Medical Ethics:Medical Ethics:
Public Health andPublic Health and
Human RightsHuman Rights
[Dr] Amzad Ali
Cell: +8801713 004696
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
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
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
2. Are about the relationship between the state and
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
Medical Ethics- definition
Medical ethics is a system of moral principles that
apply values and judgments to the practice of
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.
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 Public Health Ethics?
– What is good or right?
– Study of virtue(s), May be study of philosophical
– 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
– Health promotion and disease prevention of the
– Medical ethics vs. public health ethics
• How are they similar? Different?
Medical Ethics vs. Public Health Ethics
Medical Ethics Public Health Ethics
Autonomy Democratic input
Beneficence Greatest good for
Non-maleficence Benefit-risk analyses
Social justice Social justice
Values in Public Health
“Greatest good (health) for the greatest
Health promotion and disease reduction
– Smoking, obesity, vaccinations
– Civil liberties
– Medical (e.g., vaccination adverse effects)
Analyzing an Ethical Issue
What are the facts: science, epidemiology,
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
1948 The Universal Declaration of Human Rights
1976 International Covenant on Civil and Political
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
Signatory States must not violate these
Commit to measurable progress to:
What is meant by “The Right to
“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,
Human rights violations
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?
– Coercion, sexual violence, rape as tool of war,
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
My experience is end of
I won’t cover abortion,
premature babies etc
Ethics I know a little about
4 principles of modern bioethics
Able to exercise free will in making a
A right to withhold consent
Applicable to anyone who has capacity
Literally being charitable or doing good
Performing care so as to maximise
Exercising clinical judgement
Going beyond the minimum standards
Doing no harm
Avoidance of putting a
person at risk of
Defined under the
No single definition
justice when applied to
Method of righting
Autonomy trumps the other principles
Role of justice
No coherent approach to resolving
Wishes of patient
Wishes of family
Power balance within the
Knowledge, Attitude and Practices are key elements
in medical ethics for supporting health & Human
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
Victorian Equal Opportunity and Human Rights Commission
Human Rights Law Centre
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
Hinweis der Redaktion
Ethics of octuolets. Nadya Suleman February 2009. Were 8 embryos implanted? Fewer, with subsequent splitting? American Society for Reproductive medicine recommends for moms under 35 (Nadya was 33) that no more than two embryos be implanted at a time. In addition, Nadya was single, had 6 children under the age of 8. Ethics – risks to mom and babies, caring for babies, resources (who paid for implantation?), were professional guidelines violated
Medical ethics focuses on needs of the individual (patient) vs. social or population based needs
Benefit risk analyses: Analogous to non-maleficence. We sometimes cause harm to individuals, but we know, for example when we administer vaccines, that some will die. Social justice refers to the concept of a society in which justice is achieved in every aspect of society, rather than merely the administration of law. The term can be amorphous and refer to sometimes self-contradictory values of justice. It is generally thought of as a society which affords individuals and groups fair treatment and a just share of the benefits of society. (Different proponents of social justice have developed different interpretations of what constitutes fair treatment and a just share.) It can also refer to the distribution of advantages and disadvantages within a society. Unclear how social justice is defined
Mom with octuplets Ethical principles – greatest good for the greatest number? Privacy?
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