A/HRC/28/68 omission rather than commission, such as emotional disengagement or unsanitary or unsafe conditions, and result from poor policies rather than from an intention to inflict suffering. Purely negligent conduct lacks the intent required under the prohibition of torture, but may constitute ill-treatment if it leads to pain and suffering of some severity (A/63/175, para. 49). This is the case when the suffering is severe and meets the minimum threshold under the prohibition against torture and other ill-treatment, when the State is, or should be, aware of the suffering, including when no appropriate treatment was offered, and when the State has failed to take all reasonable steps to protect the child’s physical and mental integrity. 52. Private detention is often presented as a preferable alternative to forced criminal or health-related institutionalization of children with special needs, whether those needs be physical, mental or psychological. The Special Rapporteur notes that, because national law often does not regulate private detention centres, there is a gap in legal protections that may lead to rampant abuse. 53. Special attention should be paid to children deprived of their liberty in health-care institutions (including hospitals, public and private clinics, hospices and institutions where healthcare is delivered). Children are detained in such settings primarily to treat psychiatric, psychosocial or intellectual disabilities, or drug dependence issues. Almost all States have legislation that permits the detention of children for psychiatric health purposes. 14 Persons with disabilities are particularly affected by forced medical interventions, and continue to be exposed to unwarranted non-consensual medical practices (A/63/175, para. 40). During his country visits, the Special Rapporteur has observed that, in particular with regard to children with disabilities, “incapacity” is often presumed, which limits their ability to decide where to live and what treatment to receive, 15 and may be taken as the basis of substitution of determination and decision-making by the child, or by parents, guardians, carers or public authorities. 16 Structural inequalities, such as the power imbalance between medical doctors and patients, exacerbated by stigma and discrimination, result in children with disabilities being disproportionately vulnerable to having informed consent compromised (A/HRC/22/53, para. 29). In this context, the Committee on the Rights of Persons with Disabilities, in its general comment No. 1 (CRPD/C/GC/1), explained that involuntary psychiatric treatment is prohibited on the grounds that it violates the right to consent to medical treatment under article 12 of the Convention on the Rights of Persons with Disabilities and the absolute prohibition of torture and cruel, inhuman and degrading treatment (para. 42). The Committee on the Rights of the Child, in its general comment No. 12 (CRC/C/GC/12), stated that children should be provided with information about proposed treatments and their effects and outcomes, including in formats appropriate and accessible to children with disabilities (paras. 48 and 100). 54. The Special Rapporteur observes that children who use, or are suspected of using, drugs are commonly involuntarily confined in so-called rehabilitation centres. Children thus confined are compelled to undergo diverse interventions (A/HRC/22/53, para. 40), including painful withdrawal from drug dependence without adequate medical assistance, administration of unknown or experimental medications, State-sanctioned beatings, caning or whipping, forced labour, sexual abuse and intentional humiliation. Other reported abuses included “flogging therapy”, “bread and water therapy”, and electroshock resulting in seizures, all in the guise of rehabilitation. In some countries, a wide range of other 14 15 16 Carolyn Hamilton et al., “Administrative detention of children: a global report”, UNICEF and the Children’s Legal Centre, February 2011, p. 140. See A/HRC/25/60/Add.1, para. 80 and CRC/C/GC/12, para. 21. See Convention on the Rights of Persons with Disabilities, art. 7. 11