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Human rights, ethics, and pandemic influenza


Title: Human rights, ethics, and pandemic influenza Author: ahinman Last modified by: ahinman Created Date: 7/9/2011 11:34:09 AM Document presentation format – PowerPoint PPT presentation

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Title: Human rights, ethics, and pandemic influenza

Human rights, ethics, and pandemic influenza
  • Alan Hinman and Aun Lor
  • July 2011

Outline of presentation
  • Definitions
  • Concepts of human rights
  • Public health impact on human rights
  • Principles of ethics
  • Principles of ethical practice of public health
  • Human rights/ethical issues in pandemic influenza

What is health?
  • Health is a complete state of mental and
    physical well-being, not merely the absence of
  • WHO charter

What is public health?
  • The mission of public health is fulfilling
    societys interest in assuring conditions in
    which people can be healthy.
  • Institute of Medicine

Fundamental characteristics of human rights
  • Set of beliefs about societal basis of human
  • Series of non-provable statements about what
    people need to maintain their human dignity
  • Rights of individuals
  • Inhere to individuals because they are human
  • Apply to all people around the world
  • Principally involve the relationship between the
    state and the individual

Pubic Health and Human Rights-1
  • Both PH and HR are vitally concerned with social
  • However, many PH workers do not view what they do
    as human rights activities
  • Many HR workers do not consider PH indices as
    important indicators of HR
  • Working together, PH and HR workers can have much
    greater impact

Pubic Health and Human Rights-2
  • HR workers tend to focus on denial of HR
  • PH workers tend to focus on achieving health (a
    human right)
  • How can we bring them to common understanding?

Preamble to WHO Constitution
  • "The enjoyment of the highest attainable standard
    of health is one of the fundamental rights of
    every human being without distinction of race,
    religion, political belief, economic or social

Human Rights Documentsciting Health Rights - 1
  • Universal Declaration of Human Rights
  • International Covenant on Economic, Social and
    Cultural Rights
  • International Covenant on Civil and Political
  • International Convention on the Elimination of
    All Forms of Racial Discrimination

Human Rights Documentsciting Health Rights - 2
  • Convention on the Elimination of All Forms of
    Discrimination Against Women
  • Convention on the Rights of the Child
  • Declaration on the Elimination of all Forms of
    Intolerance and of Discrimination Based on
    Religion or Belief
  • ILO Convention Concerning Indigenous and Tribal
    Peoples in Independent Countries

Human Rights Documentsciting Health Rights - 3
  • Standard Minimum Rules for the Treatment of
  • African (Banjul) Charter on Human and Peoples'
  • European Social Charter
  • Cairo Declaration on Human Rights in Islam
  • American Declaration of the Rights and Duties of

Universal Declaration of Human Rights - 1
  • Article 23 (1) - Everyone has the right
    tofavorable conditions of work
  • Article 25 (1) - Everyone has the right to a
    standard of living adequate for the health and
    well-being of himself and of his family,
    including food,medical careand the right to
    security in the event ofsicknesswidowhood, old
    age or other lack of livelihood in circumstances
    beyond his control

UDHR - 2
  • Article 25(2) - Motherhood and childhood are
    entitled to special care and assistance
  • Article 26 (1) - Everyone has the right to

International Covenant on Civil and Political
Rights (ICCPR)
  • Article one shall be subjected without his
    free consent to medical or scientific
  • Article 22 (2) restrictions on the exercise
    of this right freedom of association other than
    those which are prescribed by law and which are
    necessaryforthe protection of public health
  • Article 24 (2) - Every child shall be registered
    immediately after birth

International Covenant on Economic, Social, and
Cultural Rights - 1
  • Article 7 (b)right of everyone to the enjoyment
    of just and favourable conditions of work which
    ensuresafe and healthy working conditions
  • Article 10 (2) - Special protection should be
    accorded to mothers during a reasonable period
    before and after childbirth
  • Article 10 (3) Special measures of protection
    and assistance should be taken on behalf of all
    children and young persons

  • Article 12 (1)right of everyone to the enjoyment
    of the highest attainable standard of physical
    and mental health
  • Article 12 (2a)...reduction of the
    stillbirth-rate and of infant mortality and for
    the healthy development of the child

  • Article 12 (2b) improvement of all aspects of
    environmental and industrial hygiene
  • Article 12 (2c) prevention, treatment and
    control of epidemic, endemic, occupational and
    other diseases
  • Article 12 (2d) creation of conditions which
    would assure to all medical service and medical
    attention in the event of sickness

ICESCR Immunization
  • The core obligation of governments
  • to ensure access to immunization against the
    communitys major infectious diseases.
  • General comment 14

American Declaration of the rights and duties of
  • Article 7 - All women, during pregnancy and the
    nursing period, and all children have the right
    to special protection, care and aid
  • Article 11 - Every person has the right to the
    preservation of his health through sanitary and
    social measures relating tomedical care, to the
    extent permitted by public and community resources

Developing a public health and human rights
impact assessment
  • Define the public health problem
  • Describe the proposed public health program
  • Identify the anticipated public health impact
    (beneficial and adverse effects)
  • Identify the anticipated human rights impact
    (beneficial and adverse effects)
  • Identify alternative approaches
  • Describe the reasons for decision to select the
    proposed program or not to implement the program

(No Transcript)
Conditions in which human rights may be
restricted - Syracusa principles
  • Restriction is provided for and carried out in
    accordance with the law
  • Restriction is in the interest of a legitimate
    objective of general interest, e.g., public
    safety, public order, public health
  • Restriction is strictly necessary in a democratic
    society to achieve the objective
  • There are no less intrusive and restrictive means
    available to reach the same goal
  • Restriction is not imposed arbitrarily, i.e., in
    an unreasonable or otherwise discriminatory

Civil and political rights that may be limited
  • Right to liberty
  • Right to security of persons
  • Freedom from arbitrary arrest, detention, or
  • Freedom of movement
  • Freedom from interference of privacy, family,
  • Right to peaceful assembly and association
  • Freedom of opinion and expression

Ethics, Morals, and Values
  • Morality refers to social conventions about
    right and wrong human conduct that are so widely
    shared that they form a stable communal
  • The practice
  • Ethics is the systematic study of morality, a
    philosophical account of justified behavior
  • The theory

  • core beliefs or desires which guide or motivate
    attitudes or actionsvalues are core beliefs
    which determine how we will behave in certain
  • Making Ethical Decisions Josephson
    Ethical Institute

  • Classic medical ethics definitions
  • Self-determination - persons must be self-
    governing, rational, and not coerced
  • Respecting the wishes and choices of persons
    who have the capacity to decide
  • Protecting those who lack this capacity
  • Public health forms
  • Privacy
  • Freedom of action

  • Providing benefits
  • Balancing benefits with harms
  • Protecting persons interests and promoting the
    welfare of others
  • In public health ethics, must be interpreted
    broadly in light of social needs
  • Example Overall goal of public health policy

  • First, do no harm
  • Balancing benefits and harms
  • Example Considering the side effect profile of a
    prescription drug

  • Fairness
  • Treating similar cases similarly
  • Equality of opportunity
  • Equity in access
  • At the core of public health
  • Example Ensuring equal access to vulnerable

  • Duty to tell the truth or not to lie
  • Lies add power to the liar and diminish the power
    of the deceived

Public Health Principles
  • Public health assumes background principles
  • Social justice
  • Pragmatism
  • Equality
  • The Common Good
  • Community
  • Prevention
  • Access
  • Liberty
  • Privacy

Principles of the ethical practice of public
health - 1
  • 1. Public health should address principally the
    fundamental causes of disease and requirements
    for health, aiming to prevent adverse health
  • 2. Public health should achieve community health
    in a way that respects the rights of individuals
    in the community.
  • 3. Public health policies, programs, and
    priorities should be developed and evaluated
    through processes that ensure an opportunity for
    input from community members. Public Health
    Leadership Society

Principles of the ethical practice of public
health - 2
  • 4. Public health should advocate and work for
    the empowerment of disenfranchised community
    members, aiming to ensure that the basic
    resources and conditions necessary for health are
    accessible to all.
  • 5. Public health should seek the information
    needed to implement effective policies and
    programs that protect and promote health.

Principles of the ethical practice of public
health - 3
  • 6. Public health institutions should provide
    communities with the information they have that
    is needed for decisions on policies or programs
    and should obtain the communitys consent for
    their implementation.
  • 7. Public health institutions should act in a
    timely manner on the information they have within
    the resources and the mandate given to them by
    the public.

Principles of the ethical practice of public
health - 4
  • 8. Public health programs and policies should
    incorporate a variety of approaches that
    anticipate and respect diverse values, beliefs,
    and cultures in the community.
  • 9. Public health programs and policies should be
    implemented in a manner that most enhances the
    physical and social environment.

Principles of the ethical practice of public
health - 5
  • 10. Public health institutions should protect the
    confidentiality of information that can bring
    harm to an individual or community if made
    public. Exceptions must be justified on the basis
    of the high likelihood of significant harm to the
    individual or others.
  • 11. Public health institutions should ensure the
    professional competence of their employees.
  • 12. Public health institutions and their
    employees should engage in collaborations and
    affiliations in ways that build the publics
    trust and the institutions effectiveness.

Human rights/ethical issues in pandemic influenza
  • Delays and shortages in availability of vaccines
    and antiviral drugs - need to prioritize
  • Isolation/quarantine
  • School closings/social distancing
  • Disruption of national/community infrastructures
    including transportation, commerce, utilities and
    public safety due to widespread illness and death
    among workers and their families

US priority groups for vaccine - 1
  • 1A
  • Vaccine/antiviral manufacturers and others
    essential to manufacturing and critical support
  • Medical workers and public health workers
    involved in direct patient contact
  • 1B
  • Persons gt65 yr old with gt 1 high-risk conditions
  • Persons gt6 mo with history of hospitalization for
    pneumonia or influenza in past year

US priority groups for vaccine - 2
  • 1C
  • Pregnant women
  • Household contacts of severely immunocompromised
  • Household contacts of children lt6 mo old
  • 1D
  • Public health emergency response workers critical
    to pandemic response
  • Key government leaders

US priority groups for vaccine - 3
  • 2A
  • Healthy persons gt65 yr old
  • Persons 6 mo 64 yr old with 1 high-risk
  • Persons 6 23 mo old, healthy
  • 2B
  • Other public health emergency responders
  • Public safety workers
  • Utility workers
  • Transportation workers
  • Telecommunications/IT essential workers

US priority groups for vaccine - 4
  • 3
  • other key government health decision-makers
  • Funeral directors/embalmers
  • 4
  • Healthy persons 2 64 yr old not included in
    above categories

US priority groups for antiviral drugs - 1
  1. Patients admitted to hospital
  2. Health care workers with direct patient contact
    and EMS providers
  3. Highest risk outpatients immunocompromised
    persons and pregnant women
  4. Pandemic helath responders, public safety,
    government decision-makers
  5. Increased risk outpatients children 12 -23 mo
    old , persons gt65 yr old, persons with underlying
    medical conditions

US priority groups for antiviral drugs - 2
  1. Outbreak response in nursing homes/other
    residential settings
  2. HCWs in emergency departments, intensive care
    units, dialysis centers, EMS providers
  3. Pandemic societal responders (critical
    infrastructure groups), HCW without direct
    patient contact
  4. Other outpatients

  • Human rights and ethics play an important role in
    public health programs
  • Enjoyment of human rights may be restricted in
    order to achieve legitimate public health goals
  • We should strive to limit negative human rights
    impact of public health programs
  • All decisions should be made according to ethical