Medical Professionalism and Human Dignity Dr. Myint Oo
(GP)
Slide 2
Slide 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 accountable to those serviced and
to society Oxford English Dictionary
Slide 4
What is Medical Professionalism? Basis of medicines 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
Slide 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
Slide 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
Slide 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
Slide 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
Slide 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
Slide 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
Slide 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
Slide 12
Physician's Rights 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
Slide 13
Slide 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 Dignity gives an individual a sense of
value and worth
Slide 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
Slide 16
Health Systems Versus Human Dignity Health systems can too
often be places of punishment, coercion, and violations of basic
rightsrather 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
Slide 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 for human dignity World Medical Association
Slide 18
Physician and Human Dignity physicians shall commit to "respect
human life and the dignity of every individual;...refrain from
supporting 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
Slide 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)
Slide 20
UNESCO Declaration The Article 2 states "Everyone has a right
to respect for their dignity"
Slide 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
Slide 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
Slide 23
Universal Declaration of Human Rights Article Three: Everyone
has the right to life, liberty and security of person
Slide 24
Universal Declaration of Human Rights No one shall be subjected
to torture or to cruel, inhuman or degrading treatment or
punishment Article 5
Slide 25
Universal Declaration of Human Rights
Slide 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
Slide 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 healths 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
Slide 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
Slide 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
Slide 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
Slide 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
Slide 32
Violations of Medical Neutrality Attacks on health care
facilities, medical personnel, and patients PHR Toolkits 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
Slide 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
Slide 34
Hospital Under Attack
Slide 35
Physician persecution anywhere is a threat to professionalism
everywhere AMA Ad hoc Physicians Persecution Advisory Group
(PAG)
Slide 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 Rapporteur on medical
neutrality
Slide 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
Slide 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
Slide 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
Slide 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
Slide 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
Slide 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
Slide 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
Slide 44
Linkage Between Health and Human Rights
Slide 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 populations 2. Recognize how health professionals may be
involved in the documentation and adjudication of cases of human
rights abuses 3. Recognize that physicians have been used as agents
of the state in abusing human rights. 4. Understand the
rights-based approach to promoting health
Slide 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)
Slide 47
Declaration of Geneva - WMA 2006 I WILL NOT USE my medical
knowledge to violate human rights and civil liberties, even under
threat
Slide 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 worlds 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
Slide 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
Slide 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 professionals 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
Slide 51
Physician and Torture
Slide 52
Ethical rules directly prohibiting involvement in torture The
World Medical Associations 1975 Declaration of Tokyo, Guidelines
for Medical Doctors Concerning Torture and Other Cruel, Inhuman or
Degrading Treatment or Punishment in Relation to Detention and
Imprisonment, contains an unequivocal prohibition on any form of
active or passive participation of a doctor in torture or other
ill-treatment
Slide 53
WMA Guidelines The doctor shall not provide any premises,
instruments, substances or knowledge to facilitate the practice of
torture or other forms of cruel, inhuman or degrading treatment or
to diminish the ability of the victim to resist such treatment The
doctor shall not be present during any procedure during which
torture or other forms of cruel, inhuman or degrading treatment are
used or threatened
Slide 54
Medical Torture
Slide 55
Primary loyalty to the patient According to the Tokyo
Declaration the doctors fundamental role is to alleviate the
distress of his or her fellow men, and no motive whether personal,
collective or political shall prevail against this higher purpose.
According to the World Medical Associations Declaration on the
Rights of the Patient, whenever legislation, government action or
any other administration or institution denies patients these
rights, physicians should pursue appropriate means to assure or to
restore them"
Slide 56
Dual Obligations Health professionals have dual obligations or
dual loyalties They owe a primary duty to the patient to promote
his or her best interests and often a separate duty to employers
There is also a general duty to society to ensure that violations
of human rights are prevented
Slide 57
a&T0ga&mi f ar mydkh vltcsif;csif;ESdyfpufjcif;
uif;&Sif;Muygap/ wdkUarwmpGrf;urmvTrf; at;csrf;Muygap/
Slide 58
DISCUSSION TIME
Slide 59
Group Exercises Please mention three methods of inhuman
treatment you have seen or heard? Did you witness any violation of
medical neutrality in your country? As a physician, how would you
protect and defend Human Rights?