Human Rights and Professional Ethics Between the past and the future

Transcription

1 Human Rights and Professional Ethics Between the past and the future Henry Ascher Lars H Gustafsson

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5 Geneva declaration 1948 World Medical Association I will maintain the utmost respect for human life (...) I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient (...) I will not use my medical knowledge to violate human rights and civil liberties, even under threat

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8 Age assessment in Sweden Responsible: National Board of Forensic Medicine 1. X-ray of 8th molar 2. MRI knee

9 Age assessment In asylum cases where The National Board of Forensic Medicine should assess whether a person is above or below 18 years of age, three different answers can be given: The assessment of the completed survey indicates that the surveyor is 18 years of age or older The assessment of the survey conducted may indicate that the surveyor is 18 years or older The assessment of a survey conducted may indicate that it is under 18 years of age In addition: situations where an age assessment can not be done

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11 Statistics until September 2017 Total Knee+ / teeth % Knee + / teeth % Knee - / teeth % Knee - / teeth % Not possible to assess %

12 In summary, we can conclude that the bony fusion of the distal femoral epiphysis and the proximal tibial epiphysis as depicted by closest-to-bone 3.0 T MRI is not suitable as a sole indicator of majority in either sex in compliance with the criteria for forensic age estimation.

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14 Main findings Weak, inadequate or faulty assessments put children at risk. Children who are falsely assessed as adults may experience violations of their human rights, are at risk of being detained in unsuitable detention facilities and consequently exposed to greater risks of abuse and violence. They may further lose out on essential support and assistance to guarantee their safety, health, well-being and development. In light of these reflections and considerations, age assessment procedures will be rights based if the procedure and outcomes safeguard the human rights of the person irrespective of rigid age limits. Persons identified as children should be referred to appropriate care and protection and benefit from a best interests determination procedure for the identification and implementation of a durable solution. Persons who are assessed to be young adults should benefit from support and after-care services according to their individual needs and specific vulnerabilities.

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17 Physicians' involvement in deportation Physicians cannot be compelled to participate in any punitive or judicial action involving refugees, including asylum seekers, refused asylum seekers and undocumented migrants, or Internally Displaced Persons or to administer any non-medically justified diagnostic measure or treatment, such as sedatives to facilitate easy deportation from the country or relocation. WMA 2016

18 The World Medical Association, which includes the Swedish Medical Association, has stated that doctors should not participate in coercive measures in case of deportations. The Swedish Medical Association agrees fully with this and therefore advises doctors not to participate in the expulsion of asylum seekers. Swedish Medical Association's Council of Ethics, April 2017

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20 Lisbon declaration 1981 World Medical Association 1. Right to medical care of good quality a. Every person is entitled without discrimination to appropriate medical care. b. Every patient has the right to be cared for by a physician whom he/she knows to be free to make clinical and ethical judgements without any outside interference. c. The patient shall always be treated in accordance with his/her best interests. The treatment applied shall be in accordance with generally approved medical principles.

21 Lisbon declaration 1981 World Medical Association While a physician should always act according to his/her conscience, and always in the best interests of the patient, equal effort must be made to guarantee patient autonomy and justice Whenever legislation, government action or any other administration or institution denies patients these rights, physicians should pursue appropriate means to assure or to restore them.

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23 "Human rights are good, but......they are written for another time. The situation now is very special.... citizens' rights must the first priority.

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25 Nobody need wait a single moment before starting to improve the world