The Medical Profession and Human Rights: Handbook for a Changing Agenda (review)

The Medical Profession and Human Rights, Handbook for a Changing Agenda, by The British Medical Association (London: Zed Books in association with the BMA & New York: Palgrave, St. Martins Press, 2001); xxxiii-562 pp.

This book is the successor to Medicine Betrayed, a report by the British Medical Association primarily concerned with torture and related practices from the perspective of human rights and medical ethics. This newer volume is much more than an updating of its predecessor report. Indeed, it is more than a handbook. The work is a veritable encyclopedia of the many issues linking health, medicine, health professionals, medical ethics and human rights. The range and scope of the volume are unparalleled in the literature on health and human rights. Moreover, while researched and composed by members of the British Medical Association, the book draws examples from all over the world, including the industrialized and developing countries.

The work is graced with a Foreword by Dr. Wendy Orr who heroically struggled against the tendency of her own South African medical profession to turn a blind eye to human rights violations during the Apartheid years of national shame. Her essay concludes with a list of "lessons learned"; this valuable format is repeated in each of twenty chapters which end with "Recommendations." These policy proposals and professional cautionary notes, well calculated to promote debate and discussion, are coupled with ample bibliographic endnotes, documentary appendices and an international list of organizations and resources. The net result is a book that would serve well as an instructional text no less than a reference appropriate for all health professionals and human rights activists concerned with the full menu of civil, social and economic rights bearing on health and medicine.

At the core of this lengthy and well edited volume is concern for the right to health and medical care, issues which physicians face in multiple new contexts: patients who are traumatized refugees from areas of civil strife, media presentations of the heroic endeavors of forensic doctors investigating mass graves; new revelations from Brazil about doctors who had been complicit in torture under the past military regime; freshly surfacing information in the United States and Australia about earlier medical experiments conducted without the knowledge or informed consent of the subjects. Today, problems arise daily over the access of HIV-infected and AIDS patients to the medications on which their lives depend. These are among the many issues that postulate the question: what is meant by the right to health found in Article 25 of the Universal Declaration and more formally specified in Article 12 of the International Covenant on Social, Economic, and Cultural Rights.

Discussion about Article 12 in the Third Committee of the United Nations General Assembly showed its framers saw the right to health as embracing a wide range of socioeconomic factors that promote conditions in which people can lead a healthy life, and extends to the conditions affecting health such as food and nutrition. This expansive concept of the right to health was significantly elaborated in 2000. That year the UN Committee on Economic, Social and Cultural Rights issued important guidelines "based on the Committee's experience in examining States Parties reports over many years." ¹ Such reports, required to ensure states' accountability to the treaty committee, provide the context within which the UN Committee, in turn, seeks to assist them in implementation. One result of this process is "General Comment Number 14"—increasingly seen as the authoritative interpretation of the content of the right to health. It is consistent with the World Health Organization's definition of health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." ² These standards are found in the Declaration of Alma Ata, and they are critically discussed in the BMA Handbook. ³

The Committee's comments on the "normative content of Article 12" ⁴ explain...