Core Competencies in Human Rights for Health Professionals

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Core Competencies in Human Rights for Health
Professionals

• Towards a Generic Core Curriculum for Human
  Rights Ethics Training
• Workshop
• By Adv Boyce Mkhize, CEO HPCSA
• UCT Upper Campus
• 05 July 2006

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Human Rights Ethics Core Curriculum

• Practice of medicine raises ethical and legal
  issues and demands understanding of both
• Understanding of ethical and legal issues
  facilitates decision-making and its processes and
  creates a better basis for knowing what should be
  done in any given situation and why

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Human Rights Ethics Core Curriculum

• Growing realization that there is a core of
  skills and knowledge related to ethics that is as
  fundamental to the practice of medicine as basic
  sciences or clinical skills.
• Focus on the practice of medicine seems to be
  shifting more towards softer people skills to
  shape positive attitudes for best clinical
  intervention

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Human Rights Ethics Core Curriculum

• Hippocratic oath commentary highlights the
  important distinction between treating an ailment
  and treating a person with an ailment
• Literature suggests that healing is expedited
  where there is an appreciation that an individual
  is being treated rather than their ailment

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Human Rights Ethics Core Curriculum

• Humanity has a set of entitlements, such as a
  right to be treated with dignity and this right
  becomes even more pronounced when one deals with
  vulnerable groups such as the sick, elderly,
  women, children etc
• Practitioners unguarded and cold application of
  clinical skills might erode the essence of
  peoples rights

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Human Rights Ethics Core Curriculum

• South Africa, a country that has a legacy of
  disregard for human rights and ethics
  particularly needs to build a shared
  understanding of human rights ethics concepts
• Bill of rights needs contextual interpretation
  and application in the practice of medicine

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Historical Challenges

• Complicity of some health professionals with the
  apartheid system
• Failure of the SAMDC to deal decisively or at all
  with the health professionals who directly or
  indirectly supported the apartheid system
• Failure by SAMDC to provide guidelines and policy
  direction to health professionals in dual loyalty
  positions

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Historical Challenges

• Ethics training provided on an ad hoc,
  non-uniform and unstructured basis to medical
  students
• No system of continuing medical education and no
  guidance on how to apply human rights and ethics
  training to the daily practices of medical
  practitioners

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HPCSA Disciplinary Statistics
Category 2003/2004 2004/2005
Substandard treatment 39 19 73 31
Criminal/ dishonesty 110 54 101 43
Improper relations 10 5 28 12
Practice outside scope 44 22 32 14
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Historical Challenges

• Lack of courage or will to take proper action for
  professional misconduct particularly where it
  involved possibly crossing paths with the State
• Misuse of medical expertise and information
• Medical cover ups to support an evil system

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Historical Challenges

• Lack of a human rights discourse culture
• Lack of appropriate structures to defend
  independence of practitioners
• Lack of a culturally balanced representation in
  SAMDC
• Lack of a human rights based society and a
  democratic constitution

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Human Rights Ethics Core Curriculum

• Global Challenges
• Traditional medical curriculum has often made the
  teaching of ethics and law both eclectic and
  scarce
• Tutors have in certain instances not been
  adequately qualified to teach on the
  subjectlacking moral philosophy, moral theology
  or law backgrounds

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Human Rights Ethics Core Curriculum

• Teaching of ethics and law in some instances
  optional or not formally assessed and at times
  not even formally timetabled
• Ethics and human rights have not been regarded as
  an integral part of practice of medicine

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Human Rights Ethics Core Curriculum

• No consensus as to what ethics should be taught,
  how it should be taught and who should teach it
• Diverse forms of thinking about and analysing
  ethical issues in the practice of medicine
  ranging from a principlist approach to virtue
  ethics, narrative ethics and ethics of care

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Human Rights Ethics Core Curriculum

• International Benchmarks
• Australia and New Zealand adopted a common
  framework for teaching of ethics
• Australian Medical Council specifies that
  graduates completing basic medical education
  should know and understand ethics related to
  health care and legal responsibilities of a
  medical profession

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Human Rights Ethics Core Curriculum

• Australia and New Zealand stress that graduates
  should have an appreciation of the complexity of
  ethical issues related to human life and death,
  including the allocation of scarce resources
• UK teachers of medical ethics and law reached
  consensus on skills and attitudes graduates
  should possess

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Human Rights Ethics Core Curriculum

• As part of the global village and human rights
  and ethics being a universal concept, a need to
  establish a generic core curriculum cannot be
  overstated
• Curriculum should be academically rigorous and
  clinically relevant for presentation of both
  ethics and the law in medicine

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Human Rights Ethics Core Curriculum

• Teaching should stress the overall aims of
  medical education, the creation of good doctors
  who will enhance and promote the health and
  medical welfare of the people they serve in ways
  which fairly and justly respect their dignity,
  autonomy and rights.

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Human Rights Ethics Core Curriculum

• A core curriculum of ethics knowledge must
  address both the foundations of ethics and
  specific ethical topics.
• Ethical awareness, moral reasoning, communication
  and collaborative action skills
• Attitudes to develop ie. honesty, integrity,
  empathy, respect etc

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Declaration of Tokyo

• it is the privilege of a medical doctor to
  practice medicine in the service of humanity, to
  preserve and restore bodily and mental health
  without distinction as to persons, to comfort and
  to ease suffering of his/her patients. The utmost
  respect for human life is to be maintained even
  under threat and no use made of any medical
  knowledge contrary to the laws of humanity

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The Future??

• TOWARDS A UNIFORM CORE CURRICULUM ON HUMAN RIGHTS
  AND ETHICS!!!