1. Mary Robinson backs PHR-UK initiative on AIDS
Last December PHR-UK's Chair, Peter Hall, met the High Commissioner for Human Rights at a luncheon meeting organised by the National AIDS Trust and the All Party Parliamentary Group on AIDS at Westminster. Mary Robinson's crucial message that day was that discrimination and stigmatisation had become the most important problem in the global battle against HIV and AIDS. There is, she replied to Peter Hall's question, developing evidence implicating health professionals in discrimination.
AIDS is the largest threat facing mankind. Most of the 60 million infected with HIV to date will die from the disease, dwarfing the menace from, for instance, deaths from terrrorism.
The management of AIDS is primarily a health matter, notwithstanding its important social aspects, and that is what makes discrimination by doctors so odious and so consequential. Violations of human rights have long been acknowledged as important factors promoting HIV transmission, and speeding progress to AIDS and death. Now those living with HIV can anticipate not only the inevitable decline to premature death, aggravated by fear for the future of any children, but also uncertainly about the commitment of the profession most influential in managing their illness. And importantly, as leading members of society with special access to people living with HIV/AIDS, doctors have a pivotal role in influencing society's perceptions of the illness. .
Discrimination against patients contravenes a number of medical ethical codes - it violates one of six non-derogable obligations within Article 12 of the Covenant on Economic, Social and Cultural Rights (CESCR), the foremost legal source for the international human right to the highest attainable standard of health. Both the Geneva Declaration and the International Code of Medical Ethics proscribe discrimination, as does the Hippocratic Oath.
Recently evidence has been emerging that a significant proportion of doctors discriminate against different groups of patients. PHR-UK’s shadow report on Article 12 submitted this May to the UN Committee on Economic Social and Cultural Rights quotes research demonstrating discrimination restricting healthcare access within the NHS for groups such as elderly people, women, and people with learning disabilities (1). The prestigious National Academies' Institute of Medicine recently documented discrimination by the medical profession as a widespread phenomenon in the US (2).
PHR-UK considers that the effective elimination of discriminatory behaviour requires a profound, fundamental change in erring doctors’ perceptions of patients; an ideological transformation that recognises the inherent importance of each life, as expounded in the Universal Declaration of Human Rights (UDHR).
Doctors recognise the need for examinations, but they only assess knowledge at one point in time. Although continuing medical education refreshes and reinforces knowledge, evaluation of the quality of medical practice can only be measured by retrospective assessment of organisational or individual performances. Instruments that assess performance are often not sophisticated enough to recognise optimum medical practice, which at times can be nuanced, and can mislead. Importantly, they are always retrospective, so too late to have prevented substandard practice taking place.
Persuading doctors to publicly commit to ethical medical practice would prospectively help ensure they do not discriminate, according to a 1992 BMA working party's conclusion that personal declamations strengthen a doctor's resolve to behave with integrity (3). Medical ethical codes are governed by principles best particularised in human rights treatises - for instance the Hippocratic Oath anticipated human rights by nearly 2.5 millennia. A reinterpretation of the Oath that takes account of medical advances and social developments since 400 BC bears comparison with international law on patients rights (4) Any campaign to persuade doctors worldwide to adhere to medical ethics must derive from precepts that hold, and will continue to hold, global appeal. For maximum acceptability and durability the proposed code should avoid pomposity, exclusivity and self reverence; and, to promote public confidence, should not be 'owned' by the profession.
PHR-UK is consulting with the Office of the High Commissioner of Human Rights and UNAIDS over a proposal that the organisation take a leading role in a campaign to persuade doctors worldwide to commit to those sections of the UDHR that are pertinent to medical practice, and to promoting Article 12 of the CESCR as developed by General Comment 14 (GC 14). The 65 paragraph GC 14 provides a comprehensive explication of contemporary standards of ethical healthcare provision as well as the predeterminants for health such as the right to adequate nutrition.
The combination of the UDHR, which introduces a proper sense of awe and respect for each human being prerequisite to a healthy relationship between vulnerable patients and powerful doctors, and of GC 14, provides a unique blend of the inspirational and the functional in workaday ethical medical practice. Short of achieving a public commitments from every doctor, the educational aspects of the campaign will promote ethical medical practice, and empower the general public with the information needed to advocate on health issues.
PHR-UK is suited to playing a leading role in the campaign as a result of the authority derived from the organisation’s influential part in developing G 14 from inception to publication (1998-2000); because PHR-UK has a formidably comprehensive perspective on human rights having documented egregious violations ranging from discrimination in healthcare in South Africa (1991), to the Rwandan genocide (1994), to doctors' participation in torture (1997); and because PHR-UK is the foremost teacher of health and human rights in the UK.
Peter Hall took the opportunity to update Mary Robinson after she gave the Commonwealth Lecture in London recently. She is happy to support PHR-UK’s campaign and recommended we collaborate with the new Special Rapporteur on the Right to Health.
1. PHR–UK. Response to the UK Government’s Fourth Report under the International Covenant on Economic, Social and Cultural Rights. 2002.
2. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. March 2002
3. BMA. Medicine betrayed. London: Zed Books, 1992.
4. Hall P. Human rights within the Hippocrtic Oath. Presented at IFHHRO Health and Human Rights Conference, Amersfoort May 2002
2. PHR-UK informs UN Committee on Right to Health shortcomings in the United Kingdom
UN COMMITTEE RECOMMENDS UK STRENGTHENS ITS HUMAN RIGHTS OBLIGATIONS WITHIN HEALTHCARE
PHR-UK attended the meeting of the UN Committee on Economic, Social and Cultural Rights on May 6th and 7th to consider the implementation of the International Covenant on Economic, Social and Cultural Rights by the UK Government. This is the fourth appearance by the UK before the Committee, which sits in Geneva and examines States parties every five years.
PHR-UK provided the Committee, which consists of 18 independent experts, with copies of its report on the UK’s implementation of the right to health, which is Article 12 of the Covenant. One Committee member referred to information received from the PHR-UK Report during the session, and commented that the Committee had found it extremely helpful. The Committee also had copies of a report, produced by a coalition of UK NGOs, to which PHR-UK had contributed a chapter on the right to health.
PHR-UK’s Senior Adviser Bernie Hamilton addressed the Committee at its NGO session, a week earlier. The Committee paid great interest to the right to health, which is one of ten substantive rights listed in the Covenant, and devoted twice as much time as they normally do to its consideration. Many of the Committee’s questions relating to the right to health reflected the concerns outlined in our report. Below is a summary of the main points raised.
Paul HUNT [New Zealand]
What mechanisms are in place within the Administration to ensure that the UK’s obligations under the treaty are taken into account when formulating economic, social and cultural policies, including those of international financial institutions of which the UK is a member, as well as those obligations of other States parties ?
Should health care standards within the UK overseas territories be seen as equivalent to those of the UK or of neighbouring States, and if the latter, is this discrimination ?
Yuri KOLOSOV [Russian Federation]
Does human rights education include the International Covenant on Economic Social and Cultural Rights ?
Is it provided at primary, secondary and higher levels ?
Is it provided to police officers, social workers, nurses and judges?
Is the right to health available to each child ?
Waleed SADI [Jordan]
What is the availability of abortion in Northern Ireland for the poor as the rich can afford private abortions?
Given the problems experienced by Canada with privatisation, is the NHS working ?
Is there an anti-smoking campaign ?
What is known about the causes of cancer in the UK ?
What is the incidence of, and treatment for, cardiovascular
Eibe RIEDEL [Germany]
... drew attention to a report submitted [...] by Physicians for Health -UK, ...
Have waiting times been reduced?
Has a Care Standards Commission been established as a result of the Care Standards Act of 2001 ?
What access to private medical treatment is there by minorities, the marginalised and travellers ?
What access is there to tertiary care for the most vulnerable in society?
Are condoms, clean needles and appropriate immunization
available for the prison population ?
What is the medical school selection process, and how are the disadvantaged selected ?
What is the situation with regard to bullying within the medical profession, described as 37 per cent in the British Medical Journal ?
How does the Cancer Plan 2000 cover palliative care ?
Sergei MARTYNOV [Belarus]
What is the situation regarding access to health care, given that three out of four health managers believed that discrimination against the elderly existed ?
3. PHR-UK the foremost teacher of health and human rights in the UK
During the autumn term 2001 a PHR-UK team taught the human rights component of a unique intercalated BSc in International Health at the Whittington Hospital campus of University College London (UCL). The 10 half day sessions run by PHR-UK were judged the most popular part of the BSc course. Its success confirms PHR-UK as the foremost teacher of health and human rights in the UK.
The content of the UCL course taught by PHR-UK is an updated version of Rachel Maxwell's (nee Izzard) participatory internet course in Medicine and Human Rights developed in Dundee in collaboration with Professor Derrick Pounder in 1996. Having studied both European Human Rights and Medicine and the Law as part of her law degree, Rachel developed the cross-disciplinary course over 9 months. The first of its kind in the UK it was immediately adopted by the University of Dundee as part of the undergraduate curriculum. The topics are taught using a variety of educational strategies encouraging self-directed learning which promote the development of important generic competencies including working in groups, and the creating and making of formal, assessed presentations. The original course has been taken up by 4 medical schools in the UK.
The PHR-UK course teachers were Bernie Hamilton, who teaches human rights at Birbeck College. and Peter Hall, both of whom are been appointed honorary senior lecturers at UCL. The 10 sessions comprised an introduction to human rights and a concluding session, bracketing 8 sessions entitled Mechanisms of Redress, Torture and Death in Custody, Doctors and Torture, The Death Penalty, Public Health Control and HIV/AIDS Protection, Rape in Situations of Conflict, Seeking Asylum, and Economic, Social and Cultural Rights and the Right to Health.
The students are to be congratulated on achieving four firsts, nine 2:1s and two 2:2s. They formally evaluated the PHR-UK sessions as either excellent or good. They made a number of helpful comments which will be taken into account in designing futures course.
The success of the health and human rights component of the UCL BSc can be attributed to three factors - the quality of Rachel Maxwell's original course, the quality of the BSc students who come from all over the UK, and to Bernie Hamilton's scholarship and teaching skills. Plans to repeat the UCL course annually are well advanced
4. When doctors meet lawyers
PHR-UK Chair Peter Hall and Senior Adviser Bernie Hamilton attended the annual meeting of the International Federation of Health and Human Rights Organisations this June in Amersfoort in The Netherlands. The meeting had been scheduled to be held in Boston last fall, but was postponed because of the September 11 attacks. All eight national delegations attended, together with various observers, including the BMA, the Commonwealth Medical Association Trust and Amnesty International.
The theme of the annual conference was the Right to Health, and was attended by a number of international lawyers, including Professor Kees Flinterman, Brigit Toebes, author of The Right to Health, and Wim Coomans of the Dutch Section of the International Commission of Jurists, from the Netherlands, Eibe Riedel, CESCR rapporteur on the right to health, from Germany and Judith Asher, editor of the NGO handbook on the right to health, from Canada.
There were some hilarious moments, such as when IFHHRO delegates Len Rubenstein and Bernie Hamilton asked the speakers about monism and about the legal authority of General Comments, and lapsed into esoteric dialogues from which they had to rapidly extricate themselves before the conference theme was lost.
PHR-UK Chair, Dr. Peter Hall, who gave a paper on the parallels between the Hippocratic Oath and General Comment 14 on the Right to Health, said that the Conference was one of the best he could recall. “I think that when lawyers and doctors get to spend some time together like this examining common problems, we really come to appreciate the contribution that each can make in advancing human rights law”, said Dr. Hall as the conference closed.
The UN is revising its international guidelines on International Human Rights and HIV/AIDS. PHR-UK would like to contribute to the discussion and dissemination of these guidelines. PHR-UK also plans to draw the attention of the new Special Rapporteur on the Right to Health to the importance of HIV/AIDS.
5. PHR-UK visits Washington and Geneva
Senior Adviser Bernie Hamilton visited Washington DC in March and Geneva in April. He met with Miriam Maluwa in both Washington and Geneva to follow up on the meeting PHR-UK Chair Dr. Peter Hall had with UN High Commissioner for Human Rights Mary Robinson in December. While in DC, Bernie also met with Audrey Chapman, who chaired PHR-UK’s 1999 Conference on the General Comment to the Right to Health in St. Albans.
Miriam Maluwa is the Legal Adviser to UNAIDS, and specialises in human rights. PHR-UK is very concerned about best practice and discrimination within the health profession, and is prepared to make this the theme of International Federation of Health and Human Rights Organisations’ conference next year, and host it. The provisional title is “HIV/AIDS: Universal Precautions, Universal Rights”.
This proposal was accepted by IFHHRO at its annual business meeting, held in the Netherlands in May. The conference will depend on PHR-UK securing financial support of course, and donations or advice from our members are, as ever appreciated.
Bernie also had a joint meeting in Geneva with Lisa Oldring of the Office of the High Commissioner of Human Rights and with Ian Grubb of the World Health Organisation. It was agreed that if we are to combat discrimination in the area of HIV/AIDS within the health profession, we need to ensure that human rights standards are known and accepted, that the techniques and technologies of universal precautions are known and accessible, and that procedures are available for monitoring, reporting and remedying violations.
Dr. Peter Hall, also plans to meet with UN staff working on human rights and HIV/AIDS either in Geneva or at the Human Rights session at the World HIV/AIDS Conference in Barcelona this July.