Medical Professionalism and Human Dignity

1. Medical Professionalism and Human Dignity Dr. MyintOo (GP)

3. Professionalism • It is a vocation or the practice of an art founded upon it is used in the service of others • Its members profess a commitment to competence, integrity and morality, altruism, and the promotion of the public good within their domain • These commitments form the basis of a social contract between a profession and society, which in return grants the profession the right to autonomy in practice and the privilege of self-regulation • Professions and their members are accountableto those serviced and to society Oxford English Dictionary

4. What is Medical Professionalism? • Basis of medicine’s contract with society • Places interests of patients above those of physician, provides expert advice on health to society, and maintains standards of competence and integrity • Physicians can play as guardians of human rights http://physiciansforhumanrights.org

5. Medical Professionalism As “commitments” to the: • integrity of the human body • informed consent and freedom from coercion • equity and fairness in health care • principle of medical ethics — do no harm

6. Hippocratic Professionalism • When taking the Hippocratic Oath, a doctor makes a promise to his or her patients to “keep them from harm and injustice”

7. Three Fundamental principles of Medical Professionalism A guide to understanding physicians’ professional responsibilities to individual patients and society as a whole • Primacy of Patient Welfare • Patient Autonomy • Social Justice

8. Primacy of Patient Welfare • The principle is based on a dedication to serving the interest of the patient • Altruism contributes to the trust that is central to the physician-patient relationship • Market forces, societal pressures, and administrative exigencies must not compromise this principle

9. Patient Autonomy • Physicians must have respect for patient autonomy. Physicians must be honest with their patients and empower them to make informed decisions about their treatment • Patients’ decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care

10. Social Justice • The medical profession must promote justice in the health care system, including the fair distribution of health care resources • Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category

11. Today's Definition of Medical Professionalism Medical professionalism is evolving from: 1. autonomy to accountability 2.expert opinion to evidence-based medicine 3. self-interest to teamwork and shared responsibility

12. Physician'sRights in Patient's Care • (1) decent working conditions and fair pay; • (2) freedom of association, including unionization; • (3) due process and related rights such as fair hearing; protection of privacy and reputation; and freedom of expression and information Advancing Human Rights in Patient's Care

14. Human Dignity Means protecting another's self-esteem, a sense of pride that causes you treat yourself and others with self respect, placing value on life Human Dignity is inviolable. It must be respected and protected ѽDignity gives an individual a sense of value and worth ѽ

15. Human Dignity It denotes respect and status, and it is often used to suggest that someone is not receiving a proper degree of respect, or even that they are failing to treat themselves with proper self-respect

16. Health Systems Versus Human Dignity • Health systems can too often be places of punishment, coercion, and violations of basic rights—rather than places of treatment and care • In many cases, existing laws and tools that provide remedies are not adequately used to protect rights Twenty Mechanisms for Addressing Torture in Healthcare : Publication of Open Society Foundations

17. Physician and Human Dignity A PHYSICIAN SHALL in all types of medical practice, be dedicated to providing competent medical service in full technical and moral independence, with compassion and respect forhuman dignity World Medical Association

18. Physician and Human Dignity • physicians shall commit to "respect human life and the dignity of every individual; ...refrain fromsupporting or committing crimes against humanity and condemn all such acts • physicians shall commit to advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being" American Medical Association

19. Crimes Against Humanity • deportation or forcible transfer of population • enforced sterilization, or any other form of sexual violence • enforced disappearance of persons • inhumane acts intentionally causing great suffering or serious bodily or mental injury • Refusal to allow humanitarian aids/inadequate and inhumane response to natural disaster – R2P • Ethnic cleansing (genocide) • Enslavement International Criminal Court (ICC)

20. UNESCO Declaration The Article 2 states "Everyone has a right to respect for their dignity"

21. Declaration of Helsinki (DoH) • The Article 11: "It is the duty of physicians who participate in medical research to protect the life, health, dignity, integrity, right to self-determination, privacy, and confidentiality of personal information of research subjects World Medical Association 1964

22. Convention for the Protection of Human Rights and Dignity of the Human Being The convention's preamble contains: • Convinced of the need to respect the human being both as an individual and as a member of the human species and recognizing the importance of ensuring the dignity of the human being • Conscious that the misuse of medicine may lead to acts endangering human dignity • Measures are necessary to safeguard human dignity and the fundamental rights and freedoms of the individual with regard to the application of medicine Council of Europe 1999 Treaty

23. Universal Declaration of Human Rights Article Three: “ Everyone has the right to life, liberty and security of person ”

24. Universal Declaration of Human Rights No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment Article 5

25. Universal Declaration of Human Rights

26. Human Rights Basis for Professionalism in Health Care • Improve patient care by enhancing cultural competency, recognizing root causes of disease, and helping people stay healthier longer • Build community health to provide accessible, affordable, and quality care • Enhance health policy by using human rights to advocate for closing of racial disparities

27. Human Rights Approach to Health Care • The principles of patient welfare and social justice are central to the right to health and medical professionalism • The commitment to improving access and quality of care mirror the right to health’s fundamental “AAAQ” framework, which demands health services be available, accessible, acceptable, and of good quality. • the commitment to science and the assurance of confidentiality are critical concepts to a human rights approach to health

28. AAAQ Framework • Availability- health facilities, goods, and services must be available in sufficient quantity • Accessibility- health services must be accessible to everyone without discrimination • Acceptability- health services must be respectful of medical ethics, culturally appropriate and gender sensitive • Quality- health services must be scientifically and medically appropriate and of good quality

29. What is Medical Neutrality? Is the principle of noninterference with medical services in times of armed conflict/civil unrest Warring factions must: • protect civilians; • allow sick and wounded civilians and soldiers both to receive care regardless of their political affiliations; and • refrain from interfering with medical facilities, transport, and personnel PHR Toolkit

30. Principle of Medical Neutrality • Medical professionals are trained to treat those in need – regardless of politics, race, or religion – and governments must respect that duty • Attacks on health professionals and the sick and wounded violate the principle of medical neutrality and are grave breaches of international law PHR Toolkit

31. Medical Neutrality Ensures: • The protection of medical personnel, patients, facilities, and transport from attack or interference • Unhindered access to medical care and treatment • The humane treatment of all civilians; and • Nondiscriminatory treatment of the injured and sick

32. Violations of Medical Neutrality • Attacks on health care facilities, medical personnel, and patients • Wanton destruction of medical supplies • Willful obstruction of medical ethics • Deliberate misuse of health care • facilities, services, uniforms, or insignia • Deliberate blocking of access to • healthcare facilities and care • Arbitrary arrest or detention of • medical professionals or patients PHR Toolkits

33. Violations of Medical Neutrality • occur when civilians are turned into deliberate targets during times of war or civil unrest • Armies shell cities, obstruct the flow of food and medical supplies, and use human shields • Militaries undermine health care and retaliate against the health professionals who treat the sick and wounded • Violations of medical neutrality can rise to the status of war crimes, a grave breach of the Geneva Conventions, which govern the laws of war • As well, during periods of civil unrest, violations of medical neutrality can violate important human rights treaties such as the International Convention on Civil and Political Rights (ICCPR), the International Convention on Economic, Social, and Cultural Rights (ICESCR), and the Convention Against Torture (CAT) PHR Toolkits

34. Hospital Under Attack

35. Physician persecution anywhere is a threat to professionalism everywhere AMA Ad hoc Physicians Persecution Advisory Group (PAG)

36. Laws of War • Laws of war protect the sick and wounded and the medical professionals who treat them during times of armed conflict/civil unrest • The Medical Neutrality Protection Act of 2011: Authorizes the United States to withhold military assistance to countries found to be in violation of the principle of medical neutrality; and • Encourages the US to use its voice at the UN Human Rights Council to establish a Special Rapporteuron medical neutrality

37. Universal Declaration of HR • All human beings are born free and equal in dignity and rights • Everyone has the right to life, liberty and security of person • No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment • Everyone has the right to recognition everywhere as a person before the law

38. Human Rights and Good Health • Physician has obligation to respect and advocate for the human rights of their patients and society, as a means to promoting good health American Medical Association

39. WMA Human Rights • The (WMA) focuses its human rights advocacy on promoting the universal ethical practice of medicine • Specifically, WMA seeks to protect the rights of physicians to practice according to the ethical precepts of our profession, without persecution or interference from the state or others

40. WHO Human Rights • WHO Constitution: "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being..." "The world needs a global health guardian, a custodian of values, a protector and defender of health, including the right to health" Dr Margaret Chan, Director-General, WHO

41. Linkage between Health and Human Rights Violations or lack of attention to human rights can have serious health consequences • Harmful traditional practices • Slavery • Torture and inhuman and degrading treatment • Violence against women and children

42. Linkage between Health and Human Rights Health policies and programs can promote or violate human rights in their design or implementation • Freedom from discrimination • Individual autonomy • Rights to participation, privacy and information

43. Linkage between Health and Human Rights Vulnerability to ill-health can be reduced by taking steps to respect, protect and fulfill human rights • Freedom from discrimination on account of race, sex and gender roles • Rights to health, food and nutrition, education, housing

44. Linkage Between Health and Human Rights

45. Medicine and Human Rights The learning objectives for this issue on medicine and human rights are: 1. Understand the physician's role as an advocate for human rights, especially for vulnerable populations2. Recognize how health professionals may be involved in the documentation and adjudication of cases of human rights abuses3. Recognize that physicians have been used as agents of the state in abusing human rights.4. Understand the rights-based approach to promoting health

46. As physicians, we have a special responsibility to be defenders of human rights, one that is grounded in our heritage of caring for the sick and suffering • We are bound by a principle of medical neutrality which requires us to treat the wounded and injured whether they are friend or enemy • Because of our social status, when we speak, people listen, and thus we must speak up for people who have no voice and hold accountable those who commit human rights abuses (AMA- Virtual Mentor)

47. Declaration of Geneva - WMA 2006 I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat

48. Torture in the World Today • Amnesty International documented cases of torture and other cruel, inhuman or degrading treatment in 81 countries in 2007 • Some studies indicate that between 5 and 35% of the world’s refugees have been estimated to have experienced torture • In 2007, there were 15.9 million refugees around the world and an estimated 26 million people displaced internally by conflict • The number of torture survivors in the world today may range from 2 to 15 million • These estimates do not include those affected by war or other human rights violations

49. Abusive medical treatment • Health professionals should also be wary of any attempts (from officials) to ask them to administer treatment or medication that are not aimed at benefiting the physical or mental health of the patient, but only at assisting an interrogation or the management of a patient or detainee • The individual need not be in prison, or in detention at all, to be tortured. Health professionals must be aware that they might be considered responsible for ill-treatment in settings where patients do not have freedom of movement, for example, those detained under mental health legislation or in facilities for the elderly • Inappropriate use of medical treatment, such as overuse of sedatives, may also be ill-treatment

50. Duties of the health professional • Health professionals have a duty to treat all patients without any form of discrimination and to provide treatment based only upon medical criteria without outside influence • In cases where torture or other ill-treatment is suspected, the health professional must keep in mind that these are crimes under international law, and probably domestic law • The health professional’s duty is to document objectively any psychological or physical findings and, where pertinent, provide treatment or referral to colleagues for treatment • To do nothing may be seen as acquiescence and as compounding the abuse