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Human Rights

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Human Rights & Human Responsibilities Donna Knapp van Bogaert, PhD, D. Phil Ethics & Moral Philosophy Faculties of Medicine & Dentistry University of Limpopo Medunsa ... – PowerPoint PPT presentation

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Title: Human Rights


1
Human Rights Human Responsibilities
Donna Knapp van Bogaert, PhD, D. Phil Ethics
Moral Philosophy Faculties of Medicine
Dentistry University of Limpopo Medunsa Campus
2
Outline
  • Ethics Moral Philosophy (EMP)
  • Example Three-year EMP Programme
  • Human Rights and Human Responsibility Block
  • Outcomes/Standards, Assessments, Suggested Core
    Competencies
  • Conclusion

3
I. Aim of the Ethics Moral Philosophy Programme
  • The creation of good people who will inculcate
    the Art intrinsic in the professions of Medicine
    Dentistry by accepting their moral
    responsibility to
  • enhance and promote the health and medical
    welfare of the people they serve
  • in ways which, in the practice of fairness and
    justice, respect their rights, values, interests,
    and dignity.

4
Sub-text of the EMP Programme
  • Emphasises responsibility, the things for which
    people are accountable.
  • Professional or social roles are defined in terms
    of the responsibilities they involve.
  • Focus on the person as a professional and
    respected community member
  • Build on their good character.
  • Define the parameters of ethical (right / good)
    unethical (wrong / bad) human conduct.

5
Faculty of Medicine Ethics Moral Philosophy
Programme
  • Year 1 MBChB 8 hours / academic year full class
    sessions (class 220 students).
  • Year 2 MBChB 12 hours / academic year full class
    sessions (class 230 students).
  • Clinical Ethics Blocks (Block is 3 hrs week x 6
    weeks. Six groups - group size 40). Total year
    30 hours.
  • Year 3 MBChB 3 x 40 min sessions / academic year
    full class sessions (class 230 students).
  • Year 4 MBChB 3 x 40 min. sessions / academic
    year full class sessions (class 250 students).

6
Faculty of Dentistry
  • BDT years 2 3 One 40 minute session per week x
    40 sessions ( 10 students each class 6 blocks /
    year).
  • BDS years 3, 4 ,5 (OC), 6 (OC) One 40 minute
    session per week x 40 sessions ( 35 students
    each class 6 blocks / year).
  • BDS 5 (NC) Ethics projects 11 tutorials.
  • plus research project

7
EMP Programme Cross-Faculties
  • Both follow same general EMP curriculum.
  • Curriculum modified according to time
    constraints.
  • Each successive year builds upon prior learning.
  • Each year integrates / has relevance to
    particular learning of that year viz. greater
    emphasis on ethics in practice (ethical-clinical
    dilemmas) increases with increasing clinical
    duties.

8
II Example Faculty of Dentistry
  • 3 Year Curriculum
  • Ethics Moral Philosophy

9
Faculty of Dentistry
  • Supportive Dean Faculty
  • Continuing CPD programmes in Ethics
  • Faculty Ethics Committee
  • Dr. Marcelle Harris, HOD Integrated Curriculum
    Development
  • Ethical Practice Management Programme (EPMP)
  • Ethics Moral Philosophy 50,
  • Business Practice Management Law 50
  • Patient Interviewing Skills (student video
    sessions)
  • EPMP required and assessed as part of core
    curriculum.
  • Advantages Small classes, stringent student
    selection, buy-in by faculty.

10
Year 1 Block 1 Ideology, Logic Critical
Thinking Skills
  • Logic critical thinking skills 1-3.
  • Moral reasoning, Ethical decision-making
    guidelines.
  • Ideology Globalisation of the good life,
    advertising the media.
  • Plagiarism Class and university rules,
    referencing basics.

11
Year 1 Block 2 Introduction to Ethics Moral
Philosophy
  • Why be ethical?
  • World-views Ways of Life.
  • Overview Systems of Ethics
  • (Hippocratic Oath method, Traditional
    approaches to ethics, Rights-based approaches,
    Ethics of Care, Pragmatism, Relativism,
    Postmodern approach).

12
Year 1 Block 3 Virtues Values
  • Aristotles virtues.
  • Virtues in the practice of good medicine
    dentistry.
  • Truth-telling Legal and ethical boundaries.
  • Who or what is of value?
  • From professional values to standards.

13
Year 1 Block 4 Approaches to Ethical Problems
Deontology Consequentialism / Utilitarianism
  • Duty Respect for Persons
  • Duties, obligations, and responsibilities
  • Categorical Imperatives
  • Consequentialism
  • Utilitarianism
  • Act and Rule utilitarianism
  • The Principle of Utility
  • The Harm Principle

14
Year 1 Block 5 Approaches to Ethical Problems
Principlism Communitarianism
  • Principlism
  • Beauchamp Childresss Principlism Autonomy,
    Non-maleficence, Beneficence, Justice.
  • Tavistock Principles Rights, Balance,
    Comprehensiveness, Cooperation, Improvement,
    Safety, Openness.
  • Communitarianism
  • African Philosophy Personhood Community
  • Etizonis Communitarianism

15
Year 1 Block 6 Professionalism Responsibility
  • Students Quotas
  • Etiquette Ethics
  • The Difficult Ones Patients, staff, family,
    self.
  • Advocacy Health Promotion.
  • The Dental Hierarchy Questioning acting
    against authority.
  • Conflicts of Interest Conflict Resolution
    Faculty Ethics Committee.
  • Placing blame, asking for help.
  • Limits of tolerance.

16
Year 2 Block 1 Accepting Responsibility
  • HPCSA professional ethical guidelines,
    regulations, boundaries.
  • Being Afraid Admitting Mistakes Omissions
    commissions in student professional personal
    life.
  • Name and Shame does it matter?
  • Power responsibility the healthcare hierarchy
    dentists patients, lecturers students, men
    women.
  • Whistleblowing concept warrant.
  • HIV risks, duties, responsibilities doctor,
    student patient.

17
Year 2 Bock 2 Issues in Ethics Confidentiality
  • Professional information, privacy and respect for
    persons .
  • Trust, secrecy and security in the sharing of
    information practical considerations.
  • Students, staff supervisors Patients,
    families, friends moral tensions.
  • Disclosure of information Public versus private
    interests.
  • Compulsory and discretionary disclosure of
    confidential information.

18
Year 2 Block 3 Issues in Ethics Professional
relationships
  • Truth Truthfulness
  • Paternalism debate
  • The patients story as sub-text.
  • Collisions of Cultures and Traditions
  • Respect and tolerance any difference?

19
Year 2 Block 4 Issues in Ethics The
Responsibility of Informing
  • Informed consent the refusal of treatment.
  • Respect for persons.
  • Process of informed consent.
  • Competence ethical and legal aspects.
  • Comprehension ethical and legal aspects.
  • Voluntary acts.
  • Acting without consent when why
    justifiability.
  • Refusing treatment ethical and legal aspects.

20
Year 2 Block 5 Issues in Ethics Public Health
the Environment
  • Public Health
  • Infection control in dental practice
  • Contested illnesses difficulties in dealing with
    doubts discords.
  • Disease in individuals vs. communities
    individual rights quarantine / isolation
    management
  • Emerging infectious diseases, bioterrorism
  • Toxic Substances Disposal of Hazardous
    Waste-ethical legal issues
  • Environmental health
  • Human health health of the environment
  • Fluoridation debate
  • Anthropocentrism
  • Principles of environmental justice
  • Environmental pragmatism

21
Year 2 Block 6 Issues in Ethics Distributive
Justice Resource Allocation
  • Theories of Justice.
  • Inadequate health resources and distributive
    justice.
  • Equitable health care needs, rights, utility,
    efficiency, desert, autonomy.
  • Complexity rights (individual collective),
    legislative reform, need for institutional
    development.
  • Rationing and inequality international/ national
    / provincial allocations.
  • Boundaries of responsibility debate individuals
    self-induced illnesses cost of violence inc.
    MVA, PVA to public / healthcare system.

22
Year 3 Block 1 Issues in Ethics the Abortion
Debate
  • Reproductive Rights Reproductive
    Responsibilities.
  • Doctrine of Double Effect, Doctrine of
    Self-Defense.
  • Womens Rights, Health-professionals rights,
    fetal rights.
  • The TOP Act South African professional
    guidelines, legal requirements.
  • Personhood maternal / fetal / community
    relationship.
  • Family Planning Reproduction Advocacy.

23
Year 3 Block 2 Issues in Ethics Liberty
  • How free is free?
  • Freedom of thought discussion in private and
    public life.
  • Affecting choices? Globalisation and the
    mediasation of the good life.
  • Pornography.
  • Substance Abuse Legal ethical issues.

24
Year 3 Block 3 Clinical Research
  • Human participants in research Historical and
    contemporary examples of abuses of medical /
    clinical research.
  • Conflicts of interest in therapeutic and non
    therapeutic research.
  • HPCSA, national, international research
    guidelines.
  • Research on animals ethical debate
  • Writing research proposals process, guidelines.
  • Vulnerable Populations HIV infected, Disabled
    Persons, Women, Children, the Elderly, Prisoners,
    Refugees Displaced Persons, Students, patients.

25
Year 3 Block 4 Ethical Issues Death Dying -
Who lives? Who dies? Who chooses?
  • Punishment the death penalty debate.
  • Quality of life- whos quality?
  • Palliative care.
  • Treatment provision, non-provision, killing and
    letting die, double effect, ordinary and extra
    ordinary care.
  • Advanced directives living wills ethical
    groundings.
  • Euthanasia and physician-assisted suicide
    ethical and legal arguments .
  • Tissue, organ, bone tooth SA Anatomy Act.
  • Suicide.

26
Year 3 Bock 5 Human Rights Human
Responsibilities
  • Culpable healthcare professionals (police
    interrogation torture).
  • Rights, duties, and responsibilities.
  • National international documents concerning
    human rights.
  • Relationship between health human rights.
  • Human security, human interests, human rights
    the debate.
  • Dual loyalty and human rights.

27
Year 3 Block 6 Ethical Issues at Chair-side
  • Abuse Physical sexual abuse, sexual advances
    Whats wrong with rape, whats wrong with the
    Willing patient, willing doctor, sex as
    bargaining tool.
  • Social conduct Sexist, racial, cultural slurs
    derogatory references to patients psychological
    abuse.
  • Student Dentists Case studies from previous
    classes.

28
III Block FocusHuman Rights Human
Responsibilities
29
Why Responsibility as in Human Rights Human
Responsibility ?
  • Terms are co-relative concordant
  • Without acceptance of responsibility, rights are
    empty claims.
  • Who should accept responsibility?
  • All human beings especially healthcare
    professionals who are highly regarded trusted
    members of the community.

30
Block Objectives
  • Identify and develop novel and effective
    strategies, means and methods for the
    strengthening of the democratic fabric of South
    African society through the promotion of human
    rights responsibilities.
  • Inculcate in healthcare professionals their
    responsibility to protect and respect human
    rights.

31
Block Outcomes / Unit Standards
  • At the end of this block you will demonstrate the
    ability to
  • Discuss the concept of human rights dual
    loyalty and identify some of the reasons why,
    how, and in in what forms of society healthcare
    professionals may become involved in human rights
    violations
  • Demonstrate professional awareness of
    individuals' rights and understanding of their
    responsibilities
  • Relate the links between health and human rights
    between rights, duties, and responsibility

32
Block Outcomes / Unit Standards
  • At the end of this block you will demonstrate the
    ability to
  • Give examples of ways in which the exchange and
    dissemination of knowledge, experience, and good
    human rights practice in South Africa may be
    enhanced
  • Construct a transparent and decisive policy
    concerning institutional accountability in
    documenting, reporting, and disciplining human
    rights violators violations.

33
HRR Block Required Readings / Audio-visual
Materials
  • TRC Report on the Healthcare Sector (transcripts
    used in class role-play).
  • Dual Loyalty Human Rights (phrusa org.),
  • Cape Town Case
  • UNDHR, Tokyo Declaration, WMA documents.
  • Excerpts from Tolstoys Crime Punishment,
    Scarrys The Body in Pain, Nietzsches Thus Spoke
    Zarathustra, Millgrams Obedience to Authority.
  • Audio-visual (film) Death the Maiden.

34
Prior Knowledge
  • Preceding HRR block students have background in
    e.g.
  • Ethical theories, principles, virtues, values,
  • Ideology, influence of media asymmetrical
    power relationships, logic argumentation, e.g.
    punishment death penalty debate.
  • South African Constitution including Bill of
    Rights, Patients Rights Charter, basic
    principles of law, notes record writing
    keeping (from practice management section),
  • HPCSA other professional guidelines,
  • Individualist communitarian approaches to
    ethics.
  • Historical grounding of consent (Nuremberg Code),
    principles of informed consent, concept
    identification of vulnerable populations.
  • Institutional ethics class, race gender,
    economic disparities distinctions effects of
    globalisation of good life social
    responsibility as professional in the community
    theoretical dimensions of concepts of rights,
    historical documentation of
  • human rights abuses

35
Assessment Methods
  • (1) Example In-class test
  • Questions include e.g.
  • Define and discuss the problem of dual loyalty in
    health care.
  • Identify the links between health and human
    rights.
  • Give examples of human rights abuses occurring in
    open societies in closed repressive
    societies.
  • Discuss some reasons why healthcare professionals
    are targeted by morally corrupted governments.
  • List three important documents which support
    human rights.

36
Assessment
  • (2) Case study example
  • From your own clinical experience, you will
    identify an incident of human rights abuse. In
    your case study analysis you will include
  • An introduction to the case in which you discuss
    your responsibility to protect and respect human
    rights.
  • Then you will
  • Describe the circumstances of the abuse
    (role-players their relationships),
  • Provide a description of the type of HR violation
    (including the name of the document (s) in which
    the abuse is identified).
  • Include your personal documentation of the abuse,
  • Identify to whom you reported the abuse,
  • Discuss the final resolution to the incident.
  • You will conclude with your ideas concerning
    institutional mechanisms that should be put in
    place for prevention of future abuses.

37
Assessment
  • (2) Case study example
  • In the Cape Town case, doctors were removed
    from becoming gatekeepers viz. reporting to
    government health authorities non-citizens /
    aliens requesting health care. Instead, the
    responsibility for this was given to ward clerks.

38
Assessment, cont.
  • In this assignment you will critisise the case
    focusing on the issue of dual loyalty.,
  • First, you will summarise the case. Then, you
    will define the term dual loyalty.
  • Next, you will provide arguments for the
    application of the concept dual loyalty being
    applied only to healthcare professionals as
    opposed to it being extended to all workers
    within the healthcare system.
  • Then you will argue against the positions you
    have just identified.
  • You will conclude by developing your personal
    argument pro or con the cases resolution.

39
Assessment
  • (3) Institutional Human Rights Accountability
    Policy Example
  • In this assignment you will develop a document in
    which you identify institutional accountability
    mechanisms for holding those who violate human
    rights accountable for their actions. You will
  • Refer to South African history and include the
    ethical reasons for holding individuals
    accountable for their actions (you will
    necessarily discuss the concept of collective
    responsibility),
  • the professional standards (HPCSA) concerning
    human rights violations, and
  • references to documents articulating the need for
    protection from human rights abuses.
  • Then you will discuss problems you anticipate in
    implementing this policy (e.g. who decides, who
    monitors),
  • Finally, you will provide some ideas for
    resolving the problems you have identified.

40
EMP Programmes Educational Objectives
  • Knowledge
  • To know specific facts, concepts, principles or
    theories.
  • Comprehension
  • To understand, interpret, compare or contrast.
  • Application
  • To solve problems, to render ideas for solutions,
    to apply knowledge to new dilemmas.
  • Analysis
  • To identify organisational structure, to
    recognise relationships, organising principles.
  • Synthesis
  • To create something new, to think outside the
    box, to propose an action.
  • Evaluation
  • To judge the quality of something based on its
    adequacy, value, logic or use.

41
Core HRR Competencies
  • Evaluation , treatment, documentation, and
    institutional policy development concerning human
    rights violations including disciplinary
    measures.
  • Fundamental knowledge of human rights and the
    laws, documents, and declarations which support
    promotion of human rights in the healthcare
    context.
  • Recognition of why healthcare professionals are
    targets for immoral governments in power quests.
  • Acceptance of responsibility of healthcare
    professionals to advocate for, respect, and
    protect human rights.
  • Exchange and dissemination of knowledge,
    experience, and good human rights practice.
  • Recognition and protection of the rights of
    vulnerable populations.

42
IV. Conclusion
  • Overviewed the Ethics Moral Philosophy (EMP)
    Programme and outlined the HRR block within it
    at the UL Medunsa Campus.
  • Described the HRR Blocks
  • Outcomes / Block standards
  • Assessments
  • Objectives
  • Provided our core competencies
  • Argue that when human rights and human
    responsibilities are embedded within an Ethics /
    Ethics Moral Philosophy programme, students are
    empowered with a richer and deeper understanding
    of their personal and professional
    responsibilities to protect, respect, and
    advocate for human rights.

43
No conflicts of interest. Thank you.
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