Health and Human RightsHealth and Human Rights

BIOETHICS AND MEDICOLEGAL DIVISIONFACULTY OF MEDICINEFACULTY OF MEDICINE

UNIVERSITAS SUMATERA UTARA

WHO Definition of HealthWHO Definition of Health

Health is a state of complete physical, mental p p y ,and social well-being and not merely the absence of disease or infirmity

The correct bibliographic citation for the definition is:C fPreamble to the Constitution of the World Health

Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July , , , ; g y1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948into force on 7 April 1948.

The Definition has not been amended since 1948.

Bringing Health and Human Rights g g gTogether

Health and Human Rights

The goal of the health and human rights

g

The goal of the health and human rights linkage is to advance the human well-being beyond that which could be reachedbeyond that which could be reached by either the Health or the Human Rights

h i d d tlapproach, independently

Every country in the world is now party y y p yto at least one human rights treaty

that addresses health-related rights,that addresses health related rights, including the right to health

and a number of rights related toand a number of rights related to conditions necessary for health

Links Between Health, Biomedical Ethics and Human Rights

UNESCO D l ti Bi thi

g

UNESCO Declaration on Bioethics and Human Rights

Global Health Bi thiGlobal Health Diplomacy

Bioethics Education

Human Rights

Health and Human Rights g

• Violations or lack of attentionViolations or lack of attention to human rights can have i h lthserious health consequences

(e g harmful traditional practices slavery(e.g. harmful traditional practices, slavery, torture and inhuman

and degrading treatment, violence against women and children)

Health and Human RightsHealth and Human Rights

Health policies and programmes• Health policies and programmes can promote or violate human rights p g

in their design or implementation(e g freedom from discrimination(e.g. freedom from discrimination,

individual autonomy, rights to participation privacyrights to participation, privacy

and information)

Health and Human RightsHealth and Human Rights• Vulnerability to ill-healthVulnerability to ill-health

can be reduced by taking stepst t t t d f lfillto respect, protect and fulfill

human rights (e.g. freedom from discrimination

on account of race sex and gender roleson account of race, sex and gender roles, rights to health, food and nutrition,

education housing)education, housing)

Source: “25 Questions & Answers on Health & Human Rights”, WHO

Commonalities: Bi di l Ethi d H Ri htBiomedical Ethics and Human Rights

B th G t f W ld W II• Both Grew out of World War II (Nuremburg Code)

• Both Focus on Individual Rights and gHuman Dignity

• Both ebbed in 1950’s and 1960’s and resurged in the 1980’s and 1990’sresurged in the 1980 s and 1990 s

Commonalities: Biomedical Ethics and Human RightsBiomedical Ethics and Human Rights

• Both have distanced from the philosophical• Both have distanced from the philosophical and moved towards more practical approach

• Neither imbued with strong enforcement capacity (unless encoded into local law)capacity (unless encoded into local law)

B th d b th i it• Both are empowered by their capacity to inspire policy change in social and professional norms

The History of Health and Human Rights

• In 1945, The United Nations stated ,that all people are “born free and equal

in dignity and rights”g y g

• In 1948, The Universal Declaration of Human Rights was passed by the UN General Assemblyby the UN General Assembly

The Right To Health

Ethical Lapses –pHuman Subject Protection

Renate; #70917. “I was taken to a hospital where I was measured and X-rayed; blood was taken from my neck. Once, I was strapped to a table and cut with a knife. I got poison injections that made me throw up and have diarrhea.”

Ethical Lapses –Human Subject Protection

• Dr Carl Clauberg (left) with his staff• Dr. Carl Clauberg (left) with his staff in the operating room in Block 10, A h itAuschwitz.

• (Non-surgical methods of sterilization on Jewish female prisoners in Auschwitz I)on Jewish female prisoners in Auschwitz I)

The prosecution team during the Doctors Trial; Nuremberg Germany;the Doctors Trial; Nuremberg, Germany;

December 1946

Ethical Lapses – Human Subject ProtectionThe Oslo Study 1909 NorwayRosenwald Study 1930 USARosenwald Study 1930 USATuskegee Syphilis Study 1932 – 1972 USANazi Medical Expermts 1941-1945 GermanyU.S. Radiation Expermts 1944-1974 USA

"The men's status did not warrant ethical debate.

They were subjects, not patients; y j , p ;clinical material, not sick people"

Universal Declaration of Human Rights, Article 25Article 25

“Everyone has the right to a standardof living adequate for the health and well g q

being of himself and of his family, including food, clothing, housing and medical care

and necessary social services, and the right to security in the event g y

of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstancesold age or other lack of livelihood in circumstances

beyond his control.”

International Bill of Human Rightsg

• Universal Declaration of Human Rights• Universal Declaration of Human Rights

• International Covenant on Civil and Political Rights (ICCPR)

• International Covenant on Economic,International Covenant on Economic, Social and Cultural Rights (ICESC)

International Covenant of Economic, Social and Cultural Rights,

Article 12(1)Article 12(1)

The States Parties to the present Covenant recognizeto the present Covenant recognize

the right of everyone to the enjoyment of the highest attainable standard

of physical and mental health.of physical and mental health.

International Covenant of Economic, Social and Cultural Rights Article 12(2)

• The steps to be taken by the States Parties to the present t t hi th f ll li ti f thi i ht

Social and Cultural Rights, Article 12(2)

covenant to achieve the full realization of this right shall include those necessary for:

a) The provision for the reduction of the stillbirth rate andof infant mortality and for healthy development of the child;

b) The improvement of all aspects of environment and industrial hygiene;

c) The prevention, treatment and control of epidemic, endemicoccupational and other diseases

d) The creation of conditions which would assure to all medicaservice and medical attention in the event of sickness.

General Comment 14 (2000) The right to the highest attainable standard

f h lth ICESCR A ti l 12of health, ICESCR Article 12

I t t i t t ti f th C itt• Important interpretation from the Committee on Economic, Social and Cultural Rights

• “Health is a fundamental human rightindispensable for the exercise p

of other human rights”

Cl l t t th t th i ht t h lth• Clearly states that the right to health includes the determinants of health

and NOT THE RIGHT TO BE HEALTHYand NOT THE RIGHT TO BE HEALTHY

General Comment 14• The right to health contains essential

elements:elements:– Availability

A ibilit– Accessibility• Nondiscrimination

Physical accessibility• Physical accessibility• Economic accessibility (affordability)

Acceptability– Acceptability– Quality

P ti i ti– Participation

International Treaties and Conventions RelevantConventions Relevant

to Health and Human Rights

• Convention on the Elimination of All Forms of Discrimination Against Women (1979)of Discrimination Against Women (1979)

C ti A i t T t d Oth C l• Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or P i h t (1984)Punishment (1984)

• Convention on the Rights of the Child (1989)

International Treaties and Conventions RelevantConventions Relevant

to Health and Human Rights

• International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families (1990)( )

• Convention on the Prohibition and• Convention on the Prohibition and Immediate Action for the Worst Form

f Child L b (1999)of Child Labour (1999)

CEDAW (1979)CEDAW (1979)Convention on the

Elimination of All Forms of Discrimination Against

WomenWomen

CEDAW (1979), Article 1• For the purposes of the present Convention,

the term "discrimination against women"the term discrimination against womenshall mean any distinction, exclusion or

restriction made on the basis of sex which has the effect or purpose of impairing

or nullifying the recognition, enjoyment or exercise by women irrespective of theiror exercise by women, irrespective of their marital status, on a basis of equality of men

and women, of human rights and f d t l f d i th liti lfundamental freedoms in the political,

economic, social, cultural, civil or any other fieldcivil or any other field.

CEDAW (1979) Article 12CEDAW (1979), Article 12

• 1 States Parties shall take all appropriate1. States Parties shall take all appropriate measures to eliminate discrimination

against women in the field of health careagainst women in the field of health carein order to ensure, on a basis of equality

f dof men and women,access to health care services,

including those related to family planning

CEDAW (1979) Article 12CEDAW (1979), Article 12 • 2. Notwithstanding the provisions2. Notwithstanding the provisions

of paragraph I of this article, States Parties shall ensure to womenStates Parties shall ensure to women appropriate services in connection

with pregnancy confinementwith pregnancy, confinement and the post-natal period,

ti f i hgranting free services where necessary, as well as adequate nutrition

d ring pregnanc and lactationduring pregnancy and lactation

CRC (1989)Convention on the Rights of g

the Child

CRC (1989) Article 1CRC (1989), Article 1

• For the purposes of the present Convention, a child means every human beinga child means every human being below the age of eighteen years

unless under the law applicable to the child, majority is attained earlier. j y

CRC (1989), Article 24

1 States Parties recognize1. States Parties recognize the right of the child to the enjoyment

of the highest attainable standard of health and to facilities for the treatment

of illness and rehabilitation of health. States Parties shall strive to ensure

that no child is deprived of his or her right of access to such health care servicesof access to such health care services

CRC (1989), Article 24 continued

• 2. States Parties shall pursue full implementation of this right and, in particular,

shall take appropriate measures:

(a) To diminish infant and child mortality;

(b) To ensure the provision of necessary medical assistance and health caremedical assistance and health care to all children with emphasis on the development of primary health care;on the development of primary health care;

CRC (1989), Article 24 continued2. States Parties shall pursue full implementation

of this right and, in particular, shall take appropriate meas resshall take appropriate measures:

(c) To combat disease and malnutrition, including within the framework of primary health care, through, inter alia, th li ti f dil il bl t h lthe application of readily available technology and through the provision of adequate nutritious foods and clean drinking waternutritious foods and clean drinking-water, taking into consideration the dangers and risks of environmental pollution;and risks of environmental pollution;

CRC (1989), Article 24 continued(d) T i t t l(d) To ensure appropriate pre-natal

and post-natal health care for mothers; ( ) T th t ll t f i t(e) To ensure that all segments of society,

in particular parents and children, are informed have access to educationare informed, have access to education and are supported in the use of basic knowledge of child health andgnutrition, the advantages of breastfeeding, hygiene and environmental sanitation and the prevention of accidents;

(f) To develop preventive health care, guidance for parents and family planning education and services.

CRC (1989), Article 243. States Parties shall take all effective

and appropriate measures with a view to abolishing traditional practices prejudicialto abolishing traditional practices prejudicial to the health of children

4. States Parties undertake to promote and encourage international co-operation with a view to achieving progressively the full realization of the right recognized g gin the present article. In this regard, particular account shall be taken of the needsparticular account shall be taken of the needs of developing countries.

Indonesian LawIndonesian Law

• Women’s Health: ?(Domestic Violence Law of 2004)(Domestic Violence Law of 2004)

• Child Health: Child Protection Law (2002)

How?How?

• How do vulnerable populations get protections?get protections?

Advocacy for Health Rights

The Roles of Doctors and Lawyers as Advocates for Change

Mechanisms for Legal Redress of Human Rights Abuses

• National legal judicial system• National legal judicial system

• Regional mechanism

• International mechanism

Regional Mechanismsg

Regional human rights mechanism

Inter-American systemInter-American system(OAS) Africa

EuropeCouncil of Europe & EU

Regional Human Rights Instruments

• American Declaration of the Rights and Duties of Man (1948)

• European Convention for the Protection of Human Rights and Fundamental Freedoms (1950)

• African Charter on Human and People’s Rights (1981)

• “Protocol of San Salvador” (1988)

• Inter-American Convention on the Elimination • of All Forms of Discrimination Against Persons with

Disabilities (1999)

International Human Rights M h iMechanisms

The UN System

TensionTension

P bli IndividualPublic Health

Individual Rights

(Human Rights)(Human Rights)

Thank You