Human Rights in Patient Care Application of General Human Rights Principles in Context of Patient Care (J. Overall - from Cohen and Ezer Framework Article 2013)

HRPC and the Right to Health HRPC: encompasses additional rights that pertain to the delivery of health care to patients Right to Health: includes many human rights that fall outside health care delivery context but play a role in determining health outcomes HRPC: specifically addresses stakeholder rights inside health care settings HRPC and the Right to Health

HRPC and Patient Rights Alternative to “patients’ rights” Patients’ Rights: rooted in consumer framework HRPC: derived from inherent dignity HRPC: neutrally applies universal, legally-recognized human rights principles HRPC: protects both patients and providers HRPC: admits limitations justified by human rights norms HRPC and Patient Rights

HRPC and Patient Rights Differences Patients’ rights often link to consumer framework, not to human rights framework Patients’ rights inhere to patients because they are recipients of a transaction – more closely resembling contractual rights Patients’ rights lack the “inherent,” inalienable,” or “universal” qualities of human rights HRPC and Patient Rights Differences

HRPC and Patient Rights Difference Patients’ rights omit rights of other stakeholders in health care delivery – the focus is only on the patient HRPC apply to everyone HRPC recognize that health care providers enjoy same human rights as everyone else (rather than posing special rights for patients, as against those who provide them with health care HRPC and Patient Rights Difference

HRPC and Patients Rights Differences Patients’ rights: do not automatically recognize need to place limitations on rights in the health context HRPC recognizes that rights of no single patient are absolute HRPC: limitations conform to assessment of factors (appropriate, effectiveness, proportionality, alternative) Courts: use this analysis in placing limits on human rights in health care context – often in response to express or implied limitation clauses in national constitutitons HRPC and Patients Rights Differences

HRPC and Patient Safety or Quality Medical Care Patients may have a right to quality care and to freedom from injury But not all low-quality care rises to the level of a human rights violation for which the state is responsible Simple negligence: tort against an individual health care provider To constitute a human rights violation: mistreatment by health care provider(s) must be systemic HRPC and Patient Safety or Quality Medical Care

HRPC and Patient Safety or Quality Medical Care If systemic, state should address problem systemically: amend policies or regulations; ensure appropriate training; monitoring services; establishing opportunities for complaint and redress; take disciplinary measures when warranted Human rights do not end with quality care: a patient may have the best medical care, but it was provided without patient consent HRPC and Patient Safety or Quality Medical Care

Recognizes interrelations between patient and provider rights Particularly in cases of “dual loyalty” Dual loyalty: health providers face simultaneous obligations to patients and the State- may be pressured to abet human rights violations HRPC: Interrelations

A means to examine SYSTEMIC issues and STATE responsibility Human Rights principles include right to highest attainable standard of health But also: Civil and Political Rights (such as freedom from torture and inhumane treatment to liberty and security of person Attention to: rights of socially-excluded groups to be free from discrimination in delivery of health care The Human Rights Lens

Provider Rights Freedom of association Enjoyment of decent working conditions Right to due process Provider Rights

HRPC and Bioethics Complimentary but distinct HRPC carry legal force and can be applied through judicial action; systemic approach Bioethics: autonomy, beneficence, justice, non-malfeasance in patient care context (also medical research and public health) HRPC: complimentary set of legal norms developed through judicial interpretation (freedom, non-discrimination, security of person HRPC and Bioethics

HRPC adds to bioethics a method for arriving at concrete decisions about how to judge complex and ethically challenging clinical interventions – and a set of procedures for enforcing those decisions HRPC: rooted in a legal framework, has operational norms, and procedures such as courts and human rights commissions, to identify, adjudicate, and remedy abuses HRPC and Bioethics

HRPC and Advocacy HRPC framework brings a focus on advocacy Through courts, media, or political negotiation - legal remedy or community mobilizing HRPC provides a “language” to articulate and mobilize around justice concerns HRPC and Advocacy

HRPC and Public Health Ethics (PHE) Complimentary PHE: ensures that public health interventions provide benefit and minimize harms, respect individuals’ dignity and rights to greatest extent possible and are implemented fairly PHE: creates professional codes to self-regulate and to instill public trust in professions HRPC: targets governments or the policies they endorse HRPC and Public Health Ethics (PHE)