12 A practical guide to the Istanbul Protocol – for psychologists and adopt a supportive, non-judgmental approach. It is not appropriate to observe the strict “clinical neutrality”. Clinicians need to be sensitive and empathic in their questioning while remaining objective in their clinical assessment. (See § 162, § 262 and �� 263 in the Istanbul Protocol.) 2. ‘RISK OF RE-TRAUMATIZATION’ VERSUS ‘NECESSITY OF OBTAINING SUFFICIENT AND APPROPRIATE INFORMATION’ “Several basic rules must be respected (see chapter III, section C.2 (g)). Information is certainly important, but the person being interviewed is even more so, and listening is more important than asking questions[...]” (Istanbul Protocol, § 135). Physical and psychological examinations by their very nature may re-traumatize the patient by provoking and/or exacerbating psychological distress and symptoms by eliciting painful affect and memories. The interview must be structured so as to minimize the risk of re-traumatizing the torture survivor. The clinician needs to balance two important requirements which should be complementary, but may sometimes conflict: the need to obtain a useful account, and the importance of respecting the needs of the person being interviewed (Giffard, 2000). The primary goal of documenting allegations of torture is to create an accurate, reliable, precise and detailed record of events by taking into account the personal situation and the psychological condition of the individual (Giffard, 2000; Wenzel, 2002). Interviewers should show sensitivity in their questioning and watch out for signs of tiredness or distress (Giffard, 2000). A subjective assessment has to be made by the clinician about whether and to what extent pressing for details is necessary for the effectiveness of the report in court, especially if the interviewee demonstrates obvious signs of distress. (See § 135, § 149 and § 264 in the Istanbul Protocol.) 3. DILEMMAS ARISING FROM DUAL OBLIGATIONS Dilemmas may occur when ethics and law are in contradiction. Circumstances can arise where their ethical duties oblige health professionals not to obey a particular law, such as a legal obligation to reveal confidential medical information about a patient. There is consensus in international and national declarations of ethical precepts that other imperatives, including the law, cannot oblige health professionals to act contrary to medical ethics and to their conscience. In such cases, health professionals must decline to comply with the law or a regulation rather than compromise basic ethical precepts. Whatever the circumstances of their employment, all health professionals owe a fundamental duty to care for the people they are asked to examine or treat. They cannot be obliged by contractual or other considerations to compromise their professional independence. They must make an unbiased assessment of the patient’s health interests and act accordingly. (See § 66 and § 68 in the Istanbul Protocol.)