The role of professional associations in promoting ‘the
right to health’ and other human rights
Julian Sheather
BMA ethics department
The BMA believes that professional associations have ethical duties to provide leadership,
support and guidance for doctors and other professionals involved in promoting and
protecting human rights, whether this involves defending violations of individual human
rights, or in promoting the ‘right to health’ and other social, economic and cultural rights.
Much of the BMA’s work that falls under the rubric of the ‘right to health’ has traditionally
been undertaken via its public health responsibilities.
RESPONSIBILITIES OF MEDICAL ASSOCIATIONS
National medical associations have somewhat different roles in different countries. The
BMA, for example, is a professional body which, as a trade union, represents doctors'
interests but does not have powers to fulfil disciplinary functions, register or de-register
doctors or examine their fitness to practise. In the UK, such regulatory and disciplinary
functions are the domain of the General Medical Council. In some other jurisdictions, the
picture is different and the professional body may also be the regulatory authority. In this
section, we set out the general moral responsibilities which are common to all medical
associations, most of which are also applicable to nursing associations and other
organizations of health professionals.
Providing Leadership
Most professional associations can provide effective leadership in routine matters. A far
harder task, however, is to take a stand in situations of great risk or civil crisis. As ‘the right
to health’ inevitably engages with issues about the allocation of extensive public goods, its
promotion can result in political conflict, and this can provide considerable difficulties for
some national medical associations. Not all professional bodies face such challenges but they
should, nevertheless, fulfil an effective leadership role in the sphere of medical ethics and
human rights, including:
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establishing clear standards of ethical practice; disseminating information about good
practice and ensuring that appropriate disciplinary procedures are in place (even if they
are not responsible for administering them);
ensuring the existence of monitoring systems for the way medicine is practised in
different contexts, including those situations where doctors are most likely to be put under
pressure to deviate from ethical standards, such as prison medicine, care in closed
institutions and police stations, forensic medicine and medicine in the armed forces;
ensuring that they do not support, financially through investment or otherwise,
organizations or industries whose activities cause harm to public health, such as the arms
industry; and
striving to change laws or government policies that appear unjust and whose foreseeable
end is prejudicial to public health or likely to prevent doctors from caring appropriately
for patients.
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Providing Guidance and Promoting Awareness
As previously mentioned, a key function of a national medical association is to ensure that
doctors have clear guidance about legal and moral standards. One way of ascertaining where
there is a need for such guidance is by consulting doctors about their current knowledge and
attitude on specific issues. As well as clarifying whether further detailed guidance is needed
and where there are misconceptions about doctors' duties, such an exercise also raises
awareness within the profession about the range of issues upon which doctors ought to take
an interest.
When a need for guidance has been identified, associations can meet that need by producing
publications, contributing to the development of medical curricula and playing a role in
continuing medical education. Ready-made guidance, such as the various declarations of the
World Medical Association (WMA), should not only be disseminated to doctors, in their own
language by medical associations, but efforts should also be made to ensure that it is
implemented in practice.
There is a great deal that professional associations can do to promote awareness about ethics
and human rights issues, among their own members and a wider public, through their
journals, seminars and conferences. Professional bodies can also support voluntary medical
groups that undertake human rights activities and letter campaigns. Professional bodies can
support exchange programmes and voluntary overseas medical work or help medical students
find posts in developing countries during their training. They can publicize the work of
humanitarian organizations such as Medecins sans Frontieres and Medecins du Monde.
Ethics and Human Rights Training
Ethics teaching is a key sphere in which professional bodies can make a contribution.
Medical associations should encourage medical schools to incorporate ethics into the core
undergraduate curriculum. They should also disseminate international declarations and
statements on standards of medical ethics and human rights. Again ready-made collections
are already available, such as Amnesty International's Ethical Codes and Declarations
Relevant to the Health Professions, the WMA's Handbook of Declarations and the index of
International Guidelines on Bioethics published by the Council for International
Organizations of Medical Sciences (CIOMS). Medical bodies should support doctors
undertaking some type of formal commitment or oath to observe ethical standards.
The BMA also supports the involvement of medical associations in the provision of human
rights training at undergraduate level and as part of continuing professional development.
Liaison with Student Organizations
Some of the organizations that are most active in raising awareness of human rights are
national and international medical student organizations. In many parts of the world, they
organize symposia, the production of teaching materials and support networks. Clearly, the
campaigning activities of medical students are particularly important since they influence the
attitudes of future doctors and future members of national medical associations.
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The BMA recommends that medical associations maintain strong links with organizations of
medical students, encourage their campaigns on behalf of human rights and ensure that the
guidance and support available to practising doctors also be made available to students.
Establishing a Human Rights Committee
One measure which can promote awareness in countries where human rights are particularly
at risk is the establishment of a specific committee on human rights within the medical
association. The Kenya Medical Association's Committee on Human Rights, for example,
was established in 1998 and undertakes a range of activities, such as documenting cases of
alleged torture, publishing a newsletter explaining where abuses are most likely to occur,
organizing meetings and petitions and providing information on issues such as how doctors
can lobby ministers on human rights issues. In 1999, one of the activities of the human rights
committee was to visit the Kenya Medical Association Divisions all over the country talking
to doctors, encouraging them to become involved in human rights activities and advising
them on lobbying.
Campaigning Against Harmful Practices
From a ‘right to health’ perspective, 'health' is increasingly viewed as a multidimensional
concept that includes far more than the absence of disease. Prejudice and unfair
discrimination impede an individual's ability to enjoy good health and can also impact
gravely on the wellbeing of society. The WMA has considered at length the moral
responsibilities of medical associations to campaign against discriminative practices,
particularly but not only, those which involve doctors. By raising issues which are political,
social or cultural as well as medical, the WMA has made clear its expectation that medical
associations will play a campaigning role to support health promotion in its widest sense.
Medical associations should also monitor legal developments in their country which might
have implications for medical practice, and lobby legislators if such legislation contravenes
standards of public health or principles of medical ethics and human rights.
Campaigning for Equitable Access to Quality Health Care
In most countries there are some sectors of the population which do not enjoy equitable
access to good quality health care. Among such marginalized groups are the poor, prisoners,
migrants, asylum seekers, indigenous and homeless people. The World Medical Association
has published a number of consensus statements on public health issues, emphasizing the
duty of medical associations to campaign, in conjunction with others, to promote equitable
and good quality health care. By their health campaigns, medical associations can draw
attention both to the human rights issues arising from inequity and the public health
consequences of ignoring the health needs of some populations. In addition in some
countries, rehabilitation services are not sufficient for the numbers of people who have
suffered trauma and violence. This is another area in which medical associations can be
influential.
Promoting Measures to Improve Health and Welfare
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Closely allied with the responsibility to campaign against harmful discrimination is the role
of professional medical bodies in benefiting the health of their own community and of people
in other countries. Health organizations have an obligation to oppose measures that damage
health, such as the proliferation of armaments, the existence of unsafe work practices, unsafe
research, unregulated use of noxious substances such as pesticides and the improper disposal
of toxic materials and the inclusion of medicine in economic trade embargoes. Again, the
World Medical Association has published consensus statements on a wide range of such
issues, including condemning the use of landmines and the practice of female genital
mutilation.
IMPEDIMENTS TO ACTION BY MEDICAL ASSOCIATIONS
Most medical associations fulfil some of the above-mentioned functions but some experience
impediments of various kinds.
Political Repression
Unfortunately, in countries where torture and other gross violations of human rights are
commonplace, medical associations rarely seem able to address this abuse even though their
own members are likely to be harassed, threatened or even killed. Some of the reasons for
this situation are self-evident. Medical associations themselves may become the target of
repression, as in the case of the Syrian Medical Association whose brave attempt to stand up
for basic human rights resulted in catastrophe for prominent doctors. Its actions indicate the
potential scale of danger faced by individual doctors even when they band together with
colleagues and with other professionals, such as lawyers.
Lack of Resources
Some medical associations are so devoid of funds and other material resources as to have
great difficulty in achieving basic tasks, such as providing a clear code of ethical guidance for
their members. This, for example, was the situation of the Albanian Medical Association after
its establishment in 1990, in probably the poorest country in Europe. At that time, Albania
was a country in transition, lacking infrastructure, and its medical profession had long been
isolated from contact with colleagues abroad. During the previous Hoxha regime, traditional
Hippocratic values had been labelled as undesirably bourgeois. Doctors had been expected to
obey party cadres without question and some reported having been beaten if they objected.
Training in medical ethics and in international standards was almost non-existent despite
valiant efforts by a few doctors to teach themselves and follow developments abroad. An
early priority of the Albanian Medical Association, therefore, was to raise awareness of
ethical standards. Production and dissemination of an Albanian Code of Medical Ethics
absorbed half of its income, leaving very few resources for basic functions such as the
establishment of even a meagrely equipped central office.
Tremendous variations exist in the capabilities and resources that such organizations can
command to tackle the tasks outlined in preceding chapters as essential elements in effective
human rights strategies. Regrettably but predictably, the medical associations facing the
biggest challenges in human rights terms are often those with the least resources and support
themselves. In many cases, they acquit themselves with great credit despite the lack of
funding and material resources. Nevertheless, it is with this awareness of the challenge outrunning resources that we ask supra-national bodies, such as the World Medical and World
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Psychiatric Associations, to consider fostering schemes such as the development of
'partnerships' between developed and developing national medical associations.
Lack of Awareness of the Relevance of Human Rights
Many medical associations do not consider that human rights have any real relevance for
their work although this view is gradually changing and the ways in which medical ethics and
concepts of human rights overlap and complement each other is being increasingly
recognised. This congruence of goals is increasingly echoed in codes of medical ethics,
issued by national bodies such as the Uruguayan Medical Association and influential
international associations such as the Commonwealth Medical Association.
Legacy of Past Suspicion
Another reason for the failure of some medical associations to work effectively in the human
rights sphere is their lack of opportunity or will to collaborate co-operatively with other
organizations active in that field. Professional bodies usually see themselves as independent
and apolitical rather than as part of a multi-professional alliance. They may feel
uncomfortable working with non-governmental organizations (NGOs) that have a very
different membership and political focus to that of a medical association. While health
organizations may be suspicious of NGOs which are perceived as pressure groups with their
own agenda, some of this suspicion may be mutual, as medical associations are sometimes
perceived as excessively bureaucratic and traditionalist. Nevertheless, as is mentioned further
below, the BMA's strong recommendation is that groups which have common aims in
relation to human rights should work together to maximize their effectiveness.
POTENTIAL SOLUTIONS
A solution which addresses many of these problems can be found in the development of
effective networks of health professionals, medical students' organizations, human rights
activists, legal experts and national medical associations.
Networks of Medical Associations and Medical Groups
A good model of such collaborative work can be seen in the campaigns, conferences and
educational activities carried out by the International Federation of Health and Human Rights
Organisations (IFHHRO). This is a network of medical groups which initially developed out
of the establishment in many countries of new branches of the organization Physicians for
Human Rights (PHR). During the 1990s, the PHR network found that it had much in
common with other well-established medical human rights groups. One of the most notable
of these is the Johannes Wier Foundation in the Netherlands which has long implemented an
extensive programme of human rights activities, including missions to investigate human
rights violations, publication of reports and training manuals and campaigning work. As the
IFHHRO network has expanded, national medical associations such as the BMA and the
Turkish Medical Association have joined it and benefited greatly from its expertise on all
aspects of human rights work. Organizations of medical students are also increasingly
involved in the campaigning and educational roles of the network.
Partnerships and Exchange of Skills
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The BMA supports the development of partnerships between well-established and newly
developing medical and nursing associations to share expertise and experiences. Professional
partnerships can promote exchange schemes of personnel or concentrate on the exchange of
materials such as guidelines and ethics teaching materials. We would also strongly encourage
organizations of health professionals to pool expertise, not only through traditional
mechanisms such as international meetings, conferences and professional exchanges but also
through newer means of communication, such as websites. Many organizations have
developed helpful guidelines and these can be shared and adapted through the internet rather
than each organization having to re-invent similar guidance. Mutual support in the face of
ruthless and powerful governments requires associations of health professionals to band
together to share guidelines, moral support and information about strategies proved to be
effective in other comparable situations. Where medical associations are unable to act for
political or other reasons, we expect other medical and nursing associations to lend what
support and help they can to colleagues in those countries so that they are not left bereft of
help.
Networks with other Professions
The BMA also strongly advocates the development of alliances between disparate groups,
including representative organizations of doctors, nurses, lawyers, journalists and social
workers to provide essential mutual support and protection in the human rights sphere. By
producing joint strategies, the professions can increase their influence. To be really influential
in the human rights field, medical associations and other professional groups also need to
have contact with reliable media commentators and investigative journalists who are able to
publicize abuses and inequities. Co-operative ventures between health professionals and
lawyers are increasing in many countries.
Liaison with NGOs
It is vital that professional isolationism be countered by the development of new strategies for
working with non-governmental organizations and those already well-versed in international
human rights law. Of particular importance is effective liaison with non-governmental
organizations (NGOs), especially those involved in information-gathering, in obtaining
redress for survivors of abuse and in supporting asylum seekers. NGOs are changing and
growing in various ways. Western industrialized countries initially provided the grassroots
experience of public sector activities to stimulate the development of NGOs. This is
changing, as is the way many NGOs are staffed. In the past, health sector NGOs were seen as
apolitical deliverers of services to the poor and marginalized. Their staff came predominantly
from the developed world and the organizations were often run by expatriates. This pattern
too has changed. Many health-related NGOs have moved from a service role to a more
consciously influential role, taking up causes of injustice and challenging the authorities.
Even though it may not be their primary aim, NGOs are effective in influencing public policy
and changing the way that the state operates by obliging the authorities to be publicly
accountable. The Danish Medical Association provides a good model of collaboration with
NGOs which are active in the human rights sphere.
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