Medical Ethics: Public Health and Human Rights

1. Medical Ethics:Medical Ethics:
Public Health andPublic Health and
Human RightsHuman Rights
[Dr] Amzad Ali
Email: ali.amzad@gmail.com
Skype: ali.amzad
Cell: +8801713 004696

2. 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?

3. 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

4. Services and facilities of a public
nature affect human rights

5. 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

6. 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.

7.  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.

8. Do You Expect it?

9. 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.

10. What is Rational or Justified?

11. 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?

12. Medical Ethics vs. Public Health Ethics
Medical Ethics Public Health Ethics
Individuals Populations
Autonomy Democratic input
Beneficence Greatest good for
the greatest
number
Non-maleficence Benefit-risk analyses
Social justice Social justice

13. 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)

14. 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?

15. 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

16. State Responsibilities
Signatory States must not violate these
rights
Commit to measurable progress to:
Respect
Protect
Fulfill

17. 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

18. Human rights violations
 Forced labor
 Destruction / seizure of crops / livestock
 Arbitrary arrest and detention
 Forced military conscription
 Torture, rape, execution

19. 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

20. 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

21. Ethics I know a little about
 4 principles of modern bioethics
 Autonomy
 Justice
 Benificence
 Non-maleficence

22. 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

23. Beneficence
 Literally being charitable or doing good
 Performing care so as to maximise
patient wellbeing
 Exercising clinical judgement
 Going beyond the minimum standards
required

24. 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

25. Justice
 No single definition
 Usually distributive
justice when applied to
medical ethics
 Fairness
 Equity
 Method of righting
wrongs

26. Limitations
 Very simplistic
 Autonomy trumps the other principles
 Role of justice
 No coherent approach to resolving
conflicting principles

27. 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

28. 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

29. Thank You

30. 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