PHA-Exch> Teaching of human rights in medical schools

[Claudio Schuftan]

from Peterhall at doctorsforhumanrights.


*Submission to the GMC on education for Tomorrow’s Doctors*

*The right to the highest attainable standard of health should*

*be taught within the Core Undergraduate Medical Curriculum*

*1. The embedment of human rights within healthcare delivery is now
Government policy*

The publication by the Department of Health of the policy document *Human
Rights in Healthcare -*

*A Framework for Local Action *in March 2007 was a seminal event - it is the
first time a government

has acknowledged the importance of respect for human rights to health.
"Neglecting people’s

human rights is bad for their health. In contrast, the protection and
promotion of their human rights

is not only good for individuals’ health; it makes for better services for
everyone".1 The document,

which focuses primarily upon the Human Rights Act, listed nine advantages
from using a human

rights approach to healthcare, including the facilitation of the design and
delivery of health services

in a person-centred way. In October 2008 the Department of Health published
a second edition of

the policy document that takes account of collaborative work between the
Department and five

NHS Trusts at incorporating human rights into healthcare delivery since 2007
2.

*2.0 Making the case for education for doctors on human rights*

2.1 Health rights

Health rights are ubiquitous. Every country is party to at least one, and
many generic laws such as

the Human Rights Act enjoy surrogate health rights status through ‘knights
move’ case law3 4. The

Magna Carta of health rights is Article 12 of the UN International Covenant
on Economic, Social

and Cultural Rights, along with its General Comment 14 - a sixty five
paragraph explication that

exhaustively defines states’ obligations, health entitlements, and their
ethical implementation using

Doctors for Human Rights, 91 Harlech Rd, Abbots Langley, WD5 0BE
www.doctorsforhumanrights.org/

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1 Equality and Human Rights Group. Human rights in health—a framework for
local action. p4. London: Department of Health,

2007.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073473
(accessed

14/03/2009)

2 Department of Health (2008) Equality and Human Rights Group. Human rights
in health‹a framework for local action. p18.

London: Department of Health, 2008
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/

PublicationsPolicyAndGuidance/DH_088970 (accessed 14/03/2009)

3 Eleanor D. Kinney, The International Human Right to Health: What Does This
Mean For Our Nation And World? Indiana Law

Review, Vol. 34, 1465 (2001)

4 Samanta A, Samanta J. The Human Rights Act 1998—why should it matter for
medical practice? J R Soc Med 2005;98:404-410

http://jrsm.rsmjournals.com/cgi/reprint/98/9/404 (accessed 14/03/2009)

human rights principles5 6. Four in every five countries worldwide have
ratified the Covenant as

binding international law. The findings of the 2008 report from the UN
Commission on Social

Determinants of Health, *Closing the gap, *leaves no doubt as to the pivotal
importance of the

conditions of daily life – the circumstances in which people are born, grow,
live, work, and age - to

health.7 As the former UN Special Rapporteur on the right to the highest
attainable standard of

health (Special Rapporteur) observed, *Closing the gap *amounts to a human
rights report because it

exposes systemic inequality and discrimination on a global scale, and the
struggle against inequality

and discrimination which lie at the heart of human rights.8

2.2 Doctors understanding of health rights

It is now thirty three years since the UK ratified the International
Covenant on Economic, Social

and Cultural Rights, and fourteen years on from the World Conference On
Human Rights in Vienna

that recognised the importance of special education in human rights and
humanitarian law for health

professionals. Yet doctors remain largely ignorant of the significance of
economic, social and

cultural rights in general, and the right to the highest attainable standard
of health in particular. As

the Special Rapporteur explained to the Human Rights Council in 2007, the
right to health is one of

the most extensive and complex human rights in the international lexicon,
and cannot be realised

without health professionals. He added, “To be blunt, most health
professionals whom the Special

Rapporteur meets have not even heard of the right to health. If they have
heard of it, they usually

have no idea what it means, either conceptually or operationally. If they
have heard of it, they are

likely to be worried that it is something that will get them into trouble”.9

Most doctors' understanding of health rights is sketchy. Many are sceptical
of their relevance to

healthcare, yet they are the ally of good medical practice and scourge of
inadequate resources. They

neither create limitless responsibility nor inspire endless potential for
litigation. A BMJ editor

recently complained that a paper on health rights submitted for publication
“covers complex

concepts and laws that most readers will know nothing about, and the
language is dense and filled

with jargon” (personal experience). Successful submissions for publication
of human rights papers

in medical journals are rare. A common reason for rejection is, the editors
claim, that they are of

insufficient interest to the reader. Yet, until the medical profession
receives adequate education on

health rights, medical practitioners will remain indifferent because of
ignorance of the importance

of human rights to health.

Doctors for Human Rights, 91 Harlech Rd, Abbots Langley, WD5 0BE
www.doctorsforhumanrights.org/

2

5 United Nations. International Covenant on Economic Social and Cultural
Rights. Geneva: UN, 1976

http://www2.ohchr.org/english/law/cescr.htm (accessed 14/03/2009)

6 United Nations. The right to the highest attainable standard of
health. Geneva:
UN, 2000. (General comment No 14.)

www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.En?OpenDocument (accessed
14/03/2009)

7 CSDH (2008). Closing the gap in a generation: health equity through action
on the social determinants of health. Final Report of

the Commission on Social Determinants of Health. Geneva, World Health
Organization. http://www.who.int/social_determinants/

thecommission/finalreport/en/index.html (accessed 14/03/2009)

8 Hunt P. (2009) Missed opportunities: human rights and the Commission on
Social Determinants of Health. Global Health

Promotion. Supplement 1, 2009

9 Special Rapporteur on the right to the highest attainable standard of
health (2007) Hunt P, Report on progress and obstacles to the

health and human rights movement, in addition to cases on the right to
health and other health-related rights. This report (A/HRC/

4/28) was submitted to the Human Rights Council on 17 January 2007

http://www2.essex.ac.uk/human_rights_centre/rth/reports.shtm (accessed
14/03/2009)

2.3 The importance of a human rights culture within healthcare delivery

The parliamentary Joint Committee on Human Rights has now carried out three
separate

investigations; into healthcare for elderly people, for asylum seekers and
for people with learning

disabilty - all of which exposed violations of human rights. “In the course
of our recent inquiries on

the treatment of asylum seekers and the human rights of older people in
healthcare, we have raised

our concerns about the lack of respect afforded to the human rights of the
some of the most

marginalised and vulnerable members of our society. In the course of this
inquiry, these concerns

have intensified. The evidence reveals that adults with learning
disabilities continue to face a high

level of prejudice and discrimination, ranging from patronising behaviour to
criminal assaults”.10

The 2008 Michael Inquiry into healthcare for people with learning
disabilities reported evidence of

appalling examples of discrimination, abuse and neglect across the range of
health services.11 More

recently, the Parliamentary and Health Service Ombudsman’s inquiry into the
deaths of six people

with learning disabilities publicised in the Mencap report *Death by
indifference*, described “the

devastating impact of organisational behaviour which does not adapt to
individual needs”12.

Worryingly, not only did the Ombudsman discover a lack of leadership and a
failure to understand

the law in relation to disability discrimination and human rights, but
despite the extensive

recommendations from the Michael Inquiry, she is “still left with an
underlying concern that similar

failures to those identified in the investigations will occur again – and
indeed may be occurring

today in services provided or commissioned by NHS bodies and councils across
the country.”13

2.4 Current human rights education

Two recent informal surveys of the 32 UK medical schools carried out a year
apart - January 2008

and 2009 - asked if any education on the right to the highest attainable
standard of health was

included within medical student core curricula. In 2008 only two responded
positively - Warwick

University reported it was mentioned briefly in the first year, and Glasgow
reported that one

diagram from the WHO report *25 Questions and Answers on Health and Human
Rights, *which

describes the right to the highest attainable standard of health, was
discussed. One year later three

medical schools, Newcastle, Leeds and Sheffield, reported they were taught
health rights, but only

briefly and as an addendum to another subject (personal communication). A
recent paper from the

US on health and human rights education reported that a majority of deans of
schools of medicine

and public health believe that knowledge about human rights is important in
health practice and

support the inclusion of health and human rights in their institutions.14

Doctors for Human Rights, 91 Harlech Rd, Abbots Langley, WD5 0BE
www.doctorsforhumanrights.org/

3

10 Joint Committee on Human Rights. (2008) A Life Like Any Other? Human
Rights of Adults with Learning Disabilities. p95.

http://www.publications.parliament.uk/pa/jt200708/jtselect/jtrights/jtrights.htm
(accessed
14/03/2009)

11 Michael J. (2008) Healthcare for all. p7.
http://www.iahpld.org.uk/Healthcare_final.pdf (accessed 14/03/2009)

12 Mencap. (2007) Death by indifference. London.
www.mencap.org.uk/document.asp?id=284 (accessed 14/03/2009)

13 Parliamentary and NHS Ombudsman (2009). Six lives: the provision of
public services to people with learning disabilities.Part

one, p7-12
http://www.ombudsman.org.uk/improving_services/special_reports/hsc/six_lives/index.html.
(accessed 14/03/2009)

14 Cotter LE, Chevrier J, et al. (2009) Health and Human Rights Education in
U.S. Schools of Medicine and Public Health: Current

Status and Future Challenges. PLoS ONE 4(3): e4916.
doi:10.1371/journal.pone.0004916. http://www.plosone.org/article/info:doi/

10.1371/journal.pone.0004916 (accessed 14/03/2009)

*Commentary*

During her investigation into the deaths of six people with learning
disabilities, the Ombudsman

aspired to find a way to change the attitudes and culture in healthcare
delivery - yet she remains

apprehensive. In *Valuing People Now, *which was published in January 2009
as the Government

response to the Michael Inquiry recommendations, the authors declaim that
people with learning

disabilities have the same human rights as everyone else - rather missing
the point that human rights

are designed primarily for the disempowered, not those who can look after
themselves.15

Nonetheless *Valuing People Now, *is an exceptionally important document,
not least because it uses

the term human rights no less than fifty four times in 149 pages*, *and
constituting as it does a

declaration of intent that healthcare workers must respect human rights - or
else.

As such it requires nothing less than the *educated *support of the whole
medical profession.

*Recommendation*

*The right to the highest attainable standard of health should become an
essential component*

*of the Core Undergraduate Medical Curriculum*

Doctors for Human Rights, 91 Harlech Rd, Abbots Langley, WD5 0BE
www.doctorsforhumanrights.org/

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15 Department of Health. (2009) Valuing people now: a new three-year
strategy for people with learning disabilities. p30 http://

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093377
(accessed
14/03/2009)
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