Treating healthcare as a human right

Counting down the minutes to medical attention while waiting on a hospital trolley in the wee small hours, one may have many thoughts: but not necessarily about the International Covenant on Economic, Social and Cultural Rights.

Yet, under Article 12 of this treaty, Ireland has committed itself to ensuring that medical treatment in the event of sickness is a human right. Not only that but, as a signatory, the State has also recognised the right of "everyone" to enjoy the "highest attainable standard of physical and mental health" – no strings or health insurance policies attached.

The big problem in Ireland and many countries is that patients and their families or carers don't often think about this rights-based approach, according to Prof Sofia Gruskin, director of the global health and human rights programme at the University of Southern California's Institute for Global Health.

Gruskin, who is also adjunct professor at the Harvard School of Public Health and an associate editor of the American Journal of Public Health, will be a keynote speaker on this subject at a conference to be hosted as part of President Michael D Higgins's ethical initiative at NUI Galway (NUIG) on Friday.

“In defining the human right to health and to healthcare, we talk about the AAAQ framework,” she says. “By this, we mean available, accessible, acceptable (AAA) and of good quality (Q), and there has to be a commitment to accountability and transparency,” she explains.

“We do have to recognise that no health system in the world can provide all these immediately and completely,” she says. “But there is a difference between incapacity and unwillingness, and the key issue within that is the idea of progressive realisation – as in, governments setting benchmarks and targets, and accepting that they will be held accountable.

“One has to be aware that there is often a difference between what governments will say to each other . . . and what they will say at a national level,” Gruskin notes. “It is also incredibly important that patients are aware of their rights, and that they – we – know there is a difference between saying ‘Please may I have this?’ and ‘I am entitled to this’ in treatment,” she says. “Medical and health staff have rights too, but they also have responsibilities.”

While she was living in San Francisco during the first wave of HIV-related illness in the 1980s, Gruskin began to take an interest in the human rights dimension to healthcare. "I saw some of my friends die at a time when there was no proper legal system in place for them, as in, no recognition of same-sex partnerships, no recognition of the right to will belongings to partners, and a lot of stigma," she says. "I then became very interested in the implications for that internationally, such as in the implications for women in sub-Saharan Africa, " she says.

Her focus has been on non-communicable disease, child and adolescent health, HIV/Aids, sexual and reproductive health, gender-based violence and health systems. This includes the right to a safe abortion – but she cautions that in human rights law, there is “no right to abortion”.

“Where women are in a position that they need to seek one, they do have the right to a safe procedure, and it is a legitimate healthcare service,” she says.

"Human rights is a language that speaks to people everywhere, except in the US," she says. "Europe is way ahead of the US: just see what it took to get Obamacare through." And she describes Brazil as a global leader. "It is not necessarily a role model for all human rights, but in the case of access to healthcare it recognises that right in its constitution. For example, Brazil has made antiretroviral drugs for the treatment of HIV/Aids available for free."

“It does have a number of problems, but we can all still learn from its mistakes as it has a very good system of accountability which we can refer to,” she says.

"Rosie", the alias used by the late Susie Long, sparked a debate about inequalities and the two-tier Irish healthcare system in 2007. The Ohio-born mother-of-two had been referred for a colonoscopy by her GP in the summer of 2005 after she presented with a number of symptoms. She didn't have private health insurance, and her cancer had spread by the time she was diagnosed.

As she recounted on RTÉ Radio's Liveline, it was during a chemotherapy session in January 2007 that she had learned the full reality of the two-tier system. Another patient, with private insurance, had been diagnosed within three days of being referred and was going to recover. Long died later that year.

“Susie Long raised both human rights and moral issues,” says Dr Diarmuid Ó Donovan, co-convenor of the conference with Prof Michael O’Flaherty of the Irish Centre for Human Rights at NUIG.

O’Donovan, a senior lecturer in social and preventive medicine at NUIG, and HSE West director of public health, has recently returned from several spells of working with victims of Ebola. “The opportunity arose to organise this as part of President Higgins’s ethical initiative, and he will be in attendance,” O’Donovan says.

It will be the first conference of its type, in engaging all stakeholders. There has been little if any previous debate, although former Ombudsman for Children Emily Logan has commented publicly about children's rights in healthcare settings in the context of research on the issue published in November, 2013. In her new post as Irish Human Rights and Equality Council chief commissioner, Logan will make a full statement on the right to health as part of her report to the UN on the International Covenant on Economic, Social and Cultural Rights in June. The Human Right to Health conference takes place at Áras Moyola, NUIG, on Friday, February 6th. For more details, see iti.ms/1BKyKu5