WMA updates advice on medically indicated termination of pregnancy

Revised advice to physicians on medically indicated termination of pregnancy has been issued by the World Medical Association.

At its recent annual General Assembly in Reykjavik, the WMA reiterated that where the law allows medically indicated termination of pregnancy to be performed, the procedure should be carried out by a competent physician.

However, it agreed that in extreme cases it could be performed by another qualified health care worker. An extreme case would be a situation where only an abortion would save the life of the mother and no physician was available, as might occur in many parts of the world. This amends previous WMA advice from 2006 that only physicians should undertake such procedures.

The meeting agreed that patients must be supported appropriately and provided with necessary medical and psychological treatment along with appropriate counselling if desired by the patient.

The revised policy emphasises that the convictions of both the physician and the patient should be respected. It adds that patients must be provided with necessary medical and psychological treatment along with appropriate counselling if desired.

In another change to WMA policy, the Assembly reaffirmed its view that physicians should continue to have a right to conscientious objection to performing an abortion, while ensuring the continuity of medical care by a qualified colleague. But it added that in all cases physicians must perform those procedures necessary to save the woman’s life and to prevent serious injury to her health.

Physicians must work with relevant institutions and authorities to ensure that no woman is harmed because medically-indicated termination of pregnancy services are unavailable.

The preamble to the revised policy states: “Medically indicated termination of pregnancy refers only to interruption of pregnancy due to health reasons, in accordance with principles of evidence-based medicine and good clinical practice. This Declaration does not include or imply any views on termination of pregnancy carried out for any reason other than medical indication.”

WMA President Dr. Leonid Eidelman said that the revised policy was part of the WMA’s procedure to review all policy that was 10 years old and follows two years of discussion and debate.

“As the document says, termination of pregnancy is a medical matter between the patient and the physician. But attitudes toward termination are a matter of individual conviction and conscience that should be respected,” Dr Eidelman said.

“A situation where a patient may be harmed by carrying the pregnancy to term presents a conflict between the life of the foetus and the health of the pregnant woman.

“Different responses to resolve this dilemma reflect the diverse cultural, legal, traditional, and regional standards of medical care throughout the world and the revised policy recognises this fact.”

Solution to mandatory reporting must not be second best

The AMA has called on Health Ministers to make sure the health of the nation’s doctors is not compromised by second-rate mandatory reporting laws.

The call comes as the Queensland Government prepares to introduce a Bill to the State Parliament in an attempt to address the issue.

The AMA has not been provided with the contents of the Bill, and fears that amendments sought by the AMA and many others were ignored by the COAG Health Council.

The Health Practitioner Regulation National Law Amendment (Tranche 1A) Bill, agreed by Health Ministers at the COAG Health Council on 12 October, must not be a second-best solution that may not protect the health of doctors, the AMA has warned.

AMA President Dr Tony Bartone said that the Health Ministers may believe they have made sufficient changes to the existing laws, but the AMA is adamant that its proposed amendments were vital to make the new national laws safe enough to give doctors confidence to seek help for their own health needs.

“Our fear is that the Bill going before the Queensland Parliament will stop doctors seeking health care when they need it,” Dr Bartone said.

“We fear that this Bill will not stop doctor suicides.

“Mandatory reporting affects every doctor, their families, their loved ones, their colleagues, and their patients.

“Our doctors desperately need legislation that does not actively discourage them from seeking medical treatment when they need it. Doctors are patients too. They should have the same rights to access confidential high-quality medical treatment as their own patients and all other Australians do.

“We urgently need a nationally consistent approach to mandatory reporting provisions. It will provide confidence to doctors. It will enable and empower them to seek treatment for their own health conditions anywhere in Australia.”

Dr Bartone said he could not understand why the COAG Health Council did not adopt the AMA recommendations and evidence in framing the new laws.

The AMA amendments were a minimum requirement since the Ministers refused to adopt the current successful and workable Western Australia laws, which will remain in place regardless of the COAG action.

The AMA has lobbied hard for changes to the mandatory reporting laws, including directly to successive COAG Health Council meetings and through lobbying of Ministers by State and Territory AMAs.

The changes need to be such that they will protect the health of doctors, which in turn will benefit patients.

Inquiry agrees with AMA’s aged care recommendations

A Parliamentary Committee report has accepted many of the AMA’s recommendations on how to improve the care of vulnerable Australians in residential aged care facilities, including the need for more registered nurses.

AMA President Dr Tony Bartone, who appeared before the Inquiry in May, said that the recommendations of the Report on the Inquiry into the Quality of Care in Residential Aged Care Facilities in Australia largely align with AMA policy.

“It is critical that residents in aged care facilities, and the doctors visiting them, have access to appropriately trained staff at all times,” Dr Bartone said.

“The AMA has been advocating for a registered nurse-to-resident ratio that aligns with the level of care need, and ensures 24-hour registered nurse availability.

“The Committee has recommended that it be enshrined in law that all residential aged care facilities provide for a minimum of one registered nurse to be on-site at all times.

“This is a good first step. However, we recognise that one registered nurse will not be enough in many residential aged care facilities, which may have hundreds of frail residents.

“We are pleased that the Committee has further recommended that the Government specifically monitor and report on the correlation between standards of care, including complaints and findings of elder abuse, and staffing mixes to guide further decisions in relation to staffing requirements.

“In the most recent survey of AMA members who visit patients in residential aged care, more than one in three doctors said that they plan to cut back on or completely end their visits over the next two years, citing a lack of suitably trained and experienced nurses, and inadequate Medicare patient rebates.

“Our members are also concerned about the trend to replace registered and enrolled nurses with personal care attendants, who are not appropriately trained to deal with the health issues older people face.

“The Committee has acted on these concerns, recommending that the Government review the Medicare rebate for doctor visits to residential aged care facilities, and a review of the Aged Care Funding Instrument (ACFI) to ensure that it is providing adequate levels of care for the individual needs of aged care recipients.

“The AMA also notes the recommendation to improve the Community Visitors Program to ensure volunteers visiting aged care facilities are better able to respond to suspected abuse. The AMA Position Statement on Health and Care of Older People 2018 called for education and training programs on the recognition, intervention, and management of elder abuse.

“While we have a Royal Commission, the AMA still urges the Government to act as a matter of urgency in responding to the many reviews that have now been completed. We have seen too many cases of abuse and neglect to delay action any further. The need for access to appropriate quality care cannot continue to be left unaddressed.”

LUKE TOY and MARIA HAWTHORNE

The AMA Submission to the Inquiry into the Quality of Care in Residential Aged Care Facilities in Australia is at submission/ama-submission-house-representatives-standing-committee-health-aged-care-and-sport-%E2%80%93

The AMA Position Statement on Resourcing Aged Care 2018 is at position-statement/aged-care-resourcing-2018

The AMA Position Statement on Health and Care of Older People 2018 is at position-statement/health-and-care-older-people-%E2%80%93-2018

The AMA Submission to the Department of Health’s Draft Charter of Aged Care Rights is at submission/ama-submission-department-health-%E2%80%93-draft-charter-aged-care-rights

The AMA Aged Care Survey is at article/2017-ama-aged-care-survey

The AMA Position Statement on Health and Care of Older People 2018 is at position-statement/health-and-care-older-people-%E2%80%93-2018

The AMA Submission to the consultation on the Terms of Reference for the Royal Commission into Aged Care Quality and Safety is at submission/ama-submission-department-health-terms-reference-royal-commission-aged-care-quality-and

AMA keeps up pressure over Nauru

Aggressive lobbying from the AMA has sparked a groundswell of support for the urgent removal of refugee families from Nauru.

While the Australian Government grapples with an onslaught of criticism over its handling of the worsening asylum seeker issue, AMA President Dr Tony Bartone continues to pressure the highest levels of power.

Following his recent letter to Prime Minister Scott Morrison, demanding a policy rethink and the urgent transfer of children and their families from Nauru, Dr Bartone has maintained the call through numerous media appearances as well as closed-door meetings.

The Prime Minister initially dismissed the AMA’s call, but since being swamped with expressions of outrage from both inside and outside of his own party – all in the face of a potential by-election loss in Wentworth – he put on the table the prospect of refugees being resettled in New Zealand.

The New Zealand Government has repeatedly offered to take 150 asylum seekers from Nauru, but the offer has been continually met with rejection by the Australian Government.

Opposition Leader Bill Shorten has also received internal and community pressure over Labor’s position on asylum seekers, and so flagged a private member’s bill aimed at making medical transfers from Nauru much simpler.

This all happened in a week when Médecins Sans Frontières confirmed its people had been kicked off of Nauru, and also when the senior Australian doctor contracted by IHMS to provide medical care to the asylum seekers, Dr Nicole Montana, was removed.

Dr Bartone described the developments as “extremely concerning” and pointed to “crisis upon crisis” developing on the island.

“It highlights the confusion and chaos around the medical treatment being provided to a group of very vulnerable people and various stages of medical care required on their behalf,” he told ABC Radio.

“What we’re very clear about is that doctors working on Nauru, or any other processing centre, should be able to deliver the best care, the best appropriate care required by their patients.

“These people are under the care entrusted to the Australian Government, they are responsible for their health and wellbeing while in those centres, and they need to ensure that the provision of medical care is foremost unimpeded in that process.”

Dr Bartone said the AMA was continuing its advocacy on the issue and in addition to wanting all children and their families removed from Nauru, it is calling on the Government to allow an independent delegation of Australian medical professionals to visit the island.

“We need a solution in this area. We need a solution which brings to a head this ongoing crisis. We’re talking about the lives of children, in particular, many in very, very serious states of urgent medical care requirement, and we really do need to know that every day that goes by is another day of suffering for these children in particular,” he said.

“What we’re saying is the Government and the appropriate department there is remaining steadfast with the lack of transparency in the approaches, in the information sharing. The information flow is very, very slow, very, very guarded, and very, very piecemeal when it does come our way. This is unacceptable obviously.”

The AMA President has met with Shadow Immigration Minister Shayne Neumann and has said Labor’s proposal is pragmatic – in the absence of anything meaningful coming from the Government – and the AMA was backing it.

“This approach, this legislation, will seek to both reduce the bureaucratic process in this transfer, increase the transparency, increase the medical decision-making powers, and increase the independent medical oversight of the whole medical treatment process on the facilities… and ensure that vulnerable children, in particular, but anyone who requires urgent medical attention is afforded that care, appropriate care, before they get too far down the track,” Dr Bartone said.

“What we know is that if the Minister has the final decision, that needs to be independently verified by a second medical doctor within 24 hours of that decision. That both speeds up the process of the decision-making capacity and it would be a very, very brave Minister who would refuse the advice of two treating doctors, independent, and then have to report back to Parliament in a transparent way to the Australian public that that decision was not proceeded with.”

A number of the Government’s own MPs publicly broke ranks this week to demand action and the urgent removal of children from Nauru.

A host of other medical and health groups, as well as the Law Council of Australia, have backed the AMA’s call for the immediate removal of asylum seeker children and their families off Nauru.

CHRIS JOHNSON

ausmed/ama-demands-urgent-fix-humanitarian-emergency-nauru

AMA critical of Qld Pharmacy Inquiry recommendation

The Queensland Pharmacy Inquiry has recommended that options be developed for what it is describing as “low-risk” prescribing by pharmacists.

The AMA has condemned the recommendation, saying patients will lose out if it is adopted.

Recommendations are listed in the Queensland Parliament’s Health, Communities, Disability Services, and Domestic and Family Violence Prevention Committee Report into the Establishment of a Pharmacy Council and Transfer of Pharmacy Ownership

Chairman of the Inquiry, Aaron Harper said: “We see potential for pharmacists to do more than they currently do – with some prescribing of medications in low-risk situations and subject to a range of safeguards.”

But AMA President Dr Tony Bartone said that and some other recommendations add up to bad news for patients.

“The Report contains recommendations to expand the role of pharmacists, including in relation to the prescribing of medications,” Dr Bartone said.

“It is well known that the more that other non-medical health professionals are involved in prescribing, the higher risks of medication error and adverse reactions.”

Other recommendations include lowering the minimum age for pharmacist-administered vaccinations to 16, retaining current pharmacy ownership laws, and establishing a new pharmacy advisory council for the State.

Dr Bartone said GPs were only trained primary health professionals who have the skills needed to properly and comprehensively diagnose patients, prescribe the right medications, and refer patients to other health care providers as appropriate.

“These are skills that come from years of observing and examining patients, and understanding how text books and the real live patient overlap,” he said.

“Clinical training is an art that has its foundations over the centuries, and cannot be learnt by simply and solely reading texts.

“GPs currently work closely with their pharmacist colleagues on a daily basis, and respect the unique skills they bring to the care of patients, particularly with respect to the quality use of medicines.”

Dr Bartone said the AMA was in the middle of a real effort to introduce the medical home concept in Australia, where GPs are able to coordinate patient care, with full access to a patient’s medical history.

“But let me be very clear about this Report, which completely overlooks the reality of quality primary health care,” he said.

“It totally ignores the well-understood need in our health system to strengthen the coordination of care, and the need to encourage patients to have a long-term relationship with a usual GP or general practice.

“The Report also opens up a serious conflict of interest for pharmacists who will gain commercially through prescribing of medications, and then being able to dispense them.

“We already know that pharmacies sell many complementary medicines that are not backed by clinical evidence. This highlights the retail pressure they are under to sell products to consumers regardless of patient need.

“The recommendations in this Report, if adopted, would set Australia on a dangerous course.”

Dr Bartone said Australia had a GP-led model of care that is the envy of the world, with GPs highly accessible in most parts of the country.

Australia has primary care outcomes that are second to none.

He said the Australian community deserved better than what was recommended in the Report. The focus of policymakers, he said, needed to be on building on the proven model of GP-led care, rather than undermining it by giving in to the retail interests of the pharmacy sector.

“Any access concerns cannot be solved by providing a second-best alternative,” Dr Bartone said.

CHRIS JOHNSON

[Perspectives] Yvonne Sylvain: women’s health pioneer in Haiti

In the mid-20th century, a remarkable woman used her medical prowess and social prestige to address inequalities in Haitian society and raise the profile of public health. Born in Port-au-Prince in 1907, Yvonne Sylvain was the sixth of seven children of the poet, diplomat, and lawyer Georges Sylvain and his wife Eugénie. Both parents were part of a progressive intellectual elite that campaigned against the US occupation of Haiti, which lasted from 1915 to 1934. With a staunch feminist for a mother, the four Sylvain sisters all pursued either PhDs or medical training and furthered the cause of women’s rights.

Greetings from the new Secretary-General

BY AMA SECRETARY-GENERAL DR MICHAEL SCHAPER

It’s a great pleasure to take up the role as your new national Secretary-General.

The SG’s role is pretty straight forward: to ensure that the machinery of the national secretariat is working efficiently and effectively, supporting our elected officebearers in their role as the national public face of the profession, and helping the different State and Territory AMAs in their work.

Advocacy and public campaigning is central to the work of the AMA, and to do this well we need to have a sophisticated team of policy personnel, media experts and administrators backing them up.

Doctors and the members of the broader medical community continue to be rated by Australians as one of – if not the – most trusted professions in the country. Medicine matters to everyone. It affects us all, and we need to ensure that Governments always keep this at the centre of their decision-making.

We will continue being active advocates for the sector. AMA members need to be getting value for money, they need to be kept informed of our policy debates and have the chance to contribute to them. We need as many doctors as possible to join, and to get involved.

The federal structure of the organisation needs to be respected and supported, so that local AMAs can also deal with local issues. We also have some great staff working in the Canberra office on your behalf, and I’m keen to attract other high-calibre recruits to join us when vacancies emerge.

Finally, we have to manage the finances of the organisation carefully, and ensure that member funds – your funds – are spent effectively. These are some of the early priorities I’ll be working on.

Previous office-bearers in this position have come from a wide variety of different walks of life: while originally most Secretaries-General were doctors, over the last 30 years the reach has expanded to include lawyers, ministerial advisers, health sector administrators, and a range of others.

My own background is also similarly diverse, with experience in small business advocacy, senior government administration, politics, academia, professional associations and national regulation. (Incidentally, that’s where the “Dr” title comes from – a PhD based on research into some professional practice management issues in the allied health sector.)

Finally, I hope also to be able to get out and meet as many members and local office-bearers as possible. A national organisation has its membership spread right over the country, and I’ll be working with our President to ensure that we both get to meet with, and hear the concerns of, AMA cardholders across Australia.

After all, it’s your organisation, and we’re here to serve you.

My Health Record important, but let’s fix the problems

BY ASSOCIATE PROFESSOR ANDREW C MILLER, CHAIR, MEDICAL PRACTICE COMMITTEE

The policy problems the My Health Record seeks to address are genuine. The Australian health system operates as a collection of disconnected siloes. Patient records exist as isolated fractions scattered among their treating doctors. Without the MHR there is no other institutional mechanism that facilitates the flow of patient information between healthcare settings, and between healthcare practitioners.

Many of the greatest failures in patient care and safety result when patients are required to move across the health system but their clinical information does not follow them.

At the recent Senate Community Affairs Inquiry into the My Health Record System, the Chair of the AMA’s Ethics and Medico-Legal Committee, Dr Chris Moy, used the following case study to illustrate the practical benefits generated by a My Health Record. The story was provided to Dr Moy by a colleague and an AMA member, Dr Danny Byrne. He wrote:

“Earlier this year I had a new patient move to Adelaide from Nepean Blue Mountains in NSW, one of the opt out trial areas.

He had a serious neurological condition and could no longer look after himself, so he had to move to Adelaide to be looked after by his brother.

Normally a new patient like this would arrive with little or no information. I would have to write to his GP and specialists in NSW for copies of his clinical records.

Invariably I would expect to receive little or no information. After weeks of waiting I would usually then start from scratch by repeating the patient’s tests and starting another merry-go-round of specialist referrals. This would be at huge cost of time and money in duplication of tests and specialist referrals already done in NSW.

However, in this case the patient had a MyHR. It was immediately able to see his NSW hospital letters and results of his investigations. Within minutes I was able to pick up the required treatment plan for him recommended by his NSW specialists and begin implementing it from day one in Adelaide. This was something I had never experienced before.

The savings in time, stress and money were enormous – for the patient, his family and the wider health system.

It is ironic that I received better information from a NSW hospital that uses MyHR than I get from my local hospital a few kilometres away from me that does not.

I can see clearly now how much better care can be for patients in an opt out world for MyHR.”

Despite general agreement on the need for an electronic health record, the debate about My Health Record data security and patient privacy reached fever pitch following the Minister’s announcement of the start of the three-month opt out period.

The hyperbolic nature of the media debate means that it is not easy to decipher between discussion of genuine flaws in the security and privacy of the My Health Record System, and ill-informed alarmism.

What we know

The My Health Record System has multiple layers of security. Software cannot connect to the My Health Record unless it is secure, encrypted and certified as conformant. All connected software is subject to automated checks to ensure it maintains conformity standards. To access the My Health Record System through a clinical information system a health practitioner must:

Install conformant clinical software;
Apply for a NASH PKI certificate for healthcare provider organisations;
Install the NASH PKI; and then
Access the system using local log on details.

Conformant clinical software assigns unique staff member identification codes. A log is automatically generated to record each time a patient’s My Health Record is accessed by a health provider organisation. It is unlawful to access a My Health Record unless it is for the purpose of providing treatment to a patient who is a registered patient in the healthcare practice. Unlawful access to a patient’s record is subject to criminal and civil penalties.

The privacy controls available to patients add further security to patient data. Patients can instruct their health provider at the point of care not to upload information they consider sensitive. They can put a Record Access Code across their whole record or an individual document so only the providers who have been given the pin code can see them. Patients can also set up alerts to receive a text or email notification if their Record is accessed by a new health provider. Patients can also remove documents from their Record.

This represents a logged communication chain that far surpasses the existing standard in the vast majority of institutions and practices.

Proposed amendments

At the President’s press club address in on July 25, he told journalists he would “do what-ever it takes” to prevent the rich data base of sensitive patient information in the My Health Record System being used by Governments for purposes unrelated to healthcare. The Minister responded quickly to these concerns and introduced a new bill – the My Health Records Amendment (Strengthening Privacy) Bill 2018 (the Bill).

The amendments in the Bill provide protection to data stored in the My Health Record data base that is substantially tighter than the controls that apply under the Privacy Act 1988 (Commonwealth) to patient data stored in the clinicians own patient records. If the Bill passes the Parliament, the system operator will be prohibited from releasing My Health Record information without a court/tribunal order and only for very limited purposes.

Australians who opt out will have their MHR extinguished; as will also happen when they die. There will be no centrally collated echo to prompt privacy concerns.

Fit for purpose?

If the Bill passes Parliament and authorised disclosure concerns are addressed, will the My Health Record then be fit for purpose and acceptable to doctors? Depends who you ask. If you ask a Specialist, the answer is likely ‘no’.

Many Specialists remain deterred from connecting to the My Health Record because their clinical software providers have not invested in the upgrades necessary to provide seamless interoperability with the My Health Record System. Most specialist software does not provide the option to upload Specialist letters, despite this being the most important function for Specialists’ communication. It is time for Government intervention to remove this barrier to Specialist participation.

Specialists have not received anywhere near the same level of support to adopt the My Health Record as that provided to general practitioners over a number of years to date. It is vital this Government does not repeat the mistakes of the United Kingdom where they realised too late they had failed to provide sufficient technical support to clinicians who had trouble using the e-health records. Apart from the problematic interoperability between Specialist software and the My Health Record System, the compliance obligations on and doctors are substantial. Much more needs to be done to help specialists engage with the My Health Record if it is to succeed.

New laws to help protect against critical medicine shortages

Medicine companies will have to report shortages of important medicines as soon as they occur, following the successful passage of new laws through Parliament.

The Government is hailing it as ‘landmark legislation’ aimed at protecting supply of critical and life-saving medicine to Australian patients.

The new law also insists that if a critical drug is being removed from the market, the Health Department must be notified by the manufacturer at least 12 months in advance, or as soon as possible.

Health Minister Greg Hunt said the new law protects patients who rely on vital medicines, and also gives the community, medicine companies and patients the opportunity to take action to mitigate against a medicine shortage.

Mandatory reporting will apply to all prescription medicines as well as other medicines that are vital for public health, such as EpiPens and inhalers.

Tough penalties will apply to companies that do not comply with these new laws, including fines of up to $210,000 for each infringement and the possibility of further court action.

“I make no apologies for taking a hard-line approach to ensuring patients aren’t kept in the dark about a potential medicine shortage,” Mr Hunt said.

“A shortage that will severely impact on patients must be notified to the Therapeutic Goods Administration (TGA) as soon as possible, and no later than two working days after the medicine company knows or should know of the shortage.

“Medicine shortages have become an increasing problem in recent years, as medicine companies (manufacturers or importers) have failed to comply with the current voluntary reporting scheme.

“Earlier this year, Australia was one of several countries hit by a shortage of EpiPens, which provide lifesaving adrenalin for people who have had an acute allergic response.

“In this and a number of other cases, the shortages were not reported in advance to the TGA within the Department of Health. As a result, patients and doctors were not alerted in time for them to make alternative arrangements.”

Under the new law, a critical medicine is deemed to be in shortage if there is not enough, or likely will not be enough, for all patients in Australia who take it or may need to take it, at any time in the next six months.

Responses to a shortage could include re-directing the available supplies to patients who need them most, nominating alternative treatments and providing Pharmaceutical Benefits Scheme coverage for the alternatives.

Medicine companies must also notify the department of shortages that will not have a severe impact on patients. They will have up to 10 working days to do so.

“Shortages cannot always be avoided but, when they do occur, this mandatory reporting scheme will help Australian patients and health professionals to be more prepared,” the Minister said.

“I want to thank the medical sector who have worked closely with my Department and the TGA on improving the process for reporting medicines shortages and their willingness to improve the system through legislative change.

“In particular I want to thank Medicines Australia, the Australian Medical Association, the Society of Hospital Pharmacists of Australia, the Pharmacy Guild of Australia, the Australian Self Medication Industry, the National Pharmaceutical Services Association, the Pharmaceutical Society of Australia and the Generic and Biosimilar Medicines Association.

“These groups have worked collaboratively together and with Government to design a new approach that will support and protect Australian patients.”

The new mandatory reporting scheme for medicines shortages is included in the Therapeutic Goods Amendment (2018 Measures No. 1) Bill 2018, passed by the Senate in September.

The new law will come into effect on 1 January 2019.

World doctors condemn torture in Uganda

The World Medical Association has rebuked the Government of Uganda, followed reports detainees in the East African nation are being tortured and denied access to specialised medical care.

Dr Yoshitake Yokokura, WMA President, has written to Uganda’s Prime Minister Ruhakana Rugunda to express the WMA’s revulsion at what he described as “the pervasive practice of torture” in Ugandan detention places.

The letter sets out details of the violence and rape that the Uganda Human Rights Commission discovered when it visited detention centres.

It also reinforces the call from the Uganda Medical Association to respect the rights of patients and to protect doctors documenting and denouncing torture in Uganda.

The letter states: “Torture and other cruel or degrading treatments are one of the gravest violations of international human rights law. It destroys the dignity, the essence of the human being. As physicians, we are revolted by the devastating consequences of this practice for victims, their families and society as a whole, with severe physical and mental injuries.”

The letter calls on Uganda’s Prime Minister to take immediate and effectives measures to prevent and stop such intolerable shaming practices and to be an inspiring model for other countries.

“We have received appalling reports about a number of detainees in Uganda being tortured while under arrest and then denied access to medical attention, even when the Uganda Medical Association has offered to help them,” Dr Yokokura said.

“Such activities are especially disappointing, since Uganda is one of only 10 African countries with anti-torture legislation and is a signatory to the United Nations Torture Convention.

“Torture is unconditionally prohibited by the United Nation Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment that Uganda ratified in 1987, hereby establishing its consent to be bound by the provisions of the Convention.

“No exceptional circumstances whatsoever, whether a state of war or a threat of war, internal political
instability or any other public emergency, may be invoked as a justification of torture.”

The letter concludes: “We call on you to act as a matter of priority to ensure effective access to comprehensive health care to those in need and to allow and ensure that physicians can follow their ethical duties to provide medical care in an undisturbed and professional manner without intimidation and repression.”