Reproductive Health and Human Rights Integrating Medicine, Ethics, and Law

by Cook, Rebecca J.; Dickens, Bernard M.; Fathalla, Mahmoud F.

• ISBN13: 9780199241323
• ISBN10: 0199241325
• Format: Hardcover
• Copyright: 2003-06-19
• Publisher: Clarendon Press

Summary

Rebecca Cook, Bernard Dickens, and Mahmoud Fathalla, leading international authorities on reproductive medicine, human rights, medical law, and bioethics, integrate their disciplines to provide an accessible but comprehensive introduction to reproductive and sexual health. They analyze fifteen case-studies, representing a wide array of recurrent problems, focusing particularly on resource-poor settings. Approaches to resolution are considered at clinical and health system levels. They also consider the kinds of social change that would relieve the underlying conditions of reproductive health dilemmas.

Author Biography

Rebecca J. Cook and Bernard M. Dickens are Professors of Law at the University of Toronto Mahmoud F. Fathalla is Professor of Obstetrics and Gynaecology at Assiut University, Egypt

Table of Contents

List of Tables	xxiii
List of Abbreviations	xxiv
Biographical Notes	xxvi
Part I. Medical, Ethical, and Legal Principles
Introduction and Overview	3	(5)
Reproductive and Sexual Health	8	(26)
Overview	8	(3)
Reproductive Health	11	(2)
The concept	11	(1)
A definition	12	(1)
A global concern	13	(1)
Sexual Health	13	(1)
Reproductive Health: A Woman's Concern	14	(3)
Gender differentials in health	14	(1)
The unfair burden on women in reproductive health	15	(2)
Women's health is more than reproductive health	17	(1)
Men Have Reproductive Health Needs Too	17	(1)
Determinants of Reproductive Health	18	(1)
Reproductive Health Indicators	19	(3)
A Global Overview of Reproductive Health	22	(9)
Safe motherhood	22	(1)
Availability of essential basic and comprehensive health care	22	(1)
Deliveries by skilled birth attendants	22	(1)
Access of pregnant women to prenatal care	23	(1)
Maternal mortality	23	(1)
Perinatal mortality	24	(1)
Anaemia	25	(1)
Fertility by choice	25	(1)
Total fertility rate	25	(1)
Contraceptive prevalence	26	(1)
Abortion	26	(2)
Sexually transmitted infections	28	(1)
Not including HIV	28	(1)
HIV infection	28	(1)
Female genital cutting (circumcision/mutilation)	29	(1)
Infertility	30	(1)
Cervical cancer	30	(1)
Progress and Challenges	31	(3)
Health Care Systems	34	(27)
Overview	34	(2)
The Health Care System and the Right to Health	36	(1)
Special Considerations in Reproductive Health Care	37	(3)
Dealing with healthy people	38	(1)
Dealing with more than one `client'	38	(1)
Dealing mostly with women	39	(1)
Dealing with society	40	(1)
Shortcomings in the Performance of the Reproductive Health Care System	40	(8)
Imbalance in the health care system	40	(1)
Health facilities	40	(1)
Human resources	41	(1)
Hospital beds	42	(1)
Inefficiency in the health care system	42	(2)
Inadequate responsiveness to women's expectations and perspectives	44	(1)
A health system that cares	44	(1)
Women as ends and not means	45	(2)
A fragmentary response to a totality of needs	47	(1)
Mainstreaming the Gender Perspective in the Health Care System	48	(1)
Challenges in the Implementation of Reproductive Health Care	48	(1)
Health Care Systems and the Law	49	(4)
Legal principles governing health care delivery	49	(1)
Obstructive laws	50	(2)
The health profession and human rights law	52	(1)
Literacy in human rights law	52	(1)
Compliance with human rights law	52	(1)
Advocacy for human rights	53	(1)
The Question of Resources	53	(6)
Overall resources	53	(3)
Fair allocation of resources	56	(1)
Priorities in the allocation of resources	56	(1)
Reproductive health is special	57	(1)
The cost of not providing reproductive health services	57	(2)
The Commitment	59	(2)
Ethics	61	(34)
Overview	61	(2)
The Origins of Bioethics	63	(2)
The Role of Bioethics	65	(1)
Bioethical Orientations	66	(2)
Duty-based bioethics	66	(1)
Consequentialist or utilitarian bioethics	67	(1)
Feminist bioethics	67	(1)
Other bioethical orientations	68	(1)
Principles of Bioethics	68	(6)
Respect for persons	69	(1)
Autonomy of capable persons	69	(1)
Protection of persons incapable of autonomy	70	(1)
Beneficence	70	(1)
Non-Maleficence	71	(2)
Justice	73	(1)
Levels of Bioethical Analysis	74	(3)
The microethical level	74	(1)
The macroethical level	75	(1)
The mesoethical level	76	(1)
The megaethical level	76	(1)
Reproductive and Sexual Health Ethics	77	(6)
Research Ethics	83	(4)
Ethics and the Law	87	(3)
Ethics and Human Rights	90	(2)
Ethics Review	92	(3)
Legal Origins and Principles	95	(53)
Overview	95	(2)
The Role of Law and of Lawyers	97	(3)
Legal Reform for Reproductive Health	100	(2)
The Evolution of Reproductive Health Law	102	(5)
From morality to democracy	103	(1)
From crime and punishment to health and welfare	104	(1)
From health and welfare to human rights	105	(2)
Legal Principles Governing Reproductive Health Care	107	(2)
Decision-Making	109	(11)
Informed decision-making	109	(4)
Free decision-making	113	(2)
The role of third parties	115	(1)
Partner authorization	115	(1)
Parental consent	116	(2)
Substitute decision-making	118	(2)
Regulation of Information	120	(8)
Privacy	120	(1)
Confidentiality	121	(1)
Unauthorized disclosures	122	(1)
Disclosure to patients	123	(1)
Authorized disclosures	124	(1)
Related concerns	125	(1)
Third-party interests	125	(1)
Third-party peril	126	(2)
Competent Delivery of Services and the Law of Negligence	128	(11)
Relation between legal and professional standards	129	(3)
Standards for determining professional competence	132	(2)
Delegated authority	134	(2)
Evidence for determining professional competency	136	(1)
Sexual misconduct	137	(2)
Conscientious Objection	139	(3)
Safety and Efficacy of Products	142	(2)
Criminal Law	144	(4)
Human Rights Principles	148	(68)
Overview	148	(2)
Sources and Nature of Human Rights	150	(4)
Rights Relating to Reproductive and Sexual Health	154	(4)
Evolution of reproductive rights	154	(2)
Duties to implement reproductive rights	156	(1)
Restrictions and limitations of rights	157	(1)
The Application of Human Rights to Reproductive and Sexual Health	158	(57)
Rights relating to life, survival, security, and sexuality	159	(1)
The right to life and survival	160	(1)
Essential obstetric care	161	(1)
Anti-retroviral and associated treatment	162	(2)
The right to liberty and security of the person	164	(1)
Unsafe abortion	164	(1)
Female genital cutting	165	(1)
Confidentiality	166	(2)
Compulsory diagnostic testing	168	(2)
The right to be free from inhuman and degrading treatment	170	(1)
Rape and the subsequent denial of justice	170	(1)
Denial of abortion services (including following rape)	171	(1)
Involuntary sterilization	172	(1)
Denial of adequate medical treatment	173	(1)
Sexuality	173	(2)
Rights relating to reproductive self-determination and free choice of maternity	175	(1)
The right to decide the number and spacing of one's children and the right to private and family life	175	(1)
Denial of contraceptive sterilization	176	(1)
Choice of termination of unintended pregnancy	177	(1)
Putative father's veto	177	(1)
Same sex intimacy	178	(1)
The right to marry and to found a family	179	(2)
`The family is entitled to protection by society and the State'	181	(1)
Marriageable age	182	(1)
Health and social effects of child marriage	182	(2)
Free and full consent	184	(1)
The right to maternity protection	185	(1)
The right to maternity protection during employment	186	(1)
Rights relating to health and the benefits of scientific progress	187	(1)
The right to the highest attainable standard of health	187	(3)
Available resources and their fair allocation	190	(2)
Health sector reform	192	(2)
The right to the benefits of scientific progress	194	(2)
Rights to non-discrimination and due respect for difference	196	(2)
Sex and gender	198	(1)
Sex and gender non-discrimination in the family	199	(1)
Sex and gender non-discrimination in health	200	(2)
Marital status	202	(1)
Age	203	(2)
Race and ethnicity	205	(2)
Health status/disability	207	(2)
Sexual orientation	209	(1)
Rights relating to information, education, and decision-making	209	(1)
The right to receive and to impart information	209	(2)
The right to education	211	(2)
The right to freedom of thought, conscience, and religion	213	(2)
Progress and Challenges	215	(1)
Implementation of Legal and Human Rights Principles	216	(39)
Overview	216	(1)
Human Rights Needs Assessment	217	(4)
Clinical care	218	(1)
Health systems	218	(1)
Underlying conditions, including social, economic, and legal conditions	219	(2)
Development of Legal Claims	221	(9)
Identify the wrong, its causes, and the wrongdoer	221	(1)
Document the alleged wrongs	222	(2)
Determine which laws are implicated	224	(1)
Identify standards by which to determine whether and how laws are violated	225	(3)
Assess how to pursue effective remedies	228	(1)
Determine which agencies or individuals are bound to provide remedies	229	(1)
Advancement of Legal Claims	230	(25)
National procedures	230	(1)
Implementation of legal and human rights principles	231	(3)
Courts of law	234	(2)
Criminal law approaches	236	(2)
Civil (non-criminal) law approaches	238	(2)
Alternative dispute resolution	240	(2)
Regulatory and disciplinary approaches	242	(1)
The international exception	243	(2)
Legislative approaches	245	(2)
Human rights commissions	247	(1)
Ombudsmen	247	(1)
Regional and international approaches	248	(1)
Reporting procedures	249	(1)
Complaint procedures	250	(1)
Inquiry and communications procedures	251	(4)
Part II. From Principle to Practice
Overview	255	(7)
Methodology	256	(3)
Choice and Sequence of Case Studies	259	(3)
Female Genital Cutting (Circumcision/Mutilation)	262	(14)
Background	262	(2)
Medical Aspects	264	(2)
Ethical Aspects	266	(2)
Legal Aspects	268	(2)
Human Rights Aspects	270	(2)
Approaches	272	(4)
Clinical duty	272	(1)
Health care systems obligations	273	(1)
Social action for underlying conditions	273	(1)
The health approach	273	(1)
The cultural approach	273	(1)
The women's empowerment approach or the development/gender approach	274	(1)
The ethical/legal/human rights approach	274	(2)
An Adolescent Girl Seeking Sexual and Reproductive Health Care	276	(11)
Background	276	(2)
Medical Aspects	278	(3)
General points	278	(1)
Sexuality	278	(1)
Sexually transmitted infections and contraception in adolescents	279	(1)
Adolescent pregnancy	279	(2)
Ethical Aspects	281	(1)
Legal Aspects	282	(1)
Human Rights Aspects	283	(1)
Approaches	284	(3)
Clinical duty	284	(1)
Health care systems obligations	285	(1)
Social action for underlying conditions	286	(1)
Sexual Assault and Emergency Contraception	287	(11)
Background	287	(2)
Medical Aspects	289	(1)
Ethical Aspects	290	(1)
Legal Aspects	291	(2)
Human Rights Aspects	293	(2)
Approaches	295	(3)
Clinical duty	295	(1)
Health care systems obligations	295	(2)
Social action for underlying conditions	297	(1)
Hymen Reconstruction	298	(7)
Background	298	(1)
Medical Aspects	299	(1)
Ethical Aspects	299	(1)
Legal Aspects	300	(1)
Human Rights Aspects	301	(1)
Approaches	302	(3)
Clinical duty	302	(1)
Health care systems obligations	303	(1)
Social action for underlying conditions	303	(2)
A Request for Medically Assisted Reproduction	305	(10)
Background	305	(1)
Medical Aspects	306	(1)
Ethical Aspects	307	(2)
Legal Aspects	309	(2)
Human Rights Aspects	311	(1)
Approaches	312	(3)
Clinical duty	312	(1)
Health care systems obligations	313	(1)
Social action for underlying conditions	314	(1)
Involuntary Female Sterilization	315	(8)
Background	315	(1)
Medical Aspects	316	(1)
Ethical Aspects	317	(1)
Legal Aspects	318	(1)
Human Rights Aspects	319	(1)
Approaches	320	(3)
Clinical duty	320	(1)
Health care systems obligations	320	(1)
Social action for underlying conditions	321	(2)
Counselling and Caring for an HIV-Positive Woman	323	(13)
Background	323	(1)
Medical Aspects	324	(1)
Ethical Aspects	325	(3)
Legal Aspects	328	(1)
Human Rights Aspects	328	(1)
Approaches	329	(7)
Clinical duty	329	(2)
Health care systems obligations	331	(1)
Social action for underlying conditions	332	(4)
HIV Drug Research and Testing	336	(9)
Background	336	(1)
Medical Aspects	337	(1)
Ethical Aspects	337	(2)
Legal Aspects	339	(1)
Human Rights Aspects	340	(1)
Approaches	341	(4)
Clinical duty	341	(1)
Health care systems obligations	342	(1)
Social action for underlying conditions	343	(2)
Responding to a Request for Pregnancy Termination	345	(11)
Background	345	(2)
Medical Aspects	347	(1)
Ethical Aspects	348	(2)
Legal Aspects	350	(1)
Human Rights Aspects	351	(2)
Approaches	353	(3)
Clinical duty	353	(1)
Health care systems obligations	353	(1)
Social action for underlying conditions	354	(2)
Prenatal and Pre-Implantation Genetic Diagnosis for Risk of Dysgenic Inheritance	356	(7)
Background	356	(1)
Medical Aspects	357	(1)
Ethical Aspects	357	(1)
Legal Aspects	358	(1)
Human Rights Aspects	359	(1)
Approaches	360	(3)
Clinical duty	360	(1)
Health care systems obligations	361	(1)
Social action for underlying conditions	361	(2)
Sex-Selection Abortion	363	(9)
Background	363	(1)
Medical Aspects	364	(1)
Ethical Aspects	365	(2)
Legal Aspects	367	(1)
Human Rights Aspects	368	(1)
Approaches	369	(3)
Clinical duty	369	(1)
Health care systems obligations	370	(1)
Social action for underlying conditions	370	(2)
Treating a Woman with Incomplete Abortion	372	(6)
Background	372	(1)
Medical Aspects	373	(1)
Ethical Aspects	374	(1)
Legal Aspects	374	(1)
Human Rights Aspects	374	(1)
Approaches	375	(3)
Clinical duty	375	(1)
Health care systems obligations	376	(1)
Social action for underlying conditions	377	(1)
Confidentiality and Unsafe Abortion	378	(7)
Background	378	(1)
Medical Aspects	379	(1)
Ethical Aspects	380	(1)
Legal Aspects	381	(1)
Human Rights Aspects	381	(1)
Approaches	382	(3)
Clinical duty	382	(1)
Health care systems obligations	383	(1)
Social action for underlying conditions	384	(1)
Domestic Violence	385	(8)
Background	385	(1)
Medical Aspects	386	(1)
Ethical Aspects	387	(1)
Legal Aspects	388	(1)
Human Rights Aspects	389	(1)
Approaches	390	(3)
Clinical duty	390	(1)
Health care systems obligations	391	(1)
Social action for underlying conditions	391	(2)
A Maternal Death	393	(12)
Background	393	(1)
Medical Aspects	394	(1)
Ethical Aspects	395	(2)
Legal Aspects	397	(1)
Human Rights Aspects	398	(1)
Approaches	399	(6)
Clinical duty	399	(1)
Health care systems obligations	399	(1)
Social action for underlying conditions	400	(5)
Part III. Data and Sources
Reproductive Health Data	405	(23)
World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects	428	(5)
Human Rights Treaties and UN Conference Documents	433	(4)
International Human Rights Treaties	433	(1)
Regional Human Rights Treaties	434	(2)
UN Conference Documents	436	(1)
Human Rights Relating to Reproductive and Sexual Health	437	(8)
States Parties to Human Rights Treaties	445	(18)
Human Rights Treaty Committees: General Recommendations/Comments	463	(47)
Committee on the Elimination of Discrimination against Women, General Recommendation 19: Violence against Women	463	(6)
Committee on the Elimination of Discrimination against Women, General Recommendation 24: Women and Health (Article 12)	469	(8)
Committee on Economic, Social and Cultural Rights, General Comment 14: The Right to the Highest Attainable Standard of Health (Article 12)	477	(22)
Human Rights Committee, General Comment 28: Equality of Rights between Men and Women (Article 3)	499	(8)
Committee on the Elimination of Racial Discrimination, General Recommendation 25: Gender Related Dimensions of Racial Discrimination	507	(3)
Summary of the International Guidelines on HIV/AIDS and Human Rights (1996)	510	(3)
Sample Application to Petition a Human Rights Treaty Body	513	(4)
Annotated Table of Cases	517	(9)
Select Bibliography by Chapter	526	(6)
Annotated Listing of Relevant Websites	532	(11)
Index	543