medical ethics: public health and human rights
TRANSCRIPT
Medical Ethics: Medical Ethics: Public Health and Public Health and Human RightsHuman Rights
[Dr] Amzad AliEmail: [email protected]
Skype: ali.amzad
Cell: +8801713 004696
Outline What is Human Rights? What is Medical Ethics? Mention some
important points of medical ethics Differentiate between rights and privilege Do you think that you are enjoying all
health rights? If not, how can it be ensured?
Core Themes Human rights protection can have profound
impacts on the health of individuals, communities, and populations
Rights violations which affect populations need to be investigated and addressed using population-based methods
Responses based on human rights principles may improve disease prevention and control, and better the human rights contexts for those at dual risk
Services and facilities of a public nature affect human rights
HUMAN RIGHTS in a nutshell 1. Belong to everyone – they can’t be taken away from
marginalised individuals 2. Are about the relationship between the state and individuals 3. Provide a floor, not a ceiling, of basic standards, below
which the state must not fall and which it must protect or fulfil
4. KEY PRINCIPLES :In a democratic society– Fairness– Respect– Equality– Dignity
Medical Ethics- definition
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine.
Science is not the highest value to which all other orders of values should be subordinated
The term ethics is derived from the Greek word ‘”ethos” which means custom or habit.
An ethical judgment is the judgment to good practice, what and how we ought to deal with conflicting situation.
Practical or applied ethics means application of ethics or morality to the understanding of practical issues.
Research ethics is based on the premise that it is ethical to experiment on human in carefully controlled conditions.
Do You Expect it?
What to do?8 month child with pneumonia, tested HIV positive. Mom refuses testing for herself, is 6 months pregnant, and states she cannot tell her husband of her possible HIV positive status as he may leave her.
What is Rational or Justified?
What is Public Health Ethics? Morality
– What is good or right? – Study of virtue(s), May be study of philosophical
abstractions Ethics
– What is good or right in a profession– Emphasis on right actions, not abstractions
Public health ethics– “Public health is what we, as a society, do collectively, to
assure the conditions for people to be healthy.” (IOM,1988)– Health promotion and disease prevention of the population– Medical ethics vs. public health ethics
• How are they similar? Different?
Medical Ethics vs. Public Health Ethics
Medical Ethics Public Health EthicsIndividuals PopulationsAutonomy Democratic inputBeneficence Greatest good for the greatest numberNon-maleficence Benefit-risk analysesSocial justice Social justice
Values in Public Health “Greatest good (health) for the greatest
number” Health promotion and disease reduction
– Smoking, obesity, vaccinations
Cost/benefit analyses– Economic– Civil liberties– Medical (e.g., vaccination adverse effects)
Analyzing an Ethical Issue What are the facts: science, epidemiology,
medicine? Who are the stakeholders and decisionmakers? What are the options? What are the legal constraints: laws, regulations? What values/ethical principles ought to apply? What are the conflicts? What is the recommended decision?
Human Rights Instruments and Public
Health 1948 The Universal Declaration of Human Rights
1976 International Covenant on Civil and Political Rights
1976 International Covenant on Economic, Social and Cultural Rights
1981 Convention on the Elimination of All Forms of Discrimination against Women (CEDAW)
Autonomy, Privacy, Confidentiality, Informed consent, and Choice
State Responsibilities
Signatory States must not violate these rights
Commit to measurable progress to:RespectProtectFulfill
What is meant by “The Right to Health”
“The right to health does not mean the right to be healthy, nor does it mean poor governments must put in place expensive health services for they have no resources. But it does require authorities put in place policies and action plans which lead to available and accessible health care for all in the shortest possible time. To ensure that this happens is the challenge facing both the human rights community and public health professionals.”
UN High Commissioner for Human Rights, Mary Robinson
Human rights violations
Forced labor Destruction / seizure of crops / livestock Arbitrary arrest and detention Forced military conscription Torture, rape, execution
How do human rights violations increase vulnerability to STI & HIV? Increased Exposure
– Coercion, sexual violence, rape as tool of war, population mixing
Increased Acquisition and Transmission– Treatment delays or gaps, barriers to access,
lack of condoms/contraception
Increased morbidity and mortality– Barriers to access and to information
Beginnings and endings
Ethical dilemmas cluster at the beginning and end of life
My experience is end of life
I won’t cover abortion, fertility treatment, premature babies etc
Ethics I know a little about
4 principles of modern bioethics
Autonomy Justice Benificence Non-maleficence
Autonomy
Paramount Being self-governing Able to exercise free will in making a
personal decision A right to withhold consent Applicable to anyone who has capacity
Beneficence Literally being charitable or doing good Performing care so as to maximise
patient wellbeing Exercising clinical judgement Going beyond the minimum standards
required
Non-malificence Doing no harm Avoidance of putting a
person at risk of avoidable harm
A 1st step towards beneficence
Defined under the Hippocratic oath
Justice No single definition Usually distributive
justice when applied to medical ethics
Fairness Equity Method of righting
wrongs
Limitations
Very simplistic Autonomy trumps the other principles Role of justice No coherent approach to resolving
conflicting principles
Other factors Patient expectations Family expectations Genuine uncertainty Wishes of patient Wishes of family Cultural values Religious values
Preferences of professionals
Power balance within the healthcare team
Trust policies Financial issues Legal issues
Conclusions Knowledge, Attitude and Practices are key elements
in medical ethics for supporting health & Human rights.
Constraints inherent in context demand creative thinking and adapted solutions
Grass-roots community organizations, NGOs, Youth Networks and Health forums can take the lead for awareness building and responses
Building capacity to monitor PH programs – Ensures success of programs– Potential to understand direct and indirect impacts
of human rights violations on health Utilization of Technology & rational behaviours can
improve situation
Thank You
RESOURCES Victorian Equal Opportunity and Human Rights Commission website www.humanrightscommission.vic.gov.au Human Rights Law Centre website www.hrlrc.org.au The Victorian Charter of Human Rights and Responsibilities can be
downloaded from this site or from www.austlii.edu.au British Institute of Human Rights report, The Human Rights Act –
Changing Lives. Website www.bihr.org.uk