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Medical Ethics: Public Health and Human Rights

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Medical Ethics: Public Health and Human Rights

  1. 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. 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. 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. 4. Services and facilities of a public nature affect human rights
  5. 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. 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. 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. 8. Do You Expect it?
  9. 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. 10. What is Rational or Justified?
  11. 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. 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. 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. 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. 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. 16. State Responsibilities Signatory States must not violate these rights Commit to measurable progress to: Respect Protect Fulfill
  17. 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. 18. Human rights violations  Forced labor  Destruction / seizure of crops / livestock  Arbitrary arrest and detention  Forced military conscription  Torture, rape, execution
  19. 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. 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. 21. Ethics I know a little about  4 principles of modern bioethics  Autonomy  Justice  Benificence  Non-maleficence
  22. 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. 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. 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. 25. Justice  No single definition  Usually distributive justice when applied to medical ethics  Fairness  Equity  Method of righting wrongs
  26. 26. Limitations  Very simplistic  Autonomy trumps the other principles  Role of justice  No coherent approach to resolving conflicting principles
  27. 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. 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. 29. Thank You
  30. 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

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?