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Violence prevention receives international attention
MEDICINE AND HEALTH POLICY
EU deplores US execution of mentally ill prisoner inmates who pose a danger to themselves or others, or in cases in which “the treatment is in the inmate’s medical interest” (see Lancet 2003; 361: 621). Singleton’s lawyers argued that treating him to make him competent to be executed could not be in his “medical interest”. Singleton’s symptoms had worsened during his imprisonment; he had delusions and heard voices. He was given antipsychotic drugs in the 1990s, but did not always take them. When he became sicker, after not taking them, he was involuntarily medicated. Singleton’s execution was opposed by several groups, including Amnesty International and the European Union (EU). In a letter to Michael Huckabee, the governor of Arkansas, the EU’s current leaders wrote: “The EU strongly believes that the execution of persons suffering from a mental disorder is contrary to widely accepted human-rights norms
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
AP
n Jan 6, 2004, a mentally ill man in Arkansas was executed by lethal injection, after spending nearly a quarter of a century in prison. Charles Singleton was convicted in 1979 of the murder of Mary Lou York, a shop assistant in a grocery store, during a robbery. Diagnosed by prison doctors as a paranoid schizophrenic, Singleton was also at the centre of a decision, by the US 8th Circuit Court of Appeals in February last year, which affirmed the right of states to medicate prisoners forcibly, even if only to execute them. The Supreme Court declined to hear an appeal of the lower court’s decision. A 1986 US Supreme Court decision, Ford versus Wainwright, prohibits execution of mentally ill people on the grounds that such action violates the US Constitution’s ban on “cruel and unusual punishment”. But a 1990 case (Washington versus Harper) paved the way for states to forcibly treat
O
Arkansas’ death-row inmates spend their last night in this cell
and in contradiction of the minimum standards of human rights set forth in several international human rights instruments.” One of the standards referred to is UN Resolution 2003/67, which exhorts any country that still
allows capital punishment “not to impose the death penalty on a person suffering from any form of mental disorder or to execute any such person”. Faith McLellan
Violence prevention receives international attention fficials from several countries met at WHO headquarters in Geneva on Jan 12 to launch a new initiative: the Global Interpersonal Violence Prevention Alliance (GIVPA). The purpose of this organisation will be to prevent interpersonal violence and avoid its effects on health. “The worsening trends of violence will not be reversed without this kind of commitment”, Etienne Krug of WHO’s Department of Injuries and Violence Prevention told The Lancet. WHO said interpersonal violence kills 1400 people every day. Many more are injured, beaten, or tortured. Since the launch of WHO’s report on violence and health in Oct 2002, around 15 countries have started to develop national plans for violence prevention, Krug noted. Despite these achievements, a major challenge for the new alliance is to eliminate the taboo associated with violence. “We need to . . . initiate the discussion”, Krug said. “As long as we cannot talk about it we cannot adequately understand the problem and start planning prevention.” Patricia Omidian, a Kabul-based medical anthropologist, hoped that GIVPA would pay special attention to violence against women in southeast Asia, particularly Pakistan, Afghanistan, and India. In Pakistan, for example, hundreds of women are killed by their families each year in the name of “honour”. But “laws in the region often protect perpetrators rather than the victims of violence”, she warned. For example, rape victims in Pakistan and Afghanistan are often
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imprisoned for having illegal sexual contact. Amar Jesani (Centre for Enquiry into Health and Allied Themes, Mumbai, India) welcomed the establishment of the new alliance, but suggested that it should through nongovernmental organisations and individuals dedicated to preventing violence, in addition to government agencies. He complained that in many conflict situations—for example, the recent violence in Gujarat, India—government agencies and “even many health professionals from the private sector” might have personal or political agendas that make impartiality difficult to ensure. In such situations, he said, it is only the independent organisations that can raise voice against violence. Anthony Zwi (University of New South Wales, Sydney, Australia), who co-edited WHO’s report on violence and health suggests all national plans and action to address violence must be informed by evidence, and should be sensitive to local contexts. He believes that efforts have to be directed to the key whole-of-government interventions, however difficult they are: promoting early childhood interventions and support to families; instituting public policy controls over alcohol and firearms; and seeking a more people-centred globalisation. “Solutions from the health sector alone are limited”, he concluded. Khabir Ahmad
THE LANCET • Vol 363 • January 17, 2004 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
EU deplores US execution of mentally ill prisoner inmates who pose a danger to themselves or others, or in cases in which “the treatment is in the inmate’s medical interest” (see Lancet 2003; 361: 621). Singleton’s lawyers argued that treating him to make him competent to be executed could not be in his “medical interest”. Singleton’s symptoms had worsened during his imprisonment; he had delusions and heard voices. He was given antipsychotic drugs in the 1990s, but did not always take them. When he became sicker, after not taking them, he was involuntarily medicated. Singleton’s execution was opposed by several groups, including Amnesty International and the European Union (EU). In a letter to Michael Huckabee, the governor of Arkansas, the EU’s current leaders wrote: “The EU strongly believes that the execution of persons suffering from a mental disorder is contrary to widely accepted human-rights norms
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
AP
n Jan 6, 2004, a mentally ill man in Arkansas was executed by lethal injection, after spending nearly a quarter of a century in prison. Charles Singleton was convicted in 1979 of the murder of Mary Lou York, a shop assistant in a grocery store, during a robbery. Diagnosed by prison doctors as a paranoid schizophrenic, Singleton was also at the centre of a decision, by the US 8th Circuit Court of Appeals in February last year, which affirmed the right of states to medicate prisoners forcibly, even if only to execute them. The Supreme Court declined to hear an appeal of the lower court’s decision. A 1986 US Supreme Court decision, Ford versus Wainwright, prohibits execution of mentally ill people on the grounds that such action violates the US Constitution’s ban on “cruel and unusual punishment”. But a 1990 case (Washington versus Harper) paved the way for states to forcibly treat
O
Arkansas’ death-row inmates spend their last night in this cell
and in contradiction of the minimum standards of human rights set forth in several international human rights instruments.” One of the standards referred to is UN Resolution 2003/67, which exhorts any country that still
allows capital punishment “not to impose the death penalty on a person suffering from any form of mental disorder or to execute any such person”. Faith McLellan
Violence prevention receives international attention fficials from several countries met at WHO headquarters in Geneva on Jan 12 to launch a new initiative: the Global Interpersonal Violence Prevention Alliance (GIVPA). The purpose of this organisation will be to prevent interpersonal violence and avoid its effects on health. “The worsening trends of violence will not be reversed without this kind of commitment”, Etienne Krug of WHO’s Department of Injuries and Violence Prevention told The Lancet. WHO said interpersonal violence kills 1400 people every day. Many more are injured, beaten, or tortured. Since the launch of WHO’s report on violence and health in Oct 2002, around 15 countries have started to develop national plans for violence prevention, Krug noted. Despite these achievements, a major challenge for the new alliance is to eliminate the taboo associated with violence. “We need to . . . initiate the discussion”, Krug said. “As long as we cannot talk about it we cannot adequately understand the problem and start planning prevention.” Patricia Omidian, a Kabul-based medical anthropologist, hoped that GIVPA would pay special attention to violence against women in southeast Asia, particularly Pakistan, Afghanistan, and India. In Pakistan, for example, hundreds of women are killed by their families each year in the name of “honour”. But “laws in the region often protect perpetrators rather than the victims of violence”, she warned. For example, rape victims in Pakistan and Afghanistan are often
O
220
imprisoned for having illegal sexual contact. Amar Jesani (Centre for Enquiry into Health and Allied Themes, Mumbai, India) welcomed the establishment of the new alliance, but suggested that it should through nongovernmental organisations and individuals dedicated to preventing violence, in addition to government agencies. He complained that in many conflict situations—for example, the recent violence in Gujarat, India—government agencies and “even many health professionals from the private sector” might have personal or political agendas that make impartiality difficult to ensure. In such situations, he said, it is only the independent organisations that can raise voice against violence. Anthony Zwi (University of New South Wales, Sydney, Australia), who co-edited WHO’s report on violence and health suggests all national plans and action to address violence must be informed by evidence, and should be sensitive to local contexts. He believes that efforts have to be directed to the key whole-of-government interventions, however difficult they are: promoting early childhood interventions and support to families; instituting public policy controls over alcohol and firearms; and seeking a more people-centred globalisation. “Solutions from the health sector alone are limited”, he concluded. Khabir Ahmad
THE LANCET • Vol 363 • January 17, 2004 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.