A disenfranchising effect of the right to health?

By Julian Urrutia

Human rights embody the humanist egalitarian principle that all human beings are morally important, and that they are morally important simply because of their humanity. Princes and paupers, bankers and bums, women and men . . . we’re all subjects of human rights that are not contingent on anything other than our humanity.

There is widespread agreement that the rise of humanism is one of the most important milestones in the history of moral progress. However, it also clear that the rise of humanism did not, by itself, bring us all the way down the path of progress to where we are today: throughout colonial history, for example, humanism failed to deliver us from outrageous discrimination when the boundaries of humanity were delineated too narrowly.

Humanists are just as prone to inhumane conduct when they fail to recognize other’s humanity. When we determine what is human (and must therefore be treated with respect), we tacitly also determine what is un-human (and can therefore be exploited). As Carl Schmitt put it “Given the coherence of this two-sided aspect of humanity, it should be remembered that Bacon opposed the axiom homo homini deus to that of homo homini lupus.” (The nomos of the earth, 1950)

That’s why contemporary, liberal constitutions that recognize human rights are so great. All people are recognized as being equally human, and therefore equally subjects of human rights. This is certainly a form of moral progress. However, narrow human rights-based approaches to politics, legislation and policy-making can have similarly perverse consequences as narrow forms of humanism. Instead of delivering us from outrageous discrimination, marginalization and exploitation, a narrow focus on rights might confine us to them. For example, there is growing evidence that human-rights-based legislation and litigation often fails to achieve an effective enjoyment of the right to health to among those who need it most. Even more troubling is the possibility that, sometimes, rights-based approaches not only have little positive effects, but might in fact lead to further marginalization and disenfranchising of the poor.

Read More

10/22: Globalization and the Future of Health Law: Harmonization or Diversity?

Petrie-Flom Center Faculty Co-Director I. Glenn Cohen will give the introduction for this event featuring Belinda Bennett, Professor of Health and Medical Law, University of Sydney.

From its earliest stages, the themes of recognizing rights and managing risks have been constant features of health law debate. More recently, globalization has become an important theme for health law. International human rights law and global public health have, for example, both become important aspects of contemporary health law. In this context, it is no longer sufficient for health law to have a purely national focus. Analyzing these trends in the development of health law, Professor Bennett considers the future development of health law and whether the trend towards globalization will lead to greater harmonization or greater diversity.

Lunch will be provided.

If You Could Take a Pill to Greatly Reduce Your Chance of HIV Infection, Would You?

I have been a bit slow on blogging recently due to moving to a new house at the start of a semester (remind me why I thought *that* would be an OK idea again?) but I did want to share this very interesting piece from the New Yorker by Christopher Glazek “Why Is No One On the First Treatment To Prevent H.I.V.?

At Petrie-Flom we held a great panel discussion right when this PrEP (pre-exposure prohylaxis) treatment (and the OraQuick home HIV test) came out, and you can watch it here. (The event featured  Robert Greenwald, Director of the Center for Health Law and Policy Innovation; Douglas A. Michels, President and CEO, OraSure Technologies, Inc; David Piontkowsky, Senior Director for Medical Affairs, HIV and HIV Global Medical Director, Gilead Sciences, Inc; Kenneth H. Mayer, Medical Research Director, Co-Chair of The Fenway Institute; Kevin Cranston, Director, Bureau of Infectious Disease, Massachusetts Department of Public Health; Mark Barnes, Partner, Ropes Gray, Lecturer in Law, Harvard Law School.)

As the New Yorker Article describes (and full disclosure, I sat on an IRB that oversaw a good chunk of this research at Fenway Health at one point in my career, so I am not a disinterested observe)  the use of of the drug Truvada for PrEP has some pretty impressive figures from the clinical studies:

while adherence is a concern, as it is with condoms, Truvada offers H.I.V. protection that is more effective than any other method short of abstinence. In the N.I.H. study, for example, 5.2 per cent of the placebo group “seroconverted,” or became H.I.V. positive, compared with 2.9 per cent of the Truvada group. That’s a forty-four-per-cent added protection over-all—better than inconsistent condom use. More impressively, patients who maintained a detectable amount of the drug in their system were protected at a rate of ninety-five per cent. (A later statistical analysis estimated that the drug would need to be taken four times a week to offer protection in that range.) Grant said that people in the study who took the drug four to seven days a week “were absolutely protected. We didn’t have anyone seroconvert in our cohort in the United States.”

 

Taking Truvada to prevent H.I.V. comes with very few risks. In the N.I.H. study, one in two hundred people had to temporarily go off the pill owing to kidney issues, but even those people were able to resume treatment after a couple of weeks. While bone-density loss occasionally occurs in Truvada takers who are already infected with the virus, no significant bone issues have emerged in the PrEP studies. And though about one in ten PrEP takers suffer from nausea at the onset of treatment, it usually dissipates after a couple of weeks. According to the U.N. panel’s Karim, Truvada’s side-effects profile is “terrific,” and Grant said that common daily medications like aspirin and birth control, as well as drugs to control blood pressure and cholesterol, are all arguably more toxic than Truvada.

 

Perhaps more important, drug resistance has not been observed in people who were H.I.V.-negative when they began treatment. “We’re not seeing people getting infected who are actually taking the drug,” said Grant. “There are people who take the drug home with them and choose not to take it; they get infected, but you’re not going to get drug resistance from something that stays in a drawer.” Some patients who entered the trials turned out to already have an H.I.V. infection that was too recent to be caught by a blood test. These subjects showed a small amount of drug resistance, which is why the F.D.A. now requires doctors to conduct an H.I.V. test before putting their patients on PrEP. The larger resistance threat, though, comes from the ten million H.I.V.-positive people around the world who take antiretrovirals for treatment, including, in some cases, Truvada. “The best way to prevent drug resistance is to prevent H.I.V. infection entirely,” said Grant. “We know that when we prevent a case of H.I.V., we’re preventing a lifelong risk of drug resistance.”

But that just prompts the mystery, why aren’t more people taking the drug?

Read More

Beyond Roe: Reproductive Justice in A Changing World

By Michele Goodwin

Blogging highlights from Rutgers-Camden (conference coordinated by Professor Kimberly Mutcherson)

A few blog highlights from the Beyond Roe conference at Rutgers-Camden:

Excellent Keynote remarks presented by Byllye Avery, founder of Black Women’s Health Imperative and MacArthur Foundation Fellowship (aka Genius Award). Dr. Avery urges a close examination of the states challenging reproductive access.  She explains a link between former slave states as the new battlefront in reproductive equality…

June Carbone gives a provocative preview of her forthcoming book with Naomi Cahn: The Marriage Market

Dazon Dixon Diallo, President of Sister Love, Inc-presents new empirical data on race, youth, and reproductive decision-making and African American youths’ perspectives on abortion.

Young scholars to watch out for:

Aziza Ahmed, Assistant Professor at Northeastern School of Law presents a project on Scientific Expertise in Abortion Jurisprudence.

Lisa Kelly, SJD candidate at Harvard Law School gives an enlightening talk on Transnational abortion rights and the litigation emerging in Latin American countries.

Terrific project on the rise by Grace Howard, a PhD student at Rutgers University who presented a talk: When the Crime is Birth: “Meth Babies” and the Limits of Pure White

Haiti in a Time of Cholera

By: Efthimios Parasidis

In the midst of “the world’s worst and fastest-spreading cholera epidemic“, with more than 685,000 infected and approximately 8,400 dead, five Haitian families are suing the United Nations in federal court in the Southern District of New York. The families are seeking $2.2 billion for the Haitian government’s relief efforts and unspecified damages for Haitian families affected by the outbreak. Despite evidence which indicates that cholera was introduced by UN peacekeepers, the UN has yet to admit responsibility and has denied compensation to the victims, though it continues to provide assistance to Haiti. The UN argues that immunity precludes legal recourse, and undoubtedly will move to dismiss the complaint. Aside from the legal arguments regarding immunity, the question remains whether the UN has a moral responsibility to provide compensation and more robust remediation measures, particularly because there were “documented sanitation deficiencies” at a UN camp that has been identified as the source of the outbreak. As we await a decision from the court, and a response from the UN, cholera continues to kill nearly three Haitians each day.

 

Wednesday @ 8pm – Thomas Pogge: Effective Altruism or Mobilization for Institutional Reform?

Harvard High-Impact Philanthropy presents

Effective Altruism or Mobilization for Institutional Reform?

a lecture by Thomas Pogge

Director of the Global Justice Program and Leitner Professor of Philosophy and International Affairs, Yale University

Wednesday, October 9, 8 PM Sever 214

Professor Pogge will discuss whether some institutional reform efforts may be as effective or more effective than “effective altruism” and also whether effectiveness is the only standard by which such alternative ways of protecting people are to be compared.

Thomas Pogge is the Director of the Global Justice Program and Leitner Professor of Philosophy and International Affairs at Yale University. Additionally, he is the Research Director of the Centre for the Study of the Mind in Nature at the University of Oslo; a Professorial Research Fellow at the Centre for Applied Philosophy and Public Ethics at Charles Sturt University; and Professor of Political Philosophy at the University of Central Lancashire’s Centre for Professional Ethics. He is also an editor for social and political philosophy for the Stanford Encyclopedia of Philosophy and a member of the Norwegian Academy of Science and Letters.

Planning on coming? RSVP here

The priorities in the benefit packages vs. the priorities of those who dole out the benefits

In my last post I promised I would provide details about the new piece of statutory legislation that was recently enacted by the Colombian Congress on the right to health, but first I should talk a little more about the prior jurisprudence that set the stage for it–especially since there’s so much of it. Every year, hundreds of thousands of right-to-health cases go before judges in Colombia, and some estimate that up to one out of every five Colombians has used the judicial system to gain access to health services.

By far, most of these cases are won by the plaintiff. And they should be.

Nearly 90% of the cases that involve procedures, and over 30% of the cases for medications, involve benefits that are actually already covered by the public benefit package (plan obligatorio de salud, or POS). And most of these aren’t over particularly expensive, complicated, or scarce benefits in the POS. The most frequently litigated medications are omeprazole (Prilosec) and oxygen. The most frequently litigated procedures aren’t even the procedures themselves, but specific parts of the procedures that aren’t explicitly listed in the bundle of benefits covered by the POS. For example, the POS covers colostomies, but the insurance companies systematically deny the colostomy bags. “We’ll open the hole in your flank, but it’ll be on you to figure out what to do with the excrement that’ll start oozing out. . .”

Read More