Education and debateShared ethical principles for everybody in health care: a working draft from the Tavistock GroupIntroductionA shared statement of ethical principles for those who shape and give health care
Sir, Philip Barlow, in responding to the Tavistock Group's proposed
five major principles of health care delivery, questions the most
important - the concept of a right to health care (1, 2). Yet the reality
that people of one country live longer and more healthily than those from
another should be no more tolerable than, for instance, the reality of
violent death in Kosovo or Rwanda. Death
from preventable or remediable disease kills more than violence and is no
less tragic.
There is no principled reason why the right to life or the right to
justice should be more acceptable than the right to health - indeed the
right to life amounts to the same thing when longevity relies upon health
care. Further, denial of the principle of a right to health care could be
viewed as inimical with medical ethics - it would the a dubious
professional code that failed to require all
patients be treated equally.
The right to health care is enshrined within several international laws
ratified by the UK, but most comprehensively within Article 12 of the
International Covenant on Economic, Social and Cultural Rights. This May
the UN Committee on Economic, Social and Cultural Rights (CESCR) embarked
upon a programme that will lead to a General Comment on Article 12, which
will improve understanding, and hence implementation by state signatories
who are required to make Periodic Reports at five year
intervals. One important anticipated advance is the development, in
collaboration with the World Health Organisation, of a robust system of
benchmarks and indicators that will enhance the CESCR's effectiveness by
transforming its capacity to reliably assess a state's health care system.
To promote the productiveness of the CESCR's Day of Discussion, from which
the General Comment will spring, Article 12 will form the most substantive
issue of the annual conference of the International Federation of Health
and Human Rights Organisations, hosted in November by Physicians for Human
Rights-UK. This 'dry run' debate by invited international experts before
the Special Rapporteur, who although not medically trained has been
appointed by the CESCR to coordinate the programme, will help him plan his
approach - concluding with the General Comment sometime in the year 2000.
1. Smith R, Hiatt H, Berwick D. Shared ethical principles for
everybody in health care: a working draft from the Tavistock Group. BMJ
1999; 318: 248-251 (23 January)
2. Barlow, P. Health care is not a human right. BMJ 1999;319:321 (31
July)
Dr Peter Hall,
MBBS, MRCPI, DGM.
Chair, Physicians for Human Rights-UK,
91 Harlech Rd,
Abbots Langley
Herts
WD5 0BE
Rapid Response:
Shared ethical principles
Sir, Philip Barlow, in responding to the Tavistock Group's proposed
five major principles of health care delivery, questions the most
important - the concept of a right to health care (1, 2). Yet the reality
that people of one country live longer and more healthily than those from
another should be no more tolerable than, for instance, the reality of
violent death in Kosovo or Rwanda. Death
from preventable or remediable disease kills more than violence and is no
less tragic.
There is no principled reason why the right to life or the right to
justice should be more acceptable than the right to health - indeed the
right to life amounts to the same thing when longevity relies upon health
care. Further, denial of the principle of a right to health care could be
viewed as inimical with medical ethics - it would the a dubious
professional code that failed to require all
patients be treated equally.
The right to health care is enshrined within several international laws
ratified by the UK, but most comprehensively within Article 12 of the
International Covenant on Economic, Social and Cultural Rights. This May
the UN Committee on Economic, Social and Cultural Rights (CESCR) embarked
upon a programme that will lead to a General Comment on Article 12, which
will improve understanding, and hence implementation by state signatories
who are required to make Periodic Reports at five year
intervals. One important anticipated advance is the development, in
collaboration with the World Health Organisation, of a robust system of
benchmarks and indicators that will enhance the CESCR's effectiveness by
transforming its capacity to reliably assess a state's health care system.
To promote the productiveness of the CESCR's Day of Discussion, from which
the General Comment will spring, Article 12 will form the most substantive
issue of the annual conference of the International Federation of Health
and Human Rights Organisations, hosted in November by Physicians for Human
Rights-UK. This 'dry run' debate by invited international experts before
the Special Rapporteur, who although not medically trained has been
appointed by the CESCR to coordinate the programme, will help him plan his
approach - concluding with the General Comment sometime in the year 2000.
1. Smith R, Hiatt H, Berwick D. Shared ethical principles for
everybody in health care: a working draft from the Tavistock Group. BMJ
1999; 318: 248-251 (23 January)
2. Barlow, P. Health care is not a human right. BMJ 1999;319:321 (31
July)
Dr Peter Hall,
MBBS, MRCPI, DGM.
Chair, Physicians for Human Rights-UK,
91 Harlech Rd,
Abbots Langley
Herts
WD5 0BE
Competing interests: No competing interests