Every spring for the past three years, I have posed a question to the small group of first-year medical students who signed up for my Health and Human Rights course: “Who here has heard of the Universal Declaration of Human Rights?”
It’s an elective course, so the students are motivated. Of the 10 or 15 present, about three raise their hands. Then I ask the awkward follow-up: “Who has actually read it?” That is when all of the hands go down.
Today, Dec. 10, is Human Rights Day. It marks the date, 66 years ago, when the United Nations adopted of the Universal Declaration of Human Rights. Following World War II, the newly created United Nations adopted the document to define the fundamental rights of all humanity, including the freedom to own property, the right to public trial and the prohibition of slavery. Eleanor Roosevelt, who was one of its drafters, predicted the declaration would stand as “the international Magna Carta of all men, everywhere.” By 2009, it had been translated into 370 languages, making it the world’s most translated document. But that doesn’t mean anyone is actually reading it.
So I make sure my students do read it — all 30 articles. I ask them to identify which ones relate directly to their chosen careers in health and medicine. Most often, they choose Article 5, the prohibition of torture and cruelty. A few might mention Article 24, the right to leisure and rest. These are good answers, but they miss some important ones that are less obvious: the right to education (Article 26), the right to be employed (Article 23), the right to safe standards of living (Article 25), and the right to freedom of movement (Article 13).
I point these out, and then we talk. We talk about how, when a child is married off before her body has matured (a violation of Article 16), pregnancy outcomes can be compromised. We talk about how, HIV-positive patients who are stigmatized are denied freedom to associate with others (violating Article 20) and can miss out on getting specialized services and information that can improve their well-being. We talk about how discrimination (a violation of Article 7) profoundly impacts the health of HIV and Ebola patients; of members of certain tribes, clans and religious groups; and of individuals who identify as LGBT.
In a world where physicians in training are encouraged to know the Patient’s Bill of Rights — posted on the walls of nearly every hospital and clinic in the country — why are we not teaching them the U.N.’s Universal Declaration of Human Rights and other international human rights treaties and covenants?
To be fair, medical school is an enormous undertaking. There is so much to squeeze into four years. Curricula are packed with knowledge, competencies and skills to master. In that setting, there is very little time and energy for anything else. But teaching human rights is critical to producing doctors who are prepared to care for all patients in our increasingly diverse nation. Doctors do not have to set a foot in an overseas hospital or clinic to encounter patients whose health is affected by human rights violations. They encounter individuals who have come to the United States from other parts of the world deeply affected by human rights violations, including torture, female genital mutilation, domestic violence, sex trafficking, substandard prisons, child labor or illegal working conditions. The United States welcomed nearly 70,000 new refugees from troubled nations in 2013. More than 58,000 people received asylum in the United States in 2012. And there are more than 40-million immigrants currently living in the United States. These conditions also affect scores of U.S.-born people, in every corner of the nation.
In teaching a health and human rights course, my goal is to show future physicians that human rights are more intertwined with health than most people believe. I want them to see that the work they aspire to do is connected to important political, civic, economic and cultural dynamics. In order to provide the best patient care possible, doctors must understand the full context of their lives.
As medical educators, we are doing a better job of teaching future physicians about the various forces that shape their patients’ health. Many medical schools now highlight the “Social Determinants of Health”: The recognition that education, employment, housing, economic factors, the living and work environments, have direct and profound effects on health. But students should think about what causes those circumstances: why many girls are denied proper education, why poverty perpetuates through generations, why laborers are trafficked into wealthy nations. At minimum, doctors need to be aware of these dynamics; at most, they should strive to be activists. This may mean having to take sides in political, cultural and ideological conflicts here and abroad.
This could prove controversial. Some might question the relevance to medical education of any material that is not purely clinical – not related to the physiology of disease, diagnosis or treatment. But if we profess to engage in “patient-centered care” – a term that the medical profession throws around a lot these days — we must acknowledge what that fully implies: Our patients’ well-being extends far beyond the exam room, so caring for them means being active outside of the hospital. Doctors have a role as our patients’ advocates. I can think of no more fundamental way to fulfill that obligation than to stand up for our patients’ basic human rights.
Maybe it is time to start handing out the Universal Declaration to medical students on the day they graduate. It is a guide as vital to deeper understanding and quality execution of their jobs as the Hippocratic Oath. Sickness and health everywhere are rooted in human rights and should be understood in that context. It is our duty as educators to make sure medical students understand that, and have all of the tools to be not only competent clinicians, but compassionate citizens of the world and agents of change.
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