Improving human rights worldwide
Doctors and students have a part to play
Doctors throughout the world have been
challenged recently about their role in
promoting human rights.1 This does not mean
that human rights should be medicalised human
rights, or that doctors should play a part that has little
relationship to their "day jobs." It is a recognition that
doctors are uniquely placed to gather information on
human rights abuses and to do something about them.
Human rights abuses are common in many
countries of the world. The "traditional" abuses, such as
torture and cruel, degrading treatment, continue to
take place with depressing frequency. Doctors are often
witnesses.
Much of this abuse occurs in places where people
are detained in prisons or police cells. If they are police
surgeons or work in prisons, doctors may have to treat
people who have been abused. Those in primary and
secondary care may see them after they have been
released. In both these situations, the doctor may be
able to detect the physical and psychological consequences of mistreatment. Patients often expect the
doctor to act on their behalf. Doctors need advice, help,
and support in taking action.
An Afghan child staves off poverty by doing minor road repairs (AP PHOTO/MURAD SEZER) |
The authorities will also often tell doctors about
abuses, with the intention of getting the doctors to
cooperate by obscuring the reality of what happened.
In addition, they often want doctors to certify deaths by
torture as being "natural."
Doctors have unequalled access to the vulnerable
detainee. They can use that access to help break the
cycle of abuse. Or they can remain silent and inactive
and so become passive participants in the abuse.
Widespread abuse leads to serious consequences
for society and so is also a public health issue. In some
countries, such as the former Soviet Union, imprisonment puts prisoners at almost a 100% likelihood of
exposure to multidrug resistant tuberculosis. Catching
the disease is often a death sentence. Treatment has
limited efficacy, especially as drugs are bartered in prisons and are unobtainable outside because of high
costs. The risk of exposure of individuals, and of the
societies from which they came and to which they will
return, is now sufficiently serious to constitute a public
health emergency. If prison conditions are improved - better light, ventilation, heat, and food, and less
overcrowding - there would be a real opportunity to
break the epidemic cycle. Doctors have a part to play in
making these improvements.
But those of us who are lucky to live in countries
with relatively good human rights records also have
responsibilities. In the United Kingdom we see
refugees and asylum seekers routinely locked up in
prisons and other places of detention. These are
difficult conditions for anyone, but for those who have
just escaped from places where detainees are routinely
tortured, they are barbaric. Dispersal of asylum seekers
may remove them from centres which can treat
survivors of torture and from medical centres which
have access to the necessary translators. This in itself
raises a serious problem about access to health care.
Doctors who see detainees suffering must speak out.
Failing to do so perpetuates the abuse.
The Human Rights Act is also important.2 When
seen alongside the international debate about rights,
such as the "right to health" from the United Nations
Declaration of Human Rights,3 it is clear that doctors
have an important part to play not only in monitoring
traditional rights, and reporting abuses, but in setting
the framework for a whole new generation of rights.
Medical students are key stakeholders. They have a
professional lifetime ahead of them, they are still fired
with an enthusiasm to do good for humanity, and
they are natural net workers who collaborate with
colleagues worldwide. If human rights awareness
components are included in medical ethics courses
medical students can be given a powerful tool which
will help them throughout their professional careers.
We know that various medical student organisations,
including the Medical Students International Network
(MedSIN), are arranging their own courses, working
with established human rights groups. While this is
encouraging it shows the need for better coordination
and understanding at medical schools worldwide to
meet this need.
So doctors and medical students have a part to play
both in traditional human rights and in new areas
around the right to health. As individuals we expect
them to be courageous. As a medical association we
must be similarly brave and take on those who would
deny our patients their rights or who would threaten
our colleagues.
Courage is part of the tradition of medicine.
Doctors have always taken risks on behalf of their
patients, or when treating patients, predominantly in
terms of exposure to infections. Today our colleagues
in countries such as Turkey risk imprisonment and torture for treating victims of torture. We must offer support to the Turkish and UK governments.
This crate, which contains brass knuckles, was found in Pristina, Kosovo in 1999 (AP PHOTO/JEREMY SELWYN) |
Doctors also bring compassion and altruism into
medicine. Activism in protecting human rights is an
expression of these qualities.
And finally doctors should get involved because
patients and society expect us to. Society places doctors
in a position of respect and authority. That imposes
duties on doctors as individuals and as a group. These
include general behaviour, such as honesty and
integrity, and also acting for the public good. Doctors
are expected to act on what they see within their
professional capacity, including protecting and promoting the rights of their patients.
Doctors have a long tradition of being active in
human rights. Today this is carried out through their
medical associations as well as individually through
groups such as Amnesty International Medical Group,
the Medical Council for the Care of Victims of Torture,
Physicians for Human Rights, and many others. The
new BMA book celebrates this activity, gives examples
of successful interventions, and above all helps doctors
to discover how they can help.1
Vivienne Nathanson, head, BMA's professional resources and research group
Email: vivn@bma.org.uk
studentBMJ 2001;09:217-260 July ISSN 0966-6494
- British Medical Association. The medical profession and human rights: handbook for a changing agenda. London: Zed Books, 2001.
- Human Rights Act 1998. London: Stationery Office, 1998.
- United Nations. Declaration of human rights. Geneva: United Nations, 1948.
