Kesehatan dan Hak Asasi ManusiaSimeuleue island

Health and Human Rights Kesehatan dan Hak Asasi ManusiaTaufik Suryadi,M.D., Sp.FM.(Repr from Unsyiah)Kulsum,M.D. (Repr from Unaya)Center For Bioethics, Medical Law, Health and Human Right in Aceh

Overview

Definition of Health Definisi KesehatanThe Relationship between Health and Human Rights: Why and WhatHubungan antara kesehatan dengan HAMThe Relationship with BioethicsHubungan dengan BioetikLimitations of the Right to HealthPembatasan Hak atas Kesehatan

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Kesehatan adalah suatu kondisi baik secara fisik, mental dan sosial dan tidak hanya terhindar dari penyakit dan kecacatan.

WHO Definition of Health

Bringing Health and Human Rights Together Bawa bersama Kesehatan dan HAM

The goal of the health and human rights linkage is to advance the human well-being beyond that which could be reached by either the Health or the Human Rights approach, independently Note: Why are we talking about HHR? Because the biomedical model of disease and health does not work in promoting health for vulnerable populations as a whole. There are social justice issues that have to be confronted.

Tujuan dari lingkaran HHR adalah untuk meningkatkan kesejahteraan manusia yang mana dapat diraih dengan pendekatan HHR secara mandiri.

Health and Human Rights Kesehatan dan Hak Asasi Manusia

Promoting and protecting health is inextricably linked to respecting, protecting and fulfilling human rights

Peningkatan dan Perlindungan kesehatan adalah suatu rangkaian yang tidak mungkin keluar dari Penghormatan, Perlindungan dan Pemenuhan hak asasi manusia

Health and Human Rights Violations or lack of attention to human rights can have serious health consequences (e.g. harmful traditional practices, slavery, torture and inhuman and degrading treatment, violence against women and children).

Kekerasan atau kurang perhatian terhadap HAM dapat menimbulkan konsekuensi kesehatan yang serius. (cth. Menyakiti praktik tradisi, kemiskinan, penyiksaan dan kekejaman, kekerasan pada perempuan dan anak-anak.

Health and Human RightsHealth policies and programmes can promote or violate human rights in their design or implementation (e.g. freedom from discrimination, individual autonomy, rights to participation, privacy and information).

Kebijakan dan program-program kesehatan dapat meningkatkan atau melanggar HAM pada disain atau implementasinya (cth. Bebas dari diskriminasi, otonomi individu, hak berpartisipasi, privasi dan informasi).

Health and Human RightsVulnerability to ill-health can be reduced by taking steps to respect, protect and fulfill human rights (e.g. freedom from discrimination on account of race, sex and gender roles, rights to health, food and nutrition, education, housing).

Kerentanan terhadap penyakit dapat diturunkan dengan langkah-langkah menghormati, melindungi dan memenuhi HAM (cth. Bebas dari diskriminasi terhadap ras, jenis kelamin dan jender, hak atas kesehatan, makanan dan gizi, pendidikan dan perumahan)

Source: 25 Questions & Answers on Health & Human Rights, WHO

Links Between Health, Biomedical Ethics and Human Rights

In addition to the Health and Human Rights Linkage, health and human rights are linked to Biomedical Ethics. Remember the Principles of Bioethics are Beneficience, Malfeasance and Justice. patient/client respect, nondiscriminatory access and care, confidentiality informed consent . When I speak of the Health and Human Rights linkage, there are many aspects of biomedical ethics that are also included. During your first lecture session, you learned about the principles of Bioethics: beneficence, malfeaseance and justice. There is more of a focus on the individual in bioethics. Justice is an overlapping concept in bioemedical ethics and in hr. Human Rights, which we will talk about more today, is founded on the concept of dignity and respect for the individual. It also fits more easily into the population health model.

HealthBiomedical EthicsHuman Rights

Four Principles of BioethicsAutonomy-respect decisionsBeneficence-do goodNonmaleficence-do no harmJustice-act fairly and promote fair allocation of healthcare resourcesthe principles that seem to guide most people's thinking about bioethical issues in actual practice (a bottom-up approach). One very influential approach along these lines, known as the four principles of bioethics, attempts to describe a set of minimum moral conditions on the behaviour of health care professionals. The first principle, autonomy, entails that health care professionals should respect the autonomous decisions of competent adults. The second principle, beneficence, holds that they should aim to do goodi.e., to promote the interests of their patients. The third principle, nonmaleficence, requires that they should do no harm. Finally, the fourth principle, justice, holds that they should act fairly when the interests of different individuals or groups are in competitione.g., by promoting the fair allocation of health care resources.

The Right To Health

Tidak hanya sebatas hak untuk mendapatkan pelayanan kesehatan, khususnya pelayanan medik/kuratif hasil amandemen UUD 1945 yang mencantumkan setiap orang berhak mendapatkan pelayanan kesehatan.

Pelayanan kesehatan kuratif hanya sebagian kecil dari hak untuk sehat karena sehat bukan hanya tersembuhkan dari penyakit tetapi meliputi hal yang jauh lebih luas dan upaya untuk membuat seseorang dapat menikmati kesehatan bukan hanya dengan penyembuhan ketika ia sakit.

Banyak faktor yang ikut berperan terhadap kesehatan seseorang, antara lain:Pendidikan KesehatanPerlindungan terhadap penyakit menularTersedianya lingkungan (baik fisik maupun sosial) yang sehat, Air bersih (safe water), makanan bergizi, dan rumah (shelter) yang sehat. Baru sesudah itu tersedianya pelayanan penyembuhan yang memadai ketika seseorang terkena penyakit dan Tersedianya sarana untuk mengendalikan kesuburan (pelayanan KB dan infertilitas).

Pendidikan KesehatanKhususnya bagi kaum perempuan, akan sangat besar pengaruhnya terhadap derajat kesehatan keluarga dan individu dalam keluarga tersebut.

Seorang perempuan yang terdidik dengan baik akan mengetahui bagaimana menjaga kesehatan dirinya, suaminya dan anaknya secara benar, dan kemudian menularkan pengetahuannya itu kepada anak-anaknya.

Core contentPokok-pokok (core content) hak atas kesehatan Health For All and Primary Health Care Strategy dari WHO yang merumuskan adanya beberapa jasa kesehatan mendasar (essential basic health services)

Core content menurut strategi WHO tersebut meliputi:1. Perawatan Kesehatan:Perawatan kesehatan ibu dan anak, termasuk KBImunisasiTindakan yang layak untuk penyakit-penyakit biasa (common disease) dan kecelakaanPenyediaan obat-obatan yang pokok (essential drugs).

2. Prakondisi dasar untuk kesehatan:Pendidikan untuk menangani masalah kesehatan termasuk metode-metode untuk mencegah dan mengendalikannyaPromosi penyediaan makanan dan nutrisi yang tepatPenyediaan air bersih dan sanitasi dasar.

Prinsip-prinsip Panduan Hak Atas KesehatanAvailability: Ketersediaan pelayanan kesehatan, di mana negara diharuskan memiliki sejumlah pelayanan kesehatan bagi seluruh penduduk.

Accessibilty: Akses atas pelayanan kesehatan baik dari aspek finansial, geografis dan kultural.Aksesiabilitas finansial harus menjamin bahwa jasa pelayanan tersebut dengan biaya yang terjangkau.Aksesiabilitas geografis adalah bahwa pelayanan kesehatan tersebut dapat dicapai oleh semua orangAksesiabilitas kultural adalah bahwa pelayanan tersebut menghormati tradisi kultural masyarakat

Prinsip-prinsip Panduan Hak Atas KesehatanQuality: Kualitas pelayanan kesehatan yang mensyaratkan agar pelayanan kesehatan tersebut harus memenuhi standar yang layak

Acceptibilty: Persamaan akses terhadap pelayanan kesehatan yang mengharuskan akses itu berlaku sama, tanpa diskriminasi, dengan memberikan perhatian khusus terhadap kelompok yang rentan dalam masyarakat.

Kewajiban NegaraKewajiban untuk menghormati (obligation to respect), meliputi;

Kewajiban untuk menghormati persamaan akses atas pelayanan kesehatan dan tidak menghalangi orang-orang atau kelompok tertentu terhadap akses mereka terhadap pelayanan kesehatan yang tersediaKewajiban untuk menahan diri dari tindakan-tindakan yang dapat menurunkan kesehatan masyarakat, seperti perbuatan yang dapat menimbulkan pencemaran.

Kewajiban NegaraKewajiban untuk melindungi (obligation to protect), meliputi;

Kewajiban untuk melakukan langkah-langkah di bidang legislasi ataupun tindakan lainnya yang menjamin persamaan akses terhadap jasa kesehatan apabila jasa tersebut disediakan oleh pihak ketiga Kewajiban untuk melakukan langkah-langkah di bidang legislasi ataupun tindakan lainnya untuk melindungi masyarakat dari gangguan kesehatan yang dilakukan pihak ketiga.

Kewajiban NegaraKewajiban untuk memenuhi (obligation to fulfill) meliputi;

Kewajiban negara untuk membuat kebijaksanaan kesehatan nasional dan menyediakan anggaran negara untuk anggaran kesehatanKewajiban untuk menyediakan jasa-jasa kesehatan yang penting atau menciptakan kondisi di mana setiap individu dapat memperoleh akses yang layak dan memadai atas jasa kesehatan, termasuk di dalamnya atas asuransi kesehatan, air bersih dan sanitasi yang memadai.

THE END came back to Sumatra island

Today Ill be focusing on some practical issues and questions to use in the field in any situation to begin to identify the problems in health and human rights and determine viable solutions. I will also address some issues brought up in Paula Brentlingers talk two weeks ago and again go over some fundamentals in international law and human rights.Health is more than healthcare.Why are we talking about HHR? Because the biomedical model of disease and health does not work in promoting health for vulnerable populations as a whole. There are social justice issues that have to be confronted.In addition to the Health and Human Rights Linkage, health and human rights are linked to Biomedical Ethics. Remember the Principles of Bioethics are Beneficience, Malfeasance and Justice. patient/client respect, nondiscriminatory access and care, confidentiality informed consent

When I speak of the Health and Human Rights linkage, there are many aspects of biomedical ethics that are also included. During your first TOT session, you learned about the principles of Bioethics: beneficence, malfeaseance and justice. There is more of a focus on the individual in bioethics. Justice is an overlapping concept in bioemedical ethics and in hr. Human Rights, which we will talk about more today, is founded on the concept of dignity and respect for the individual. It also fits more easily into the population health model.

During the rest of the presentation, I will focus on these relationships: The relationship between health and biomedical ethics, health and human rights, and biomedical ethics and human rights. the principles that seem to guide most people's thinking about bioethical issues in actual practice (a bottom-up approach). One very influential approach along these lines, known as the four principles of bioethics, attempts to describe a set of minimum moral conditions on the behaviour of health care professionals. The first principle, autonomy, entails that health care professionals should respect the autonomous decisions of competent adults. The second principle, beneficence, holds that they should aim to do goodi.e., to promote the interests of their patients. The third principle, nonmaleficence, requires that they should do no harm. Finally, the fourth principle, justice, holds that they should act fairly when the interests of different individuals or groups are in competitione.g., by promoting the fair allocation of health care resources. The Right to Health is articulated first in the foundational human rights instrument, the UDHR, and then in many other legal instruments. Americans lead the way in promoting human rights. Yes, after WWII, it was Eleanor Roosevelt who lead the US Mission to build consensus around the concept of a universality of human rights and American lawyers were instrumental in drafting the UDHR. This is the foundational legal instrument articulating human rights. America was a leader in the world promoting human rights. We promoted both civil and political and economic and social rights. We supported the right to health. Americans have not supported this right for many decades, though. I believe we have gone astray and we just need to find our way back to supporting the right to health. Civil and political rights are intricately related to economic and social rights. The right to life as an argument for the right to health.

The Right to Health is considered an Economic Social and Cultural right as opposed to a civil and political right. However, civil and political rights are important in the right to health and certainly the right to life, which is considered a civil and political right is critical for the right to health. As a matter of fact, many court cases about the right to health have been argued as a right to life issue.I thought I would end with a nice cartoon from the cover of a WHO publication on the Right to Health.