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What do we know about human rights related to health care and to patients rights in Gambia

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What do human rights mean?

Human rights are rights inherent to all human beings, regardless of race, sex, nationality, ethnicity, language, religion, or any other status. Human rights include the right to life and liberty, freedom from slavery and torture, freedom of opinion and expression, the right to work and education, and many more.

Why is it called human rights?

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Every person is entitled to certain fundamental rights, simply by the fact of being human. These are called “human rights” rather than a privilege (which can be taken away at someone’s whim). They are “rights” because they are things you are allowed to be, to do or to have.

Why is human rights important?

Human rights are needed to protect and preserve every individual’s humanity, to ensure that every individual can live a life of dignity and a life that is worthy of a human being. Question: Why “should” anyone respect them? Fundamentally, because everyone is a human being and therefore a moral being.

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Both rights and obligations

This means that States have obligations and duties under international law to respect, protect and fulfill human rights.

The obligation to respect means that States must refrain from interfering with or curtailing the enjoyment of human rights.

The obligation to protect requires States to protect individuals and groups against human rights abuses.

The obligation to fulfill means that States must take positive action to facilitate the enjoyment of basic human rights.

Meanwhile, as individuals, while we are entitled to our human rights – but, we should also respect and stand up for the human rights of others.

Every woman, man, youth and child have the human right to the highest attainable standard of physical and mental health, without discrimination of any kind. Enjoyment of the human right to health is vital to all aspects of a person’s life and well-being, and is crucial to the realization of many other fundamental human rights and freedom.

The WHO Constitution was the first international instrument to enshrine the enjoyment of the highest attainable standard of health as a fundamental right of every human being (“the right to health”). The right to health in international human rights law is a claim to a set of social arrangements – norms, institutions, laws, and an enabling environment – that can best secure the enjoyment of this right.

It is an inclusive right extending not only to timely and appropriate health care but also to the underlying determinants of health, for example access to health information, access to water and food, housing, etc.

The right to health is subject to progressive realization and acknowledges resource constraints. However, it also imposes on states various obligations which are of immediate effect, such as the guarantee that the right will be exercised without discrimination of any kind and the obligation to take deliberate, concrete and targeted steps towards its full realization.

Right to health

The right to health is the economic, social and cultural right to a universal minimum standard of health to which all individuals are entitled. The concept of a right to health has been enumerated in international agreements which include the Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights and the Convention on the Rights of Persons with Disabilities.

However, there remains some international variation in the interpretation and application of the right to health due to considerations such as how health is defined, what minimum entitlements are encompassed in a right to health, and which institutions are responsible for ensuring a right to health.

Health equity

The general comment also makes additional reference to the question of equity, a concept not addressed in the initial International Covenant. The document notes, “The Covenant proscribes any discrimination in access to health care and underlying determinants of health, as well as to means and entitlements for their procurement.”

Moreover, responsibility for ameliorating discrimination and its effects with regards to health is delegated to the State: “States have a special obligation to provide those who do not have sufficient means with the necessary health insurance and health-care facilities, and to prevent any discrimination on internationally prohibited grounds in the provision of health care and health services.” Additional emphasis is placed upon non-discrimination on the basis of gender, age, disability, or membership in indigenous communities.

Relation to other rights

Like the Universal Declaration of Human Rights, the General Comment clarifies the interrelated nature of human rights, stating that, “the right to health is closely related to and dependent upon the realization of other human rights,” and thereby underscoring the importance of advancements in other entitlements such as the rights to food, work, housing, life, non-discrimination, human dignity, and access to importance, among others, towards the recognition of the right to health.

Similarly, the General Comment acknowledges that “the right to health embraces a wide range of socio-economic factors that promote conditions in which people can lead a healthy life, and extends to the underlying determinants of health.” In this respect, the General Comment holds that the specific steps towards realizing the right to health enumerated in Article 12 are non-exhaustive and strictly illustrative in nature.

Responsibilities of states and international organizations

Subsequent sections of the General Comment detail the obligations of nations and international organizations towards a right to health. The obligations of nations are placed into three categories: obligations to respect, obligations to protect, and obligations to fulfill the right to health.

Examples of these (in non-exhaustive fashion) include preventing discrimination in access or delivery of care; refraining from limitations to contraceptive access or family planning; restricting denial of access to health information; reducing environmental pollution; restricting coercive and/or harmful culturally-based medical practices; ensuring equitable access to social determinants of health; and providing proper guidelines for the accreditation of medical facilities, personnel, and equipment.

International obligations include allowing for the enjoyment of health in other countries; preventing violations of health in other countries; cooperating in the provision of humanitarian aid for disasters and emergencies; and refraining from use of embargoes on medical goods or personnel as an act of political or economic influence.

Convention on the Rights of the Child

Health is mentioned in several instances in the Convention on the Rights of the Child (1989). Article 3 calls upon parties to ensure that institutions and facilities for the care of children adhere to health standards. Article 17 recognizes the child’s right to access information that is pertinent to his/her physical and mental health and well-being. Article 23 makes specific reference to the rights of disabled children, in which it includes health services, rehabilitation, and preventive care.

Article 24 outlines child health in detail, and states, “Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States shall strive to ensure that no child is deprived of his or her right of access to such health care services.”

Human right to health care

An alternative way to conceptualize one facet of the right to health is a “human right to health care.” Notably, this encompasses both patient and provider rights in the delivery of healthcare services, the latter being similarly open to frequent abuse by the states.  Patient rights in healthcare delivery include: the right to privacy, information, life, and quality care, as well as freedom from discrimination, torture, and cruel, inhumane, or degrading treatment.  Women, sexual minorities, and those living with HIV, are particularly vulnerable to violations of human rights in healthcare settings.

For instance, racial and ethnic minorities may be segregated into poorer quality wards, disabled persons may be contained and forcibly medicated, drug users may be denied addiction treatment,

Provider rights include: the right to quality standards of working conditions, the right to associate freely, and the right to refuse to perform a procedure based on their morals. Healthcare providers often experience violations of their rights. For instance, particularly in countries with weak rule of law, healthcare

Providers are often forced to perform procedures which negate their morals, deny marginalized groups the best possible standards of care, breach patient confidentiality, and conceal crimes against humanity and torture. Furthermore, providers who do not oblige these pressures are often persecuted. Currently, especially in the United States, much debate surrounds the issue of “provider consciousness”, which retains the right of providers to abstain from performing procedures that do not align with their moral code, such as abortions.

Patient’s rights

Right to choose:

The right to choose involves patient to choose where to go and been given the choice to select the health providers from whom they want to receive health services without being manipulated by individuals or institutions

Right to access:

The right to access implies that health services are available and accessible to any individual in need.

Right to information:

The purpose of the patient receiving information on health education and preventable diseases in particular form is to prevent life threatening diseases such as HIV, AIDS.

Right to dignity:

The patient right to dignity refers to the way the patient is treated, normally with full respect and considerations without discrimination against, male, female, age, ethnic or tribal origin, religious believes, and skin color.

Right to confidentiality:

Implies assuring that any information that patient shares with any doctor or nurse at any health facility will not be accessible to any unauthorized doctor and nurse.

Right to privacy:

Exchange of information between patient and health providers should occur in an environment where consultation will not be shared/heard by a third party without the patient’s consent.

Right to comfort:

The right to comfort refers to physical and environmental facilities and examination during visit.

Right to safety:

Refers to patient’s protection against possible side effects of medications, including physical and mental conditions.

Right to continuity of care:

The right to continuity of care implies that patients receive services and supplies of medication, laboratory tests and resupply of mediations.

Right to understand:

The right to understand refers to the patient’s right to be fully aware of the diagnosis, treatment, and prognosis using words the patient can reasonably understand. If needed, efforts to provide interpreters must be taken.

Right to refuse treatment:

Patients have the right to refuse treatment to the limits permitted by law. The patient has the right to refuse the treatment if it is known to the patient that the treatment chosen is life threatening.

For further information, check with WHO website, email to Dr Azadeh on [email protected]. Send message to WhatsApp only on 002207774469.

Dr H. Azadeh, senior lecturer at the University of The Gambia, Clinical Director at Medicare Health Services

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