Human Rights

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Human Rights Human Responsibilities
Donna Knapp van Bogaert, PhD, D. Phil Ethics
Moral Philosophy Faculties of Medicine
Dentistry University of Limpopo Medunsa Campus
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Outline

• Ethics Moral Philosophy (EMP)
• Example Three-year EMP Programme
• Human Rights and Human Responsibility Block
• Outcomes/Standards, Assessments, Suggested Core
  Competencies
• Conclusion

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I. Aim of the Ethics Moral Philosophy Programme

• The creation of good people who will inculcate
  the Art intrinsic in the professions of Medicine
  Dentistry by accepting their moral
  responsibility to
• enhance and promote the health and medical
  welfare of the people they serve
• in ways which, in the practice of fairness and
  justice, respect their rights, values, interests,
  and dignity.

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Sub-text of the EMP Programme

• Emphasises responsibility, the things for which
  people are accountable.
• Professional or social roles are defined in terms
  of the responsibilities they involve.
• Focus on the person as a professional and
  respected community member
• Build on their good character.
• Define the parameters of ethical (right / good)
  unethical (wrong / bad) human conduct.

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Faculty of Medicine Ethics Moral Philosophy
Programme

• Year 1 MBChB 8 hours / academic year full class
  sessions (class 220 students).
• Year 2 MBChB 12 hours / academic year full class
  sessions (class 230 students).
• Clinical Ethics Blocks (Block is 3 hrs week x 6
  weeks. Six groups - group size 40). Total year
  30 hours.
• Year 3 MBChB 3 x 40 min sessions / academic year
  full class sessions (class 230 students).
• Year 4 MBChB 3 x 40 min. sessions / academic
  year full class sessions (class 250 students).

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Faculty of Dentistry

• BDT years 2 3 One 40 minute session per week x
  40 sessions ( 10 students each class 6 blocks /
  year).
• BDS years 3, 4 ,5 (OC), 6 (OC) One 40 minute
  session per week x 40 sessions ( 35 students
  each class 6 blocks / year).
• BDS 5 (NC) Ethics projects 11 tutorials.
• plus research project

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EMP Programme Cross-Faculties

• Both follow same general EMP curriculum.
• Curriculum modified according to time
  constraints.
• Each successive year builds upon prior learning.
• Each year integrates / has relevance to
  particular learning of that year viz. greater
  emphasis on ethics in practice (ethical-clinical
  dilemmas) increases with increasing clinical
  duties.

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II Example Faculty of Dentistry

• 3 Year Curriculum
• Ethics Moral Philosophy

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Faculty of Dentistry

• Supportive Dean Faculty
• Continuing CPD programmes in Ethics
• Faculty Ethics Committee
• Dr. Marcelle Harris, HOD Integrated Curriculum
  Development
• Ethical Practice Management Programme (EPMP)
• Ethics Moral Philosophy 50,
• Business Practice Management Law 50
• Patient Interviewing Skills (student video
  sessions)
• EPMP required and assessed as part of core
  curriculum.
• Advantages Small classes, stringent student
  selection, buy-in by faculty.

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Year 1 Block 1 Ideology, Logic Critical
Thinking Skills

• Logic critical thinking skills 1-3.
• Moral reasoning, Ethical decision-making
  guidelines.
• Ideology Globalisation of the good life,
  advertising the media.
• Plagiarism Class and university rules,
  referencing basics.

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Year 1 Block 2 Introduction to Ethics Moral
Philosophy

• Why be ethical?
• World-views Ways of Life.
• Overview Systems of Ethics
• (Hippocratic Oath method, Traditional
  approaches to ethics, Rights-based approaches,
  Ethics of Care, Pragmatism, Relativism,
  Postmodern approach).

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Year 1 Block 3 Virtues Values

• Aristotles virtues.
• Virtues in the practice of good medicine
  dentistry.
• Truth-telling Legal and ethical boundaries.
• Who or what is of value?
• From professional values to standards.

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Year 1 Block 4 Approaches to Ethical Problems
Deontology Consequentialism / Utilitarianism

• Duty Respect for Persons
• Duties, obligations, and responsibilities
• Categorical Imperatives
• Consequentialism
• Utilitarianism
• Act and Rule utilitarianism
• The Principle of Utility
• The Harm Principle

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Year 1 Block 5 Approaches to Ethical Problems
Principlism Communitarianism

• Principlism
• Beauchamp Childresss Principlism Autonomy,
  Non-maleficence, Beneficence, Justice.
• Tavistock Principles Rights, Balance,
  Comprehensiveness, Cooperation, Improvement,
  Safety, Openness.
• Communitarianism
• African Philosophy Personhood Community
• Etizonis Communitarianism

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Year 1 Block 6 Professionalism Responsibility

• Students Quotas
• Etiquette Ethics
• The Difficult Ones Patients, staff, family,
  self.
• Advocacy Health Promotion.
• The Dental Hierarchy Questioning acting
  against authority.
• Conflicts of Interest Conflict Resolution
  Faculty Ethics Committee.
• Placing blame, asking for help.
• Limits of tolerance.

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Year 2 Block 1 Accepting Responsibility

• HPCSA professional ethical guidelines,
  regulations, boundaries.
• Being Afraid Admitting Mistakes Omissions
  commissions in student professional personal
  life.
• Name and Shame does it matter?
• Power responsibility the healthcare hierarchy
  dentists patients, lecturers students, men
  women.
• Whistleblowing concept warrant.
• HIV risks, duties, responsibilities doctor,
  student patient.

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Year 2 Bock 2 Issues in Ethics Confidentiality

• Professional information, privacy and respect for
  persons .
• Trust, secrecy and security in the sharing of
  information practical considerations.
• Students, staff supervisors Patients,
  families, friends moral tensions.
• Disclosure of information Public versus private
  interests.
• Compulsory and discretionary disclosure of
  confidential information.

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Year 2 Block 3 Issues in Ethics Professional
relationships

• Truth Truthfulness
• Paternalism debate
• The patients story as sub-text.
• Collisions of Cultures and Traditions
• Respect and tolerance any difference?

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Year 2 Block 4 Issues in Ethics The
Responsibility of Informing

• Informed consent the refusal of treatment.
• Respect for persons.
• Process of informed consent.
• Competence ethical and legal aspects.
• Comprehension ethical and legal aspects.
• Voluntary acts.
• Acting without consent when why
  justifiability.
• Refusing treatment ethical and legal aspects.

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Year 2 Block 5 Issues in Ethics Public Health
the Environment

• Public Health
• Infection control in dental practice
• Contested illnesses difficulties in dealing with
  doubts discords.
• Disease in individuals vs. communities
  individual rights quarantine / isolation
  management
• Emerging infectious diseases, bioterrorism
• Toxic Substances Disposal of Hazardous
  Waste-ethical legal issues
• Environmental health
• Human health health of the environment
• Fluoridation debate
• Anthropocentrism
• Principles of environmental justice
• Environmental pragmatism

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Year 2 Block 6 Issues in Ethics Distributive
Justice Resource Allocation

• Theories of Justice.
• Inadequate health resources and distributive
  justice.
• Equitable health care needs, rights, utility,
  efficiency, desert, autonomy.
• Complexity rights (individual collective),
  legislative reform, need for institutional
  development.
• Rationing and inequality international/ national
  / provincial allocations.
• Boundaries of responsibility debate individuals
  self-induced illnesses cost of violence inc.
  MVA, PVA to public / healthcare system.

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Year 3 Block 1 Issues in Ethics the Abortion
Debate

• Reproductive Rights Reproductive
  Responsibilities.
• Doctrine of Double Effect, Doctrine of
  Self-Defense.
• Womens Rights, Health-professionals rights,
  fetal rights.
• The TOP Act South African professional
  guidelines, legal requirements.
• Personhood maternal / fetal / community
  relationship.
• Family Planning Reproduction Advocacy.

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Year 3 Block 2 Issues in Ethics Liberty

• How free is free?
• Freedom of thought discussion in private and
  public life.
• Affecting choices? Globalisation and the
  mediasation of the good life.
• Pornography.
• Substance Abuse Legal ethical issues.

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Year 3 Block 3 Clinical Research

• Human participants in research Historical and
  contemporary examples of abuses of medical /
  clinical research.
• Conflicts of interest in therapeutic and non
  therapeutic research.
• HPCSA, national, international research
  guidelines.
• Research on animals ethical debate
• Writing research proposals process, guidelines.
• Vulnerable Populations HIV infected, Disabled
  Persons, Women, Children, the Elderly, Prisoners,
  Refugees Displaced Persons, Students, patients.

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Year 3 Block 4 Ethical Issues Death Dying -
Who lives? Who dies? Who chooses?

• Punishment the death penalty debate.
• Quality of life- whos quality?
• Palliative care.
• Treatment provision, non-provision, killing and
  letting die, double effect, ordinary and extra
  ordinary care.
• Advanced directives living wills ethical
  groundings.
• Euthanasia and physician-assisted suicide
  ethical and legal arguments .
• Tissue, organ, bone tooth SA Anatomy Act.
• Suicide.

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Year 3 Bock 5 Human Rights Human
Responsibilities

• Culpable healthcare professionals (police
  interrogation torture).
• Rights, duties, and responsibilities.
• National international documents concerning
  human rights.
• Relationship between health human rights.
• Human security, human interests, human rights
  the debate.
• Dual loyalty and human rights.

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Year 3 Block 6 Ethical Issues at Chair-side

• Abuse Physical sexual abuse, sexual advances
  Whats wrong with rape, whats wrong with the
  Willing patient, willing doctor, sex as
  bargaining tool.
• Social conduct Sexist, racial, cultural slurs
  derogatory references to patients psychological
  abuse.
• Student Dentists Case studies from previous
  classes.

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III Block FocusHuman Rights Human
Responsibilities
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Why Responsibility as in Human Rights Human
Responsibility ?

• Terms are co-relative concordant
• Without acceptance of responsibility, rights are
  empty claims.
• Who should accept responsibility?
• All human beings especially healthcare
  professionals who are highly regarded trusted
  members of the community.

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Block Objectives

• Identify and develop novel and effective
  strategies, means and methods for the
  strengthening of the democratic fabric of South
  African society through the promotion of human
  rights responsibilities.
• Inculcate in healthcare professionals their
  responsibility to protect and respect human
  rights.

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Block Outcomes / Unit Standards

• At the end of this block you will demonstrate the
  ability to
• Discuss the concept of human rights dual
  loyalty and identify some of the reasons why,
  how, and in in what forms of society healthcare
  professionals may become involved in human rights
  violations
• Demonstrate professional awareness of
  individuals' rights and understanding of their
  responsibilities
• Relate the links between health and human rights
  between rights, duties, and responsibility

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Block Outcomes / Unit Standards

• At the end of this block you will demonstrate the
  ability to
• Give examples of ways in which the exchange and
  dissemination of knowledge, experience, and good
  human rights practice in South Africa may be
  enhanced
• Construct a transparent and decisive policy
  concerning institutional accountability in
  documenting, reporting, and disciplining human
  rights violators violations.

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HRR Block Required Readings / Audio-visual
Materials

• TRC Report on the Healthcare Sector (transcripts
  used in class role-play).
• Dual Loyalty Human Rights (phrusa org.),
• Cape Town Case
• UNDHR, Tokyo Declaration, WMA documents.
• Excerpts from Tolstoys Crime Punishment,
  Scarrys The Body in Pain, Nietzsches Thus Spoke
  Zarathustra, Millgrams Obedience to Authority.
• Audio-visual (film) Death the Maiden.

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Prior Knowledge

• Preceding HRR block students have background in
  e.g.
• Ethical theories, principles, virtues, values,
• Ideology, influence of media asymmetrical
  power relationships, logic argumentation, e.g.
  punishment death penalty debate.
• South African Constitution including Bill of
  Rights, Patients Rights Charter, basic
  principles of law, notes record writing
  keeping (from practice management section),
• HPCSA other professional guidelines,
• Individualist communitarian approaches to
  ethics.
• Historical grounding of consent (Nuremberg Code),
  principles of informed consent, concept
  identification of vulnerable populations.
• Institutional ethics class, race gender,
  economic disparities distinctions effects of
  globalisation of good life social
  responsibility as professional in the community
  theoretical dimensions of concepts of rights,
  historical documentation of
• human rights abuses

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Assessment Methods

• (1) Example In-class test
• Questions include e.g.
• Define and discuss the problem of dual loyalty in
  health care.
• Identify the links between health and human
  rights.
• Give examples of human rights abuses occurring in
  open societies in closed repressive
  societies.
• Discuss some reasons why healthcare professionals
  are targeted by morally corrupted governments.
• List three important documents which support
  human rights.

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Assessment

• (2) Case study example
• From your own clinical experience, you will
  identify an incident of human rights abuse. In
  your case study analysis you will include
• An introduction to the case in which you discuss
  your responsibility to protect and respect human
  rights.
• Then you will
• Describe the circumstances of the abuse
  (role-players their relationships),
• Provide a description of the type of HR violation
  (including the name of the document (s) in which
  the abuse is identified).
• Include your personal documentation of the abuse,
  
• Identify to whom you reported the abuse,
• Discuss the final resolution to the incident.
• You will conclude with your ideas concerning
  institutional mechanisms that should be put in
  place for prevention of future abuses.

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Assessment

• (2) Case study example
• In the Cape Town case, doctors were removed
  from becoming gatekeepers viz. reporting to
  government health authorities non-citizens /
  aliens requesting health care. Instead, the
  responsibility for this was given to ward clerks.

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Assessment, cont.

• In this assignment you will critisise the case
  focusing on the issue of dual loyalty.,
• First, you will summarise the case. Then, you
  will define the term dual loyalty.
• Next, you will provide arguments for the
  application of the concept dual loyalty being
  applied only to healthcare professionals as
  opposed to it being extended to all workers
  within the healthcare system.
• Then you will argue against the positions you
  have just identified.
• You will conclude by developing your personal
  argument pro or con the cases resolution.

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Assessment

• (3) Institutional Human Rights Accountability
  Policy Example
• In this assignment you will develop a document in
  which you identify institutional accountability
  mechanisms for holding those who violate human
  rights accountable for their actions. You will
• Refer to South African history and include the
  ethical reasons for holding individuals
  accountable for their actions (you will
  necessarily discuss the concept of collective
  responsibility),
• the professional standards (HPCSA) concerning
  human rights violations, and
• references to documents articulating the need for
  protection from human rights abuses.
• Then you will discuss problems you anticipate in
  implementing this policy (e.g. who decides, who
  monitors),
• Finally, you will provide some ideas for
  resolving the problems you have identified.

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EMP Programmes Educational Objectives

• Knowledge
• To know specific facts, concepts, principles or
  theories.
• Comprehension
• To understand, interpret, compare or contrast.
• Application
• To solve problems, to render ideas for solutions,
  to apply knowledge to new dilemmas.
• Analysis
• To identify organisational structure, to
  recognise relationships, organising principles.
• Synthesis
• To create something new, to think outside the
  box, to propose an action.
• Evaluation
• To judge the quality of something based on its
  adequacy, value, logic or use.

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Core HRR Competencies

• Evaluation , treatment, documentation, and
  institutional policy development concerning human
  rights violations including disciplinary
  measures.
• Fundamental knowledge of human rights and the
  laws, documents, and declarations which support
  promotion of human rights in the healthcare
  context.
• Recognition of why healthcare professionals are
  targets for immoral governments in power quests.
• Acceptance of responsibility of healthcare
  professionals to advocate for, respect, and
  protect human rights.
• Exchange and dissemination of knowledge,
  experience, and good human rights practice.
• Recognition and protection of the rights of
  vulnerable populations.

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IV. Conclusion

• Overviewed the Ethics Moral Philosophy (EMP)
  Programme and outlined the HRR block within it
  at the UL Medunsa Campus.
• Described the HRR Blocks
• Outcomes / Block standards
• Assessments
• Objectives
• Provided our core competencies
• Argue that when human rights and human
  responsibilities are embedded within an Ethics /
  Ethics Moral Philosophy programme, students are
  empowered with a richer and deeper understanding
  of their personal and professional
  responsibilities to protect, respect, and
  advocate for human rights.

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No conflicts of interest. Thank you.