PART B – Interview – ethical and clinical considerations 11 IV. CONFIDENTIALITY AND INFORMED CONSENT “Medical experts involved in the investigation of torture or ill-treatment shall behave at all times in conformity with the highest ethical standards and, in particular,shall obtain informed consent before any examination is undertaken[...]” (Istanbul Protocol, Annex I, Principle 6. (a)). before any evaluation is undertaken. The clarification of the limits of confidentiality could be seen as part of the process of obtaining consent (Alnutt & Chaplow, 2000). Clinicians have a duty to maintain confidentiality of information and to disclose information only with the patient’s informed consent. The clarification of confidentiality and its limits are of paramount importance for a well-conducted interview. The patient should be clearly informed of any limits on the confidentiality of the evaluation and of any legal obligations for disclosure of the information gathered by means of the interview and medical/psychological examination at the beginning of the interview. • based on adequate understanding of the potential benefits and adverse consequences of the evaluation • given voluntarily without coercion by others. From the outset, the alleged victim should be informed of the nature of the process, why his/her evidence is being sought, how the information given by the person would be used and possible consequences. Clinicians must ensure that informed consent is: The person has the right to refuse to cooperate with all or part of the interview and/or evaluation. In such circumstances: • The clinician should document the reason for refusal of the interview and/or evaluation • If the person is a detainee, the report should be signed by his or her lawyer and another health official. (See § 149 and § 165 in the Istanbul Protocol.) The clinicans shall obtain informed consent V. SOME DILEMMAS ENCOUNTERED DURING THE INTERVIEW PROCESS 1. BEING OBJECTIVE VERSUS BEING EMPATHIC Medical evaluations for legal purposes should be conducted with objectivity and impartiality. Objectivity and impartiality is not in contradiction with being empathic. In this sense, it is essential to maintain the professional boundaries and at the same time to acknowledge pain and distress (Giffard, 2000). The clinician should communicate that he or she is an ally of the individual