Ending medical complicity in state-sponsored torture.

Since Sept 11, 2001, state-sponsored torture has become increasingly accepted and institutionalised, despite its clear illegality; it is now practised in over 100 countries, including 14 of the G20 nations. Physicians’ involvement in torture is especially worrisome, with Abu Ghraib and Guantánamo Bay serving as well-publicised contemporary examples. In the so-called War on Terror, medical complicity has legitimised torture and condoned, justifi ed, and facilitated extreme torture techniques. Doctors have become irreplaceable in modern torture methods; procedures such as cramped confi ne ment, dietary manipulation, sleep deprivation, and waterboarding have at times been legally sanctioned due to medical supervision. In view of the clear international consensus prohibiting torture, additional laws, protocols, or declarations are unlikely to end medical complicity in torture. Indeed, doctors working for the military, intelligence agencies, and other governmental entities often face divided loyalty between their employers’ orders and medical ethics. These doctors are immunised from accountability by the same governments that employ them. Instead, to end medical complicity in torture, eff orts must be taken to bring existing laws, protocols, and declarations into eff ect through enhanced adherence, compliance, and accountability. Yet few politically feasible mechanisms exist to hold individual physicians responsible for torture activities. Globally, almost every international law imposes its obligations on national governments rather than individuals. Corresponding mechanisms for monitoring, investigation, and promotion of compliance are similarly targeted; even if they did contain individuallevel mechanisms, cooperation from states would be necessary for enforcement. Many non-binding declarations, codes, and consensus statements that of transinstitutionalisation (eg, transfer of hundreds of patients from a public mental hospital that “must” be closed to hidden private institutions) and provide active support to families of patients who have been deinstitutionalised, so that they are not left alone with their problem. A fourth fundamental right of a person with a mental disorder is not to be deprived of a full aff ective and social life because of his or her mental health problem. In the current global fi nancial crisis, people with mental disorders are among the most vulnerable, and programmes for their social inclusion are not always regarded as a priority by local administrators. This neglect must be a target for advocacy by mental health professionals worldwide. Additional rights of people with mental disorders— emphasised in the WPA survey and WPA documents— are to be active participants in service planning and delivery, rather than passive recipients of care, and to have access to physical health care of the same quality as that available to the rest of the population, with appropriate insurance coverage. The WPA is committed to promote the fulfi lment of the above-mentioned rights of people with mental disorders, fi ghting against prejudice, ignorance, misinformation, and ideological fanaticism. Mario Maj Department of Psychiatry, University of Naples, Largo Madonna delle Grazie, Naples 80138, Italy; and World Psychiatric Association, Geneva, Switzerland [email protected]