Is medical care a human right 1

Human rights

Andreas Wulf

Dr. med. Andreas Wulf is a doctor and has been working as a medical project coordinator at the Frankfurt social medical aid and human rights organization medico international since 1998, with a focus on the Middle East and international health policy and health networks. Wulf is a board member of the Association of Democratic Doctors. His main topics are global health policy and movements, health-related development cooperation, international pharmaceutical policy, as well as social and political determinants of health.

When it was founded in 1946, the World Health Organization (WHO) made "Health for All" a priority. Specifically, the "right to be healthy" means that all people must be given access to health care. In practice, there are major global differences. Financial equalization mechanisms for the poorest countries should help to fulfill the human right to health - so far, however, this has only been implemented on a voluntary basis.

This girl from the Calcutta area was successfully treated for tuberculosis. (& copy picture-alliance / dpa, Denis Meyer)

The human right to the "highest attainable level of physical and mental health" is one of the economic, social and cultural human rights ("VAC rights") as formulated by the UN in the Social Pact 1966 (Art. 12) and by the great majority of states have also been adopted [1].

The formulation, which sounds complicated at first, is intended to make it clear that there cannot be the "right to be healthy" because illness and disability are part of human life.

Precisely the experience with eugenic concepts of a "world without weakness and illness", as discussed in the first half of the 20th century and realized in Nazi Germany in hundreds of thousands of murders of mentally and physically disabled people, makes this specification necessary.

Specifically, the "highest achievable level" means that all people must be given access to health care in the event of illness. In addition, healthy living conditions must be ensured, which are summarized as "social determinants of health". These conditions, according to the World Health Organization, are influenced by the distribution of money, power and other resources at the global, national and local levels [2].

Respect, protect, fulfill

It is helpful to take a closer look at the role of the state in realizing the complex social human rights: within the framework of the social pact, it undertakes to respect, protect and fulfill human rights.

These are important distinctions. Since the debates in the 1960s there have been repeated concerns about social human rights: especially poor, so-called "less developed" countries have little capacity to provide comprehensive health care - regardless of individual financial circumstances.

For example, not all states will have the means to carry out costly heart operations or organ transplants across the board. Against this background, a gradual (progressive) realization of this health care, which is part of the fulfillment mandate, was included in the formulation of the value chain rights [3]. However, this health care must be available on a non-discriminatory basis. For example, not only the population of a capital city or the supporters of a ruling party should benefit from the state-funded services.

At the same time, the aspects of respecting and protecting health rights are no less important: to respect - the state itself must not commit any human rights violations - and to protect - it must prevent others from committing human rights violations - is, for example, the right to consent to medical procedures . Patients must therefore be informed and agree to what must also be documented.

This set of topics also includes the coercive measures that state organs such as the police and psychiatry use against people with mental illnesses: for self-protection, to prevent suicides, and external protection, i.e. to protect others. Such coercive measures always require judicial review in order to have clear control mechanisms and to restrict the freedoms of those affected only in justified emergencies and as little as absolutely necessary [4].

The debates about operative "adjustments" to the male or female gender in newborns without a "clear" gender affiliation also led to a greater focus on the right to integrity. In particular, the non-consent of the newborns was brought up here.

Another important aspect is the aforementioned non-discrimination when it comes to access to health care. On the one hand, this can affect ethnic or religious minorities as well as non-citizens or migrants; on the other hand, this right is also relevant in the large area of ​​sexual and reproductive health. In many societies, this is subject to strong moral condemnations. For example, reliable protection against diseases (especially HIV, hepatitis) for sex workers, homosexual or drug-consuming people is often not guaranteed through criminalization or strong moral condemnations [5]. The same applies to safe access to contraception and treatment of sexually transmitted diseases for young, unmarried women and men.