punishment. Other organizations and individual physicians invoked the declaration to denounce torture.
Physicians have the ability to heal the sick and wounded; they also have the power to compound their patients’ suffering. Some physicians have been perpetrators of torture; others have played roles that enabled the military or police to carry out torture. A physician, for example, could advise the torturer on methods which will leave few conclusive marks of torture. A physician may also heal the victim, for that person’s benefit or instead so that he or she can endure more torture. Other practices include the prescription of drugs to facilitate use of sensory-deprivation techniques and filing of fraudulent medical reports. None of this is new: In the Holy Roman Empire of 1532, the Constitutio Criminalis Carolina referred to “medical complicity” in torture.
The Declaration of Tokyo was passed by the World Medical Association (WMA) on October 10, 1975, the last day of the association’s five-day conference. The declaration contains a preamble and six guidelines. The preamble states that practice of medicine is a privilege, and that “utmost respect for human life is to be maintained even under threat.” It also defines torture: “the deliberate, systematic, or wanton infliction of physical or mental suffering.”
The guidelines first declare that “the doctor shall not countenance, condone, or participate in the practice of torture or other forms of cruel, inhuman, or degrading procedures,” regardless of the victim’s alleged offense, beliefs, or motives. This applies equally during international or civil wars. The next two guidelines help define when a doctor might be accountable for another’s actions. A doctor is not to “provide any premises, instruments, substances, or knowledge” to facilitate torture or maltreatment, nor shall he or she be present during any procedure in which torture or maltreatment is used or threatened. A fourth guideline proclaims that the doctor must have complete clinical independence—the doctor is to alleviate distress, a higher purpose than service of personal, collective, or political motives. The fifth provision specifically mentions forcible feeding. The provision stemmed from British treatment of Irish Republican hunger strikers.
The Declaration of Tokyo addressed recurrent abuses by physicians that occurred in recent decades in Chile, Uruguay, Syria, Colombia, Spain, South Africa, the Soviet Union, Great Britain, Iraq, and elsewhere. Many torture victims were examined at the Rehabilitation and Research Centre for Torture Victims in Copenhagen. In one report, 4 percent of torture victims examined described nontherapeutic administration of drugs by doctors, and 5 percent said that a doctor was present during their torture. Some doctors gave advice as to whether the torture should continue.
The World Medical Association was planned at an informal meeting of physicians held in London in July of 1945. Its First General Assembly met in Geneva, Switzerland, two years later. It included delegations from all continents, but the membership varied over time. At the 1975 assembly, the United States was not represented, but Canada and Great Britain were. Each continent sent at least one delegation.
The Declaration of Tokyo built on earlier WMA resolutions. The Declaration of Geneva,
Allegations of British abuses in Northern Ireland placed the torture issue on the WMA agenda. Such abuses accounted for the specific mention of forcible feeding. These issues had been raised by P. A. Farrelly and Derek Paul Stevenson at the 1974 Congress. They and other members of the Irish and British associations collaborated in the Tokyo Declaration’s composition. Those associations drafted a working paper, as did the French Medical Confederation and WMA Council chair André Wynen.
When the WMA Council met in Paris in March of 1975, it revised the declaration and placed it on the agenda of October’s General Assembly. The British Medical Association had wanted specific mention of regimes that equated opposition with mental disorder, thereby justifying “treatment” in a hospital or prison. The French working paper urged that physicians maintain an attitude of “active neutrality.” The declaration hints at both concerns, but neither was expressly included.
The WMA’s concern coincided with actions against torture in other forums. One spur was the United Nations General Assembly session in the fall of 1974. A resolution as phrased initially would have directed the World Health Organization
The U.N. General Assembly addressed the practices of torture by unanimously adopting the Declaration on Torture on December 9, 1975,
The Tokyo Declaration was approved by the 350 delegates in attendance. One who did not attend was the secretary-general, Sir William Dudley Refshauge.
The WMA proclaims that “its voice is authoritative, being the considered opinion of many medical experts from every region of the world.” The Declaration of Tokyo is accorded great authority by professional associations; the reputation of the WMA, however, has been called into question.
Physicians’ associations and publications praised the declaration. The Medical Journal of Australia called it a “courageous and responsible statement” and indicated that “by it WMA has enhanced its own stature as the one existing world voice for a profession which has much to give to the world, but which is to some extent under siege.” The Journal of the American Medical Association provided a brief description in January of 1976; when it rejoined the WMA in 1977 and began to play an active role, the American Medical Association
The declaration had a ripple effect, with additional groups noticing, publicizing, and endorsing it over the years. In 1987, Surgical Neurology declared that, as an international journal, it should take a strong position against torture. It suggested that the most important function of the declaration (which it published in full) was “to serve as a reminder to governments and to the world community that physicians are staunchly opposed to the cruel treatment of human beings.”
Member associations of the WMA and individual physicians found occasion to invoke the declaration in refusing to associate themselves with abusive practices. Once the regime of Augusto Pinochet Ugarte
The Declaration of Tokyo was followed by related action of other professional organizations. The World Psychiatric Association,
One group of critics implied that the declaration went too far. Raj Jandoo, a forensic scientist, complained that the principles were too abstract; the WMA failed “to appreciate the extreme situations that some doctors must endure in countries where repressive measures exist.” Such criticisms were partially responsible for U.N. members’ conclusion that the Tokyo Declaration was not enough, and that the United Nations should adopt a supplementary set of ethical principles.
In December of 1982, the U.N. General Assembly acted. Its principles were based on the WMA’s declaration but also incorporated the concerns of Amnesty International and other groups. The U.N. principles applied to all health personnel, whereas the Tokyo Declaration applied only to physicians. WMA leaders voiced concern about language that might absolve a military or police doctor who was present during torture. A 1978 draft of the United Nations principles would have instructed physicians “obliged by force to contravene certain aspects of these principles” to “reduce to the minimum the harmful effects” of their maltreatment.
Although it would be dubious speculation to attribute physicians’ increasing consciousness about human rights to the WMA declaration, it is certain that this consciousness led in some cases to the exposure of torture. For example, police surgeons in Northern Ireland provided documentation of ostensibly “self-inflicted” injuries that revealed a pattern of abuse. New physicians’ groups investigate and report on human rights conditions, among them Physicians for Human Rights (a U.S. group) and the French Médecins sans Frontières (Doctors Without Borders).
The WMA continued to address human rights issues. In response to the first execution by intravenous injection, carried out in Oklahoma, André Wynen, secretary-general of the WMA, issued a press release declaring that “no physician should be required to be an active participant” and that “acting as an executioner is not the practice of medicine.”
There are certainly limits to the WMA’s influence. Many physicians are unaware of its existence, preferring to participate in national medical associations, if at all. The association candidly acknowledges what it calls “a lamentable lack of awareness among the profession itself about the nature of the WMA’s work.” Nevertheless, the 1990’s brought hopes for change within the WMA and elsewhere. Physicians from the post-Soviet states and Eastern Europe welcomed opportunites to participate in such international organizations. The WMA hoped to induce its former sections to return, as a return to its former size would provide greater financial stability and added impact for its declarations, among them the Declaration of Tokyo.
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Amnesty International. Codes of Professional Ethics. 2d ed. London: Author, 1984. This pamphlet includes the text of the Declaration of Tokyo, a WMA resolution on physician participation in capital punishment, and other codes. Thoughtful introductory essays by Alfred Heijder and Herman van Geuns. No reference features. -
British Medical Association. The Medical Profession and Human Rights: Handbook for a Changing Agenda. New York: Palgrave, 2001. Thorough, well-researched account of the role of doctors and medical professionals in acts of abuse, torture, and human rights violations. Bibliography and index. -
Gordon, Neve, and Ruchama Marton, eds. Torture: Human Rights, Medical Ethics, and the Case of Israel. Highlands, N.J.: Zed Books, 1995. An examination of the reported torture of Palestinian prisoners and the role of medical ethics codes in stopping it. Appendixes and index. -
McLean, Sheila. Old Law, New Medicine: Medical Ethics and Human Rights. New York: New York University Press, 1999. Scholarly examination of the implications of medical policies on human rights. Includes bibliographical references and index. -
Stover, Eric, and Elena O. Nightingale, eds. The Breaking of Bodies and Minds: Torture, Psychiatric Abuse, and the Health Professions. New York: W. H. Freeman, 1985. Excellent reader. Essays address cases in which medical professionals have been perpetrators and victims of human rights abuses. The essay by Stover and Michael Nelson, “Medical Action Against Torture,” describes the efforts of the WMA and other organizations. Useful appendixes include ethical codes and a list of organizations. Index; bibliography organized by category. -
World Medical Association. Handbook of Declarations. London: Author, 1985. This pamphlet contains a brief description of the WMA and English, French, and Spanish texts of its declarations up to its date of publication. Declarations on general ethical principles and capital punishment are of special interest. No reference features. -
World Medical Journal. The World Medical Association’s semimonthly publication. Includes reports from the secretary-general and articles covering WMA congresses and declarations. Interactions with the World Health Organization and national medical associations are described from the WMA perspective.
Medical Group Exposes Torture in Greece and Chile
United Nations Issues a Declaration Against Torture
Soviet Citizen Group Investigates Political Abuses of Psychiatry
Paraguayan Torturer Is Convicted of Violating the Law of Nations
National Commission Against Torture Studies Human Rights Abuses
Amnesty International Works to Prevent Torture