Physicians’ involvement in human rights
As physicians we’re often confronted with different issues of ethics and human rights at different levels. Physicians can on the one hand be involved in the treatment of injuries related to war, but also in different forms of human rights violations.
Salvador Allende and Che Guevara were physicians seen as heroes and social reformers by many, even outside of their respective countries:Time magazineclaimed Guevara to be one of most influential personalities of the 20th century. On the other hand there have been physicians like Mengele or Illig working actively and by their own free decision without regard for medical ethics in the German and Austrian National Socialist regime performing dubious “research” in thespirit of that ideology.
Physicians can also be convinced toviolate ethical standardsin a situation of “dual obligations”, common in situations such as prisons. Dr. Wendy Orr, a former District Surgeon in Port Elizabeth in South Africa, wrote in her foreword to the British Medical Association’s handbook on medicine and human rights, about her work with detainees during theapartheid regime. She describes how she became aware of the systematic abuse of detainees by the security forces and the silence and complicity of her medical colleagues. She recounts her growing moral disorientation as she realized she was expected to declare patients “fit” for corporal punishment.
Similar situations have recently been reported in asylum cases even in countries with better earlier human rights track records. US physicians and psychologists have further been involved in planning and observation oftorturing prisoners in Guantanamo.
Upholding human rights
人权普遍prohibi等系统tion of torture, outlined inUN Convention against Tortureare so fundamental that they cannot be suspended under any circumstances, they are “non-derogable”, and their violation can and must be investigated and prosecuted. Physicians should have a special positive role in this process.
The “Istanbul Protocol” supported equally by the UN, and the World Medical Association, is an interdisciplinary standard that guides physicians and legal professionals to collaborate in ethical and humanitarian standards, forensic documentation, reporting, and investigation ofalleged torture. It can also contribute to new strategies in theprotection of survivorsapplying for asylum and forprosecution of perpetrators.
Physicians can put themselves at risk for upholding these legal and ethical standards. For instance, it’s beenreportedthat those who have witnessed torture in Kahrizak prison in Iran have been killed.
An Iranian physician, Ahmadreza Jalali, has beensentenced to deathin Iran because of allegations of spying for other countries. Up to now none of international protests and activities for his unconditional release have proven to lead to any significant positive development.
All over the world health professionals put themselves in danger by being involved in activities to maintain human rights through organizations such as Physician for Human Rights, Physicians without Borders, the International Rehabilitation Council for Torture Survivors. Without involvement of these organizations many areas of the world crisis regions would haveno access to medical care.
The basic background of these activities are international standards and treaties along with ethical guidelines of the medical profession. The 1948 Universal Declaration of Human Rights already mentionshealth as part of the right to an adequate standard of living(art. 25). The right to health was again recognized as a human right in the 1966International Covenant on Economic, Social and Cultural Rights. There are international instances of shortage of access to medical services, because of military conflicts or secondary to sanctions against a country.
New challenges to ethics
Recently, the practice of medicine has been subject to several transformations with unprecedented ethical challenges. One is the exponential increase in the sophistication and reach of medical technology. From genetic manipulation to in-vitro fertilization,dataandconfidentiality protectionto the ethical risks enclosed at times in theenormous advancesin life-saving research and treatment, medicine has given rise to moral challenges of huge social significance that medicine itself, and the Hippocratic tradition, have on their own not sufficiently responded to. Instead medicine has formed a fertile relationship with other disciplines, such as moral philosophy and medical law, to seek philosophically coherent and socially and legallyacceptable responses to these questions.
Given that the most serious threats to medical impartiality have come largely from interference by governmental agencies, but also by excessively powerful commercial companies or political groups, a critical aspect of medical impartiality is the doctors’ ability tospeak out about health-related aspects of conflicts.
Where, for example, doctors are seeing patients who have sustained injuries as a result of state responses to civil unrest, the documentation and reporting of those injuries is a core part of the medical response. If doctors cannot speak out, if they cannot draw attention to the health-related impacts of conflicts, they risk the loss of their professional independence.
If they voluntarily violate fundamental standards, they should not be permitted to practice and medical associations and governments should take care to take all necessary steps to ensure this principle, while on the other handsupporting human rights defenders.
Friedrich Schiller, also a physician, was against any restriction of personal or political freedom and emphasizes in the following poem in a way that could be extrapolated to the duties of physicians that we should focus our work on the needs of our patients:
Live with your century;
but do not be its creature.
Work for your contemporaries;
but create what they need,
not what they praise
Comments