ETHICS: Human Rights and Global Justice

Question 1

What is justice?

Answer 1

Justice is concerned with the reciprocal relationship between individuals and society

It carries the fundamental notion that all humans are equally valued

Question 2

What is distributive justice?

Answer 2

Distributive justice is concerned with how certain goods are shared within society

It is concerned with the access and possession of goods, services and wealth

Question 3

How did wealth and status (social deprivation) affect COVID-19?

Answer 3

Social deprivation caused:

• x1.9 diagnosis rate
• x2.3 increased death rate

Question 4

How do UK health inequalities affect life expectancy?

Answer 4

Green park station = 89 years life expectancy

Falls with every stop away from there

Stockwell = 78 years life expectancy

Question 5

Are health inequalities a matter for justice?

Answer 5

Yes:

• Nobody can control where they are born
• Health inequalities are a misfortune
• The world would be better if global health inequalities could be reduced

No:

Life is full of misfortunes, some of which cause much suffering but not all of which we consider ethical concerns

Question 6

Is justice a reward for hard work?

Answer 6

Yes:

Perhaps it is fair that to be rewarded for hard work and if you choose to work hard, it is right to reap the profits

It is up to us as individuals to make the most of our talents and to overcome our weaknesses

No:

Not all success is due to hard work but also due to start point e.g. where you were born and socioeconomic status of parents

That some people are born into poverty and extreme hardship is simply bad luck

Question 7

What are the benefits of charity?

Answer 7

Charity fosters kindness and empathy

Such kindness fosters a sense of interdependence and makes communities morally and socially richer

Question 8

If we believe in justice and value all human lives equally, is healthcare a matter for justice?

Answer 8

Yes:

Certain goods such as food, shelter and a decent level of health are essential for an autonomous life AND are necessary to be capable of flourishing or leading a life of value AND SO decent access to healthcare is a matter of justice

Amartya Sen has argued that if we value all human lives equally then justice requires that we ensure that all individuals have an equal capability to flourish/pursue lives of value

Question 9

What is the problem with charity for the recipient?

Answer 9

Autonomy of the recipient is undermined because:

• recipients are dependent on the action of donors + they have no entitlement to such assistance
• if individuals are dependent on charity to meet their basic needs, the autonomy of the recipient is undermined

Question 10

What is solidarity and its relationship with justice? Vs charity?

Answer 10

Solidarity is sense of standing together when individuals or the community are threatened. Processes and actions that promote solidarity are likely to promote social justice

With charity we choose to help those we recognise as a good cause

Question 11

To ensure equitable global access to Covid vaccines/therapies needs more than money:

• A commitment to global justice at every stage from development to delivery
• Space for voices to be heard to understand the social, political, logistical challenges to vaccine access
• Collaboration between global institutions, commercial organisations, governments, research funders and academic institutions

Answer 11

Equitable access needs to address:

• affordability
• local healthcare infrastructure
• intellectual property rights and medicines
• cultural diveristy and healthcare access

Question 12

SUMMARY:

• Pandemics amplify health inequalities
• Health care is a matter for justice
• Humanitarian aid is not a sufficient moral approach to global health inequalities
• Policies and a culture that promote solidarity are likely to promote social justice and address health inequalities

Question 13

What is the difference between moral rights and legal rights?

Answer 13

Moral rights = A special form of moral claim which impose a moral obligation on others to ensure such claims are upheld

Legal rights = Legally enforceable entitlements

BOTH: Moral and legal rights recognise all humans as having equal value

Question 14

When was the Human Rights Act established?

Answer 14

1998

Follows European convention of human rights (after war)

Question 15

What does the HRA 1998 define? What does it incorporate?

Answer 15

Defines legally enforceable rights entitlements in the UK

Incorporates European Convention on Human Rights into English Law

Question 16

What is the HRA 1998 enforcable against?

Answer 16

The Act is enforceable against public authorities not individuals or private bodies

The Courts must interpret legislation consistently with Convention Rights

Question 17

Which aspects of healthcare is the HRA 1998 applicable in?

Answer 17

HRA is relevant to many different aspects of healthcare

• Refusal of treatment
• Medical confidentiality
• Compulsory treatment and detention
• Withdrawal of life sustaining treatment
• Abortion
• Assisted suicide

Question 18

True or false: “There is no legal right to healthcare under the Human Rights Act”

Answer 18

True

Question 19

Which 4 HRA articles are relevant to healthcare?

Answer 19

Article 2: Right to life

Article 3: Prohibition of torture

Article 5: Right to liberty

Article 8: Right to a private life

Question 20

What is article 2 of the HRA 1998? What are the exceptions?

Answer 20

Right to life - everyone’s life shall be protected by law

Applicable to intentional killing (but not all avoidable death counts as intentional killing)

Exceptions:

• There is no absolute obligation to provided life saving treatment
• Withdrawal of futile treatment will not breach article 2
• The right does not extend to the fetus

Question 21

What is article 3 of the HRA 1998? What may breach article 3 in healthcare?

Answer 21

Article 3 – No one shall be subjected to torture or to inhuman or degrading treatment or punishment

This right is absolute

Examples:

• Non-consensual treatment of an incompetent individual may contravene article 3 if it is not therapeutically necessary
• Excessive restraint may contravene article 3

Question 22

What is article 5 of the HRA 1998? Which area of medicine is this most relevant in? What process must be in place for the individual is this is breached in healthcare?

Answer 22

Article 5 – Everyone has the right to liberty and security of person

This right is not absolute

Relevant in infectious diseases and psychiatry:

• Detention is lawful for mental illness or prevention of infectious disease if it is in accordance with the law
• Individuals must have access to an effective and speedy means of challenging detention
  
  • Appeal process under Mental Health Act
  • Deprivation of Liberty Safeguards

Question 23

What is article 8 under HRA 1998? Is this absolute? Where else is it relevant in in healthcare?

Answer 23

Article 8 – Everyone has the right for his private and family life

This right is not absolute

Protects a patient’s right to confidentiality

Protects the right to refuse medical treatment even if life saving

Question 24

When can article 8 be breached?

Answer 24

Article 8 will not be contravened if a breach is in accordance with the law AND is necessary in a democratic society in the interests of:

• national security,
• public safety
• the economic well being of the country
• for the prevention of disorder or crime,
• for the protection of health or morals
• for the protection of the rights and freedoms of others

Question 25

What would you advise Dr R?

B is a 61 year old man who attends A+E with a history of fever and cough. He is a heavy smoker but denies any previous health problems. The on call FY2 Dr R sustains a needlestick injury whilst taking an arterial blood gas. Dr R’s consultant is informed and asks B if he would be willing to have an HIV test. B refuses. Dr R does not want to take post exposure prophylaxis unless it is necessary.

• 1.Dr R should go back and try to persuade B to consent to the test
• 2.Performing the HIV test without consent would breach B’s HRA 1998 rights
• 3.Dr R should ask the lab to do a CD4 count instead
• 4.B must consent to the test as otherwise it would be a breach of Dr R’s human rights under Article 3
• 5.The hospital must perform the HIV test otherwise it will contravene Dr R’s right to life under article 2

Answer 25

2
(breach of B’s article 8 rights…)

Question 26

B is a 61 year old man who attends A+E with a history of fever and cough. He is a heavy smoker but denies any previous health problems. The on call FY2 Dr R sustains a needlestick injury whilst taking an arterial blood gas. Dr R’s consultant is informed and asks B if he would be willing to have an HIV test. B refuses. Dr R does not want to take post exposure prophylaxis unless it is necessary. What HRA article would doing the blood test to B breach?

Answer 26

Article 8

Question 27

B made a good recovery with no evidence of neurological deficit. At discharge he was still refusing an HIV test. 3 years later B is brought into hospital with a headache and confusion. Dr R is now an ST3 in infectious diseases. B has a GCS of 10 (E3, M4, V3). A lumbar puncture is performed and confirms a diagnosis of cryptococcal meningitis. B’s HIV test comes back positive. The next day B’s conscious level is improved (E4, M6, V4) but he remains very confused. His consultant is optimistic that B will make a good neurological recovery. B’s wife asks Dr R what is wrong with her husband.

How should Dr R respond regarding B’s HIV status?

• A.Disclose the diagnosis of HIV as his wife has a right to know under article 2 of the Human Rights Act
• B.Disclosure of the diagnosis of HIV is a justifiable breach of article 8 of the Human Rights Act as B’s wife may have been exposed to HIV
• C.Disclosure of B’s HIV status should wait until B is able to give consent
• D.Dr R cannot disclose the diagnosis of HIV as article 8 of the Human Rights Act grants B an absolute right to confidentiality
• E.The clinical team knows B’s diagnosis of HIV so the information is no longer confidential and can be disclosed

Answer 27

Option C

• Not article 2 as this is regarding intentional killing.
• The patient will be in a good position to agree or disagree so the best option is to wait until recovered since he is expected to make a good recovery
• Autonomy is least restricted if you give the patient choice * chance to tell the wife himself
• If the patient was not expected to make a recovery then you might disclose this
• There is no absolute right to confidnentiality but justfiable breaches are allowed

Question 28

HRA 1998 summary:

1. Legal rights are distinct from moral rights
2. Healthcare decisions in the UK must comply with the Human Rights Act
3. Breaches of confidentiality engage article 8 of the HRA
4. The HRA does not include a right to healthcare
5. There is no globally enforceable right to healthcare