Implementation of Istanbul Protocol for effective documentation of torture - review of Sri Lankan perspectives

Documentation of torture is a multidisciplinary, multistage scientific procedure evolved over the past decades through the experience of various strata in medical and related fields. It plays a key role in effective corroboration of facts, providing redress to victims and also has a long term regulatory impact on prevention of torture in a society. The UN endorsed Istanbul protocol serves as the model for effective documentation of torture in the present context and there were many attempts in the recent years to create a systematic and uniform approach among professional bodies to document torture by adopting it to the local medico-legal and legal systems in some less resourced countries. The post independent Sri Lanka is widely known in international human rights forums for the prevalence of torture and its endemicity since 1970s. The long term struggle to ensure justice to torture victims in Sri Lanka has been greatly enhanced by the submission of detailed medico-legal reports on them to relevant courts. As strengthening of medico-legal and legal reporting strategies were more focused towards the end of twentieth century the medico-legal and legal professionals in consensus attempted to use Istanbul Protocol for documentation of torture since 2004. However Sri Lankan experience on application of Istanbul protocol for documentation of torture signifies that unless and until a political commitment is shown by the government to internalize Istanbul Protocol into legal and medico-legal systems locally the expected outcome of effective documentation would not be evident.     

Legislation for Ukraine's public health: the current situation and paths to further development

The paper contains the findings of an analytical study of the current national health care legislation of Ukraine and identification of priority areas in its further development. One of the key objectives of the above study was to identify the compliance of the national healthcare legal framework with the approaches to health policy formation, which are set out in the documents of global and European regional international organizations, and to assess whether the national legislation includes that spectrum of functions that are to be covered by the health care legislation. The analysis showed that Ukraine's national healthcare legislation is rather strong and well developed. Though the national healthcare legislation is mostly in line with international approaches to the state health care policy formulation, the issue of enforcing already adopted laws and by-laws and ensuring their compliance by all legally established bodies, including state authorities and self-governments, citizens, NGOs, etc, is problematic.     

The legislation of CIS countries on the issue of genetically modified products

Genetic engineering is a fast-moving research field that produces many achievements, including genetically modified organisms, which are used during the production of food products. Recent decades have shown that scientists, policy makers and the general public cannot reach a consensus about the benefits and hazards of genetically modified food products. Opinions are so different, and both sides are so well-grounded, that it is not easy to reach a conclusion about this scientific achievement. Nevertheless, food security is one of the main objectives of the state, which is responsible for providing safe food products to its own citizens in the marketplace. This is why states are interested in reviewing these scientific achievements, in terms of the state's national interests and the security of its citizens. This article sets forth: (1) the main advantages and disadvantages of genetically modified products; (2) the role of national legislation in the control of food security; and (3) the attitude toward genetically modified products in the national legislatures of CIS countries. Taking these points into account, the authors come to the conclusion that actual Azerbaijan law is not responding to the changes, which have taken place in recent decades, in development of the world market and technological conditions in the production of food products. This provides the basis to conclude that, in actual conditions, the rights ofAzerbaijan citizens to the safety of food products are not well protected. At the end of this article, the authors make recommendations about the necessity of amendments to the legislation in their own country, towards the goal of greater control over such products in Azerbaijan.     

German physicians against war since 1870

Populations at risk in a disaster situation include the disabled and elderly. This large and growing segment of the population is in many ways more vulnerable than other people to safety and health hazards of disasters and has specific needs in emergency situations. The ‘Desert Storm Operation’ (Persian Gulf, January‐February 1991) as it affected the elderly and disabled in Israel is described. Although the circumstances were rather specific, the increased vulnerability and some particular needs of this population were disclosed, and could be considered in the plans for preparedness for other types of disaster situations.     

从汶川地震看大规模灾害的应急救援计划与处理

我国是多地震灾害的国家,死亡率也比较高,特别是2008年5月12日,四川省汶川发生的里氏8．0级地震是新中国发生的最严重的一次地震。标准的医疗救援方案是应对灾害应急反应最好的指南。在对灾害幸存者的救护中,掌握标准流程的人离幸存者越近,救治就越成功。不幸的是,灾害情况下的需求往往超过了单个医院的资源、能力和制定的预案。为进一步降低灾害所致的伤亡,笔者阐述了美国在大规模灾害的应急计划与处理方面的经验。     

Government public health policy: three cautionary tales from Malaysia, South Africa and the United States

Three authors describe problematic scenarios of health policy in their respective countries. These examples illustrate the role of government influences in determining resource allocation, legislation, health provision and health outcomes in very different situations. These outcomes are affected not only by attitudes to public health, but also by the legal systems in the countries which are the subjects of this study. The authors draw conclusions about the use and abuse of public health regulation.     

International collaboration in mass disasters involving foreign nationals within the EU

Identification of and investigation into the cause of death of foreign nationals in mass disasters are generally conducted according to the jurisdiction of the country in which the disaster occurs. However, such identification can be achieved only through co-operation with the authorities of the victims' countries of residence. On October 8th 2001 at Linate airport in Milan, Italy, an MD87 SAS airplane with 110 crew members and passengers on board collided on the ground with a Cessna Citation II jet with 2 pilots and 2 passengers. The plane then caught fire after having crashed into an airport baggage hangar causing the death of 4 other victims among the groundstaff. The accident claimed a total of 118 victims of 9 nationalities. Based on our experience from investigation of the Finnish victims, we explore how current national legislations of the EU member states and varying compliance with existing recommendations may influence the medico-legal investigation of a mass disaster. Legislative measures and further harmonisation of medico-legal procedures in connection with mass disasters within the EU are needed.     

Dying in the arms of Dutch governmental authorities

Thorough investigation of deaths related to police actions or of persons placed under the ‘care’ of governmental authorities is anchored in the legal systems of every democratic system. The quality of this investigation should be guarded by an adequate set of control measures. Recently the Dutch Ombudsman published a report about this issue In the Netherlands no central registry of these deaths exists. The estimates based on the available data number some 400–500 deaths in custody in the past 10 years in the Netherlands of which only in 193 cases a legal postmortem was performed. We present an overview of these cases and discuss the present Dutch practice in the perspective of national and international legislation.     

Liability for pharmaceutical products: a difficult attempt at harmonisation

On the 25 July 1985, the European Community adopted a Directive on liability for defective products. Doctors are very affected by this law because an injured person will possibly be able to take action against them. This directive had several aims: to harmonise member states' legislation concerning the legal protection of victims and to subject producers to the same framework of liability and competition rules. However, this directive currently remains relatively ineffective. Several reasons can be put forward to explain this failure. First, by leaving it open to member states to decide whether to opt for one or more derogations, the Directive has made it easier for different interpretations to emerge. Secondly, several ideas proposed by the Directive have not been defined. As a result, the different legal terminology used in different states makes the interpretation of these concepts more difficult. Our paper concludes that the Directive was soundly based. However, Member States must enquire about the solutions adopted in neighbouring countries, and the ECJ (European Court of Justice) should try to impress on states the importance of a community vision. Without an adequate level of convergence, the differences between national laws will encourage 'forum shopping' on the part of a claimant and the situation will become more difficult for prescribers.     

Interactions of law and ethics affecting reproductive choice

Controversies affecting reproductive choice can often be resolved within interactions of legal and ethical decision-making. This paper addresses three topics, following the methodology presented in Reproductive Health and Human Rights: Integrating Medicine, Ethics, and Law, by R.J. Cook, B.M. Dickens and M.F. Fathalla (Oxford University Press, 2003). The book's 15 case studies each addresses medical, ethical, legal and human rights aspects, and structural approaches at clinical, healthcare system and societal levels. STERILIZATION: Individual self-determination supports legal and ethical rights of intellectually competent persons to sterilization. Sterilization of intellectually compromised persons was historically abused, causing reactions of excessively protective prohibition. ABORTION: Most developed countries have liberalized abortion legislation, thereby reducing abortion-related mortality and morbidity, but many developing countries retain repressive colonial laws. Over 95% of the estimated 20 million unsafe abortions annually occur in developing countries. COURT-ORDERED CAESAREAN DELIVERIES: A concern in developed countries is the willingness of some courts to order Caesarean procedures over competent women's objections.     

Experience in organizing epidemic control work in catastrophes

Maintenance of preventive medicine measures is one of the main part of national system of emergency health service in disasters. The priority in this activity belongs to the mobile autonomous units, which take measures for protection of population disaster regions and military personnel from infections diseases.     

A case in south-eastern France: a review of drug facilitated sexual assault in European and English-speaking countries

Drug facilitated sexual assaults (DFSA) have been increasingly reported in the medical literature since the 1980s but their legal recognition is more recent, at least in Europe. From a case treated in south-eastern France, whose judicial consequences were known, it seemed of interest to carry out an international study of jurisprudence concerning this type of rape. While from the medical viewpoint the drugs used are well-known and their presence can be clinically verified, the legal consequences of their use in subsequent criminal prosecution is less clear-cut. Some European countries have no jurisprudence in this area, while others consider the use of drugs as an aggravating circumstance. In France, it was only in 2003 that the first case of DFSA was truly punished by the judicial system, with considerable media attention. By contrast, in English-speaking countries, particularly the United States, the use of drugs to facilitate sexual assault has frequently been recognized in legislation and in criminal prosecutions. Prevention is fundamental and is recognised as demonstrated by campaigns in various countries.     

Guidelines for the effective conduct of mass burials following mass disasters: post-Asian Tsunami disaster experience in retrospect

The frequency of mass disasters is increasing, demanding actions that deal with these promptly and effectively to secure human interests. An undeniable and inevitable reality of any mass disaster is the massive number of fatalities, which will give rise to a further chain of events ranging from the recovery of the deceased, to their transport, storage, identification and, finally, disposal. Past experience has shown that traditional human disposal methods should be redesigned according to the requisites of mass fatality scenarios, and it has been proven that a proper mass burial is by far the most appropriate and standard method for disposal of the dead due to mass disasters as it takes all its practical issues into consideration. A mass burial can be defined as burying more than one deceased of a single or related incident in a single grave or multiple graves simultaneously or separately within a restricted time period in a single or multiple burial sites located within an identified geographical area. In the present context, it is an utmost necessity that we develop uniform detailed guidelines for the proper conduct of mass burials that provide the deceased with all due respect to human dignity, as this will enable these guidelines to be incorporated into future national mass disaster management schemes as an integral component.     

Bio-medicolegal guidelines and protocols: survey and future perspectives in Europe

The preservation of uniqueness and the enhancement of the value of evidence in legal medicine is based on the implementation and development of a “quality management system,” which includes a continuous education of specialists, the introduction and application of guidelines and protocols, as well as mechanisms of internal quality control. This ongoing process shows differences with regard to various fields of knowledge such as forensic genetics, toxicology, forensic pathology or forensic psychiatry, especially if different European countries are compared. To get an overview on the development of legal medicine in different European countries, a questionnaire was developed and sent to representatives of 42 European countries to verify the existence of bio-medicolegal guidelines and protocols. A National Society of Legal Medicine is established in 27 out of 32 countries (84%) which could be included in the final analyses. In 25 countries (78%), a specialisation is necessary as a prerequisite of inclusion in a national register, and 30 of the countries (94%) have guidelines in at least one field of legal medicine. The most common guidelines concern forensic pathology (in the fields of professional qualification and sudden death), forensic toxicology (driving under the influence of drugs and substance testing) and forensic genetics (paternity testing and personal identification). The findings of this study show that comparison is possible and can be a basis for further consensus in the European medicolegal community. The process of harmonisation of the medicolegal autopsy rules in Europe initiated in 1990 was a first step on this way. Further consensus is necessary and might be gained by developing European guidelines for each field within the subdisciplines, based on a standard European Guideline Format.     

An expert assessment of the organization of medical care in peacetime catastrophes

There is given an expert evaluation of medical response and release efforts during the recent disasters in Arzamas, Sverdlovsk, Armenia and Bashkiria. Special attention is paid to the movable medical units activity, to the work of psychiatric, forensic medicine service. The attention is focused on the problem of establishing national disaster medical system.     

Nuclear war: Lessons from disaster

One of the greatest difficulties in alerting people to the possibility of nuclear war is overcoming their denial of the threat. Some degree of optimism has allowed man to avoid social paralysis in the face of the natural disasters that have been the ubiquitous experience of most generations. Paradoxically, this tendency to deny the hazards that lie in the future can interfere with an adequate appraisal of the real threats to our survival. Studying the effect of natural disasters is one way of demonstrating the danger of such denial as well as providing opportunity to understand this phenomenon. A bushfire disaster is described in an attempt to highlight some of the elements of social and psychological disruption that would arise during and after a nuclear holocaust. It is striking how most people rapidly minimize the intensity and danger of the threat they experienced in the disaster, to the point that people have taken few or no steps to prevent the inevitable recurrence of such fires. This demonstrates the extent to which people can deny threats to their survival, such as nuclear war, despite there being a substantial probability of such events.     

IAEA survey of paediatric computed tomography practice in 40 countries in Asia, Europe, Latin America and Africa: procedures and protocols

Objective

To survey procedures and protocols in paediatric computed tomography (CT) in 40 less resourced countries.

Methods

Under a project of the International Atomic Energy Agency, 146 CT facilities in 40 countries of Africa, Asia, Europe and Latin America responded to an electronic survey of CT technology, exposure parameters, CT protocols and doses.

Results

Modern MDCT systems are available in 77 % of the facilities surveyed with dedicated paediatric CT protocols available in 94 %. However, protocols for some age groups were unavailable in around 50 % of the facilities surveyed. Indication-based protocols were used in 57 % of facilities. Estimates of radiation dose using CTDI or DLP from standard CT protocols demonstrated wide variation up to a factor of 100. CTDI_vol values for the head and chest were between two and five times those for an adult at some sites. Sedation and use of shielding were frequently reported; immobilisation was not. Records of exposure factors were kept at 49 % of sites.

Conclusion

There is significant potential for improvement in CT practice and protocol use for children in less resourced countries. Dose estimates for young children varied widely. This survey provides critical baseline data for ongoing quality improvement efforts by the IAEA.

Key Points

? Paediatric computed tomography (CT) practice was audited in 40 less resourced countries. ? This audit revealed widespread (up to 100 times) variation in radiation dose. ? Specific CT protocols for certain age groups were frequently (ca. 50 %) unavailable. ? This survey demonstrates significant potential for improvement in paediatric CT practice. ? Multinational networking is an effective mechanism for quality improvement.     

The application of diagnostic reference levels: General principles and an Irish perspective

The principles of justification and optimisation, and the establishment and use of diagnostic reference levels (DRLs) are core tenets of the European Medical Exposures Directive [Council Directive 97/43], and ensuing legislation across Europe. This is the third in a series of three review articles: the previous two discussed the principles of justification and optimisation, the current review covers the concept of DRLs.In this paper, a brief synopsis of the history of DRLs is presented, and their possible applications are outlined. Approaches and progress with DRLs in a number of European countries, as derived from published literature, are summarised and a comparison of the approaches highlights some practical issues in using DRLs. Irish data are then considered in the context of literature ensuing from SI478 of 2002, and relating to the establishment of national diagnostic reference levels.The reviewed literature supports the opinion that national DRLs are preferable to those drawn from pan-European dose data.     

Dutch alcohol policy developments: the last decades and present state of affairs

The article addresses the Dutch alcohol policy over the last decades and the present state of the art. In Dutch society an ambivalent attitude towards alcohol consumption prevails. Developments in legislation and regulations, in prevention and care are described. Several key problems are identified. Among others it is concluded that too little attention is paid to alcohol compared to other drugs. Both in prevention and care evidence-based work has to be stimulated. Legislation and regulations are insufficiently used and evaluated. The government needs to constantly evaluate its policy and develop its options within the area of legislation and regulations, which should also include a critical comparison with the situation in other countries.