Hall P. Lancet 360; 1879. 7 Dec 2002
A global campaign to integrate health and human rights in undergraduate and postgraduate medical training was launched this year by Physicians for Human Rights-UK (PHR-UK). The aim, adopted in consultation with the High Commissioner for Human Rights and UNAIDS, is to anchor the doctor-patient relationship firmly to human rights principles.
Evidence for disparities in health care delivered to racial and ethnic minorities in the USA,1 and reports from UNAIDS on discrimination in HIV/AIDS treatment in India,2 indicate that discrimination by the medical profession is a global issue.
In the first part of the campaign, a report collating evidence of discrimination by UK doctors against various groups of patients was presented in May to the UN committee that monitors the right to the highest attainable standard of health.3 The report was timed to coincide with the committee's assessment of the UK government's observation of its obligations under the International Covenant on Economic Social and Cultural Rights (ICESCR, 1966).
The implications of the report which, for example, cites disparities in the treatment of ischaemic heart disease in women and elderly people, will be debated at a conference at which the UN special rapporteur on the right to health is giving the keynote speech in London, UK, on Dec 9, to mark International Human Rights Day. In response to the report, the UN committee expressed concern at "de facto discrimination in relation to some marginalised and vulnerable groups" and urged the UK government to ensure that human rights education curricula and training programmes give adequate attention to the right to the highest attainable standard of health.
The aim of teaching doctors about human rights is for an ethical code based on human rights instruments that are relevant to medical practice to be adopted in hospitals, medical schools, and general practice. Such a code could take the form of a commitment to support the sections of the Universal Declaration of Human Rights (1948) and general comment 14 (2000) of the ICESCR that define patients' health rights and provide inspirational and practical advice for everyday medical care. To this end PHR-UK's 1997 free, internet-based course in medicine and human rights, which has been used by three UK medical schools, will be updated and adapted for distance learning.
The need to educate doctors in health and human rights is shown especially by discrimination against people living with HIV/AIDS, which UNAIDS regards as the largest obstacle to preventing the spread of the disease.4
Research shows discrimination by a proportion of doctors in the developed and developing world. In India, for instance, relatives rather than patients are often given HIV test results, and seropositive patients may be denied hospital admission for the treatment of unrelated conditions.2
In the UK, a survey showed hospital staff, family doctors, and dentists to be some of the most frequent public sector providers to discriminate against people living with HIV/AIDS--one concern being difficulty finding a dentist or family doctor willing to treat someone with HIV infection.5 Research in the USA has shown that even well meaning doctors who are not overtly biased or prejudiced have unconscious negative attitudes that stigmatise minority ethnic and racial groups--with the result that these groups are less likely to receive advanced treatments for HIV infection, with consequently higher death rates.1
Stigmatisation is a process of devaluation that reinforces existing social inequalities and is difficult to eradicate. To expunge stigmatisation from medical practice, a shift in the doctor-patient relationship is required that frames doctors' moral and ethical responsibilities in the language of human rights obligations, and characterises failure to meet standards as a violation of patients' rights. The chief value of doctors committing to human rights instruments on health is that these instruments are jointly owned by both physician and patient. Furthermore, human rights laws provide the means with which doctors can resist coercion to discriminate against patients.
A global ethical code that makes patients feel valued and respected wherever they live; education in health and human rights so that doctors practise ethical medicine that is based on globally recognised human rights; and the international medical community working together from a common blueprint on the right to health to control the great diseases of the world--all require a personal commitment to the discipline of health and human rights.
Every country in the world is party to at least one human rights treaty containing key provisions on health, and 75% have ratified the ICESCR. Now is the time for doctors worldwide to openly endorse human rights principles and unite around a universal ethical code.
1 Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington: National Academy Press, 2002.
2 Bharat S, Aggleton P, Tyrer P. India: HIV and AIDS-related discrimination, stigmatisation, and denial. Geneva: UNAIDS, 2001: 16-24.
3 PHR-UK. Response to the UK government's fourth report under the International Covenant on Economic, Social and Cultural Rights. St Albans: PHR-UK, 2002.
4 Aggleton P, Parker R, Maluwa M. A conceptual framework and basis for action: HIV/AIDS stigma and discrimination. Geneva: UNAIDS, 2002.
5 Weatherburn P, Anderson W, Reid D, et al. What do you need? Findings from a national survey of people living with HIV. London: Sigma Research, 2002: 63-66.