Recently published in Annals of Internal MedicineRepresentatives from the American College of Physicians (ACP) Committee on Ethics, Professionalism, and Human Rights highlighted key points about why they believe health is a human right. Although the United Nations (UN) recognized health as a human right in 2000, countries around the world still have different views on the subject. Some align with the mission of the United Nations, while others believe it is a universal right and still others do not. In this article, ACP explores the intersection of ethical obligations, human rights, and health care reform and explains why the Academy affirms that the United States (US) should respect, protect, and achieve health for all.
Position paper: Health as a human right: A position paper from the American College of Physicians.Image source: Created with the assistance of DALL·E 3
What are human rights? Does health fit the bill?
The United Nations (UN) defines human rights as “the rights inherent to all human beings, regardless of race, sex, nationality, ethnicity, language, religion or any other identity”. However, different people and legal systems around the world have unique interpretations of human rights. While torture is almost unanimously considered a violation of human rights, health and access to health care are more controversial. While some believe health is a human right, others believe it is a privilege earned through merit or financial support.
These differing perspectives have in turn influenced national policies, with countries such as Brazil offering free health care to all citizens, while the United States remains the only developed country without universal health care. Worryingly, health care in the United States is among the most expensive in the world, and most Americans lack any form of health insurance policy, which makes them excited.
United Nations documents are at the heart of most human rights law and theory. Article 25 of the United Nations Universal Declaration of Human Rights states that an adequate standard of living, including health care, is a right and therefore inherent to every human being. To emphasize and clarify this point, the United Nations Committee in 2000 defined health as “a fundamental human right that is indispensable for the exercise of other human rights.”
Unfortunately, many countries debate or outright deny this definition, with some, including the United States, even refusing to ratify the International Covenant on Economic, Social and Cultural Rights. While the American College of Physicians (ACP) recognizes that the legitimacy of the International Covenant on Economic, Social and Cultural Rights, and by extension health, contrasts with the American tradition of personal immunity, it maintains that health Ethical and moral considerations should take precedence over legal opinions.
About the paper
This article summarizes the ACP’s position on health as a human right. It explains why the Academy believes that awareness of this in the United States can bring about positive changes in its health care policy, thereby supporting and promoting the doctor-patient relationship.
This article was prepared in connection with the work of the ACP Ethics, Professionalism and Human Rights Committee (EPHRC). Numerous ACP committees, including the ACP Council, Early Career Physicians Committee, Board of Trustees, Fellows Committee, and Student Committee, reviewed drafts of the paper. On April 24, 2023, the ACP Regrets Committee approved the publication of this work as its official position on health as a human right.
“ACP recognizes health as a human right based on the inherent dignity and equality of all patients.”
In their overarching position, the Academy calls attention to human dignity as a first principle and what this means for health. They recognize the human right to health as an ideal but challenge critical views that it is utopian. ACP highlights the decades of advances in the medical field that have extended human lifespan and comfort, and contributed to human dignity. They draw on the ideas of one of America’s foremost bioethics thinkers, the late Edmund D. Pellegrino, M.D., not only from the perspective of physicians but from the perspective of society as a whole Moral and ethical perspectives surrounding health are mentioned.
“Recognizing and implementing health as a human right requires ethical and evidence-based health care, but also optimization of the social and structural determinants of health.”
In its second position, the ACP draws on the United Nations Committee on Economic, Social and Cultural Rights’ key elements of health care – availability, acceptability and accessibility. They emphasized that recognition of health as a human right is not without limitations. This does not mean that a person in need of an organ transplant can ask for a transplant from someone else or hold the government accountable for its failure to provide an organ. This does not mean that individuals can request a prescription for any drug they want. What it does mean is that health care is designed to protect people’s chances of health from significant, remediable threats.
“Understanding health as a human right can inform the ethical design, implementation and evaluation of health care services.”
This article focuses on how ethical implications related to health as a human right inform action and accountability at national and local levels. An important example is that vulnerable, marginalized and excluded groups are less likely to be denied access to healthcare if the legal framework recognizes and follows a human rights-based approach to healthcare.
“Health, as a human right, is consistent with, but not fully encompassed by, the ethical obligations of physicians, the medical profession, and a just society.”
In its final position, the ACP summarizes the responsibilities of physicians and society in achieving the gold standard in health care. While the roles and obligations of medical professionals are self-evident, society has a responsibility to aid their efforts, whether by allocating resources during an epidemic or donating organs after death.