Promoting children's rights to health and well-being in the United States

The United States has a highly sophisticated pediatric healthcare system and spends more than any other country per capita on children's healthcare. However, not all children have access to needed and affordable health care and the life expectancy and health outcomes of children in the country are worse than in any other industrialized nation. These nations typically offer universal healthcare for children as part of a robust recognition of a children's rights framework. In 1989 the United Nations adopted the Convention on the Rights of the Child that recognizes the right of the child to the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. Currently the United States is the only United Nations member country that has not ratified the Convention on the Rights of the Child. This paper outlines the potential benefits of adopting a child rights approach based on the principles and provisions of the Convention on the Rights of the Child. The fact that countries who invest much less in healthcare compared to the United States can achieve better health outcomes provides the certainty that a solution is possible and within reach.

Identifying deficits in Ukrainian law: Forensic psychiatry misuse in proceedings of administrative offenses

Ukraine is actively denouncing and abandoning its Soviet legacy, with the legal process of decommunization being at the forefront of this process.1 However, despite Ukraine's ongoing judiciary reformation process amplified by the signing of the Association Agreement between Ukraine and the European Union, Ukraine's legal system still contains inherited Soviet legal deficiencies that allow for human rights violations. Some of the most glaring deficiencies relate to the rules and regulations for assigning and conducting forensic psychiatric examinations in cases of administrative offenses. With an aim to aid Ukraine in eliminating present legal deficiencies that allow for violations of human rights, here we discuss current definitions, rules, and regulations concerning appointment and execution of forensic psychiatric examinations in cases of administrative law violations. We place particular emphasis in our discussion on the European Court for Human Rights case "Zaichenko v Ukraine, No 2", and the reform bill that followed this case. This case is an 'in vivo' illustration of how Ukraine's legal deficiencies have created grounds for the violation of individual human rights. Our assessment of the current rules and regulations for assigning and conducting forensic psychiatric examinations in proceedings of administrative offenses reveals that the legal deficiencies persist. The proposed reform bill is thus a highly warranted initiative, which however has several issues in its formulations and fails to address a few of the worst existing deficiencies. Ukraine's legislators must do further work to put through reforms that will safeguard individuals from unjustified forensic psychiatric examinations.

Ethical Preparedness for Health Policymaking and Implementation During Public Health Emergencies: The Role of Rapid Ethical Assessment

Scholars have called for ethical preparedness for public health practice and research to address the challenges of special ethical considerations under time and resource pressure during emergencies like the COVID-19 pandemic. We propose the idea of a rapid ethical assessment (REA) that aims to provide ethical justifications and policy recommendations for a specific public health policy, which is necessary for the ethical legitimacy of health policymaking and implementation. We suggest that an REA task force be established and incorporated into the administrative procedure to perform an REA in the early, middle, and terminal stages of a policy proposed by the health authority and to determine to what extent the tradeoffs between values and priorities required by the policy are ethically acceptable. The REA task force's role is consultative, with the final decisionmaking power and political responsibilities falling on the health authority. The REA task force should adopt 4 substantial ethical principles: utilitarianism, equity, human rights, and solidarity. The REA task force would consist of a multidisciplinary team of experts and a group of representatives from those who would be affected by the proposed policy. The REA task force would operate with a 5-step procedure of (1) convening, (2) investigation, (3) determination, (4) reporting and communication, and (5) decision and reassessment. We use 2 real incidents in Taiwan to demonstrate how the REA task force could work to enhance the ethical acceptance of a policy.

Promoting human rights in mental healthcare: beyond the 'Geneva impasse'

The past decade has seen a significant growth in attention to the human rights of persons with disabilities, taken to include mental health conditions. Consequently, challenges to important areas of current psychiatric practice have emerged, with which the profession has, in general, shown limited engagement.

Psychological torture: definitions, clinical sequelae and treatment principles

Psychological torture, in its broadest sense, is the intentional infliction of suffering without resorting to direct physical violence, in what is known as 'no-touch' torture. While several other definitions of psychological torture have been suggested, there is no one precise definition. Given the rapidly evolving current global political climate and the intensification of conflict, war and asylum seeking, the need for better recognition of psychological torture among clinicians, followed by the provision of appropriate treatment support for victims, has become increasingly pertinent. This article raises awareness of the concept of psychological torture among clinicians, through an overview of its debated definitions, the modalities which constitute this form of torture, and its clinical sequelae and treatment approach.

Gerontological education: a pathway towards advancing the rights of older people

Following the UN Human Rights Declaration in 1948, much effort has been undertaken to formalize the rights of older people. This article aims to highlight the role of education in advancing the rights of older people. Raising awareness and sharing knowledge about the rights of older people through rights-based education can empower students, when entering their field of work, to be advocates for rights within their employment settings and local communities. The effectiveness of a rights-based educational training for organizations working with refugees in Jordan, which took place in Amman in January 2020, is analyzed using the participant-focused Transformative Human Rights Education (THRED) as a framing structure. Our analysis found that training participants became active in promoting the rights of older people in their workplaces. The rights of older people need to be more than a conversation, and transformational change that promotes rights can occur when people feel empowered to undertake action-oriented advocacy. The case study analysis provides an example of how influential participant-centered pedagogy, such as THRED, can be to help students in gerontology programs become active agents in promoting rights of older people in their workplaces, communities, and ultimately influencing the international dialogue.

Perceptions of the Right to Food Among Adults Aged 60 Years and Older

This study explores perceptions of the right to food and issues around food assistance and access among older adults. We conducted 20 semi-structured interviews with adults aged 60+ in Iowa, half of whom were food insecure. Most respondents expressed the right to food concerns freedom of choice rather than physical and financial access. The respondents said poor food access was due to improper choices or not accessing food assistance. While respondents believed food insecurity was morally wrong, they also believed current food assistance services are sufficient. These results have important implications for understanding how older adults think about food access.

[Information systems and regulatory documentation in El Salvador related to migration and healthSistemas de informação e documentação regulatória de El Salvador referentes a migração e saúde]

Objective

Analyze, from the perspective of international health, data on migration and health contained in El Salvador's information systems and regulatory documentation.

Method

The information and documentation systems of the Virtual Center for Regulatory Documentation of the Ministry of Health of El Salvador were reviewed in detail. Regulatory documentation on migration and health from the websites of the Central American Integration System (SICA), the Mesoamerican Initiative, and the Plan of the Alliance for Prosperity in the Northern Triangle was also studied.

Results

None of the six information systems of the Ministry of Health of El Salvador captures either immigration status or access to and use of health services. Of the 52 national documents studied, 50 do not specify actions on migration and health.

Conclusions

Not all the information systems provide data on access to and use of health services, nor information on pro-health behaviors or early warnings that are useful for decision-making by health authorities. The guidelines contained in the Salvadoran regulatory framework do not address actions related to migration and health.

Universal Design and Communication Rights: Meeting the Challenge of Linguistic and Communicative Diversity

This essay discusses Universal Design (UD) with respect to language and communication rights. Because Universal Design approaches aim at meeting human variability from the get-go, they must be able to address linguistic and communicative variability. Variability must individual variation in language functions and communication activities in the absence of disability and variability when speech, language or communicative disorders are present. Current conceptualizations of speech, language and communication disabilities take a person-centered approach and a bio-psycho-social framework of health and disease (WHO-ICF) that encompass three ontological domains: body functions and structures, activities, and participation. The framework crucially lists environmental factors that interact with each domain. I illustrate how UD can successfully be integrated with an ICF framework in the domain of speech, language and communication impairments; I then propose that the ICF model can be extended beyond disability to non-clinical populations and settings, to meet the communication rights for all.

Responsiveness of water-sector regulation in Brazil to the Covid-19 pandemic: A view through the human rights lens

This paper provides an overview of the regulatory responses to Covid-19 from the regulatory authorities of Brazilian states. This paper aims to provide new insights into the operationalization of the human rights to water and sanitation in the Brazilian regulatory authorities' actions during a health emergency. We find that communities located in unserved areas were not mentioned in the regulatory responses, nor were people in vulnerable situations. Equity and non-discrimination principles were correlated more with economic measures. This study has also identified the absence of responses related to access to sanitation facilities, with normative contents related to the issue not appearing in the content analysis.

The Right to Protest During a Pandemic: Using Public Health Ethics to Bridge the Divide Between Public Health Goals and Human Rights

Public protest continued to represent a prominent form of social activism in democratic societies during the COVID-19 pandemic. In Australia, a lack of specific legislation articulating protest rights has meant that, in the context of pandemic restrictions, such events have been treated as illegal mass gatherings. Numerous large protests in major cities have, indeed, stirred significant public debate regarding rights of assembly during COVID-19 outbreaks. The ethics of infringing on protest rights continues to be controversial, with opinion divided as to whether public health goals or human rights should take precedence. This paper applies public health ethical theory to an in-depth analysis of arguments on both sides of the debate. Using the Nuffield Council on Bioethics framework as a backdrop, proportionality and necessity of restrictions are understood as key concepts that are common to both public health and human rights perspectives. The analysis presented here finds a middle-ground between the prevailing arguments on opposing sides and is further able to rationalize the use of protest itself as an important element of a mature public health ethics response to restrictive policy. Thus, this paper aims to influence public health policy and legislation regarding protest rights during public health emergencies.

Should states restrict recipient choice amongst relevant and available COVID-19 vaccines?

Several COVID-19 vaccinations have been authorised worldwide. Whilst some vaccines are contraindicated for certain age groups or health conditions, there are often multiple clinically suitable authorised vaccine brands available. Few states have allowed recipients to choose amongst them, though there are multiple reasons why choice would be valued. We consider the policy justifications for state controls on recipient choice amongst COVID-19 vaccine brands, focusing on European countries and drawing on the UK context as an example. We contrast justifications for not offering choice at the height of the early pandemic crisis, and as some states seek to de-escalate their response and transition towards living with COVID-19. We argue that in the latter context public expectations of choice between available vaccine brands and platforms may rise, but that several considerations may justify continued restrictions on choice. A key factor which states should continue to take into consideration is the global nature of the pandemic. Insofar as offering recipient choice at a national level might exacerbate global inequity in vaccine distribution, states retain a normative and legal justification for restricting choice amongst available and clinically suitable vaccine brands.

Reparation Policy in Gendered Political Violence: Gendered Torture During the Dictatorship and the Recent "Social Explosion" in Chile

This study explores the gendered violence dimension present in the torture exerted in Chile and the problems that continue to affect the reparation policies. The analysis covers the cases of political prisoners during the Chilean dictatorship (1973-1990) and that of the people detained within the context of the social protest of October 18, 2019. The methodology used for this study includes desk research on secondary sources on gendered political violence and torture such as scholarly books, journalistic and academic articles, and non-governmental organization reports, analyzing their contents from a perspective based on human rights and gender. We argue that the crystallization of gender-based violence exerted by Chilean State agents is linked to the biases present in post-dictatorship reparation policy and reflect on the impact of these biases on the assurances of non-repetition of human rights violations.

Beyond Economics! The (Evolving) Role of Law in the Eradication of Extreme Poverty

Extreme poverty is a complex and multifaceted challenge that cannot be solely addressed through economic interventions. Traditional economic indicators, such as GDP, do not fully capture the realities of vulnerable populations who often experience discrimination and social exclusion. This has legal and human rights implications, particularly in regions such as Sub-Saharan Africa where extreme poverty is concentrated. In light of these concerns, this article critically examines the existing literature on poverty economics and law and presents an analysis of key data. Ultimately, the article argues for a comprehensive approach that prioritises law and justice as crucial components of efforts to achieve target 1 of the United Nations' Agenda 2030 for Sustainable Development. This approach should entail the establishment of legal frameworks that promote accountability for political actors and protect the rights of the poor.

Pandemic-Related Stress and Resilience Among Latinx Mothers with a History of Depression: Differences by Immigration Status

This study explores the impact of the COVID-19 pandemic on low-income, Latinx mothers in Southern California with a history of depression, including undocumented mothers and members of mixed status families. Drawing participants from a parent study that provided a maternal depression intervention to Head Start mothers (n = 119), this mixed method study integrates qualitative and quantitative data in a convergent design. Thirty-four mothers completed semi-structured qualitative interviews and standardized questionnaires in the fall of 2020. Mothers shared overwhelming economic difficulties, with the majority reporting that their family income decreased and half reporting that they were unable to pay for housing. Stressors were compounded for undocumented mothers and members of mixed-status families who were excluded from major relief programs. Stress affected maternal mental health, and mothers with precarious status reported differences in functioning. Mothers also identified positive ways that they coped with adversity. Results show that Latinx mothers with a history of depression, particularly mothers with precarious immigration status, continue to suffer considerable economic, social, and emotional impacts of the COVID-19 pandemic. Social workers can support the human rights of this population by advocating for financial relief, food assistance, and the expansion of medical-legal partnerships and physical and mental health services.

Sexual and reproductive history of female prisoners in Iran: a health care needs analysis

PURPOSE

According to estimates, there are approximately 714,000 female prisoners in the world. A considerable proportion are pregnant, of childbearing age at the time of incarceration and may experience numerous reproductive health concerns. The purpose of this study is to examine the demographics and sexual and reproductive history of female prisoners in Iran.

DESIGN/METHODOLOGY/APPROACH

Four hundred and thirty-four female prisoners (mean age: 39.0 ± 9.9) serving sentences at Qarchak prison, Iran, completed a questionnaire. The participants were recruited between October 2017 and September 2018 using a convenient sampling method. The questionnaire captured sociodemographic characteristics and sexual and reproductive history.

FINDINGS

Most respondents had 7-12 years of formal education, were housewives (69.9%), were either married (41.6%) or divorced (41.8%) and were literate (91.3%). History of drug use among the respondents was 34.7%. Most respondents had regular menstruation (63.5%) and were pre-menopausal (86.1%). Natural birth control was preferred (39.7%) compared to other methods, such as condoms (18%) and oral contraceptive pills (8.4%). Spontaneous and induced abortions were reported by 17.8% and 16.4% of respondents, respectively. There was 5.9% of respondents that reported having a history of sexually transmitted infections (STIs) before incarceration, with HPV the most common (12.7%).

RESEARCH LIMITATIONS/IMPLICATIONS

This study has limitations, including the problem of following up with prisoners to shorten the average length of their imprisonment, which can leave many issues in the field of women's health and their follow-up incomplete. Prison health care workers should also follow up on women's health and pregnancy hygiene after their release because there is usually a high prevalence of STIs in prisoners.

PRACTICAL IMPLICATIONS

The findings highlight the importance of improving the quality of women's health care and pregnancy-related care in prisons. Additionally, the importance of having a health protocol for incarcerated women in Iran. Other programs should also be implemented for women prisoners to eliminate the discrimination they may face in prison.

ORIGINALITY/VALUE

The international community has attempted to develop care guidelines for pregnant prisoners, particularly for prenatal and mental health services. However, currently in Iran no such guidelines have been developed. To date no research has explored the sexual health among female prisoners of this country. The aim of the present study was to examine the demographics and sexual and reproductive history of female prisoners in Iran. A secondary aim was to identify the health care needs of female prisoners in Iran.

Hydrocarbons and other risks in a beekeeping area of México: the precautionary principle for prevention and biotechnology for remediation

The Yucatan Peninsula is the most important beekeeping region. However, the presence of hydrocarbons and pesticides violates the human right to a healthy environment twice over; it can affect human beings directly due to its toxicological characteristics, but it also constitutes a risk, not very well dimensioned, regarding the loss of biodiversity of the ecosystem via the impact on pollination. On the other hand, the precautionary principle obliges the authorities to prevent damage to the ecosystem that may be caused by the productive activity of individuals. Although there are studies that separately warn about the decrease of bees in the Yucatan due to industrial activity, this work has the novelty of presenting an intersectoral analysis of the risk that includes the soy industry, the swine industry and the tourist industry. The latter incorporates a new risk not considered until now, which is the presence of hydrocarbons in the ecosystem. Additionally, we can demonstrate that hydrocarbons, such as diesel and gasoline, should be avoided when using no genetically modified organisms (GMOs) in bioreactors. The objective of this work was to propose the precautionary principle around the risks in a beekeeping area and to propose biotechnology without using GMOs.

The ethics of bioethics conferencing in Qatar

In 2022, the International Association of Bioethics (IAB) announced that the 17th World Congress of Bioethics would be held in Doha, Qatar. In response to ethical concerns expressed about the Qatar selection, the IAB Board of Directors developed and posted to the IAB website a response using a Q&A format. In this Letter, we (the IAB President and Vice President) address concerns about the ethics of bioethics conferencing raised in a 2023 Letter to the Editor of Bioethics by Van der Graaf et al. We do not represent the Board of Directors, and this Letter expresses solely our own views.

Identifying a Human Rights Approach to Roma Health Vulnerabilities and Inequalities in Europe: From Concept to Action

Roma communities across Europe still remain a neglected population group by way of the social and economic disadvantage that largely characterizes their lives. Roma communities continue to experience structural socioeconomic health inequalities on the grounds of their ethnic origin, alarmingly unveiling a pattern of systematic discrimination and ethnic marginalization. Without any doubt, such a highly worrying situation calls for States to incorporate Roma health rights within their law and policy agendas in a manner consistent with right to health requirements. Against this background, this paper seeks to identify an operational human rights framework for States as a driver for better informed policies and implementation as well as for Roma engagement in the deliberations about their life prospects. The paper argues that continuing, concerted, and proactive State engagement is required for effectively addressing the structural obstacles impeding Roma socioeconomic health rights realization and maximizing Roma opportunities for well-being.

The international declaration on the human right to nutritional care: A global commitment to recognize nutritional care as a human right

Access to nutritional care is frequently limited or denied to patients with disease-related malnutrition (DRM), to those with the inability to adequately feed themselves or to maintain their optimal healthy nutritional status which goes against the fundamental human right to food and health care. That is why the International Working Group for Patient's Right to nutritional care is committed to promote a human rights based approach (HRBA) in the field of clinical nutrition. Our group proposed to unite efforts by launching a global call to action against disease-related malnutrition through The International Declaration on the Human Right to Nutritional Care signed in the city of Vienna during the 44th ESPEN congress on September 5th 2022. The Vienna Declaration is a non-legally binding document that sets a shared vision and five principles for implementation of actions that would promote the access to nutritional care. Implementation programs of the Vienna Declaration should be promoted, based on international normative frameworks as The United Nations (UN) 2030 Agenda for Sustainable Development, the Rome Declaration of the Second International Conference on Nutrition and the Working Plan of the Decade of Action on Nutrition 2016-2025. In this paper, we present the general background of the Vienna Declaration, we set out an international normative framework for implementation programs, and shed a light on the progress made by some clinical nutrition societies. Through the Vienna Declaration, the global clinical nutrition network is highly motivated to appeal to public authorities, international governmental and non-governmental organizations and other scientific healthcare societies on the importance of optimal nutritional care for all patients.

The prevalence of major depressive disorder and anxiety disorders among asylum seekers in South Florida

The rapidly growing population of asylum seekers in the United States often seeks asylum following persecution and severe traumatic events. Asylum evaluations play an influential role in the process by objectively documenting human rights abuses. The purpose of this study was to describe the prevalence of major depressive disorder (MDD) and anxiety disorders among asylum seekers and analyze differences in the severity of disease by time and sub-group. Data was collected from a retrospective review of medical affidavits written from 2017 to 2020 following asylum evaluations in South Florida. Decision trees were utilized to make diagnoses for each individual's current mental health status in the U.S. and retrospectively for while in their home country. These diagnoses were recorded according to the Global Burden of Disease study criteria and utilizing validated mental health screeners. The prevalence of MDD was found to significantly decrease from 75.8% in patients' home countries to 46.7% in the U.S. Similarly, prevalence of anxiety disorders significantly fell from 85.8% to 64.2%. Gender and being a victim of sexual assault were significantly associated with severity of MDD and anxiety disorders. This reduction in the burden of mental health disease after relocation to the United States demonstrate the benefit of asylum not only as a human right, but also as a mental health intervention. Through their connection with higher application success rates and referrals to follow-up care, physician-performed asylum evaluations can thus be linked to improved health outcomes.

Human rights promotion and the 'Geneva impasse' in mental healthcare: scoping review

BACKGROUND

The World Psychiatric Association recently emphasised that the protection of human rights in mental healthcare was a 'central concern'. This paper examines recent literature on human rights and mental healthcare.

AIMS

To (a) outline how international human rights law distinguishes between the protection and promotion of human rights; and (b) explore the literature on promoting human rights in mental healthcare which avoids what has been termed the 'Geneva impasse' between those who argue that compulsory care and treatment can never comply with human rights law and those who argue that they can if certain conditions are met.

METHOD

The following doctrinal methodology was used: (a) identification and detailed analysis of international human rights conventions and commentaries; (b) identification of key literature on human rights and mental healthcare; and (c) critical analysis of key issues emerging from the literature.

RESULTS

Much of the literature on human rights and mental healthcare focuses on whether restrictions on compulsory care are required to meet the requirements of United Nations Conventions. There is an emerging literature identifying measures to promote the right to the enjoyment of the highest attainable standard of mental health.

CONCLUSIONS

There has been a focus on protecting the rights to liberty and equality before the law for mental health patients. The nascent literature on promoting human rights in mental healthcare could mark a way forward beyond the 'Geneva impasse' that has dominated public debate in recent years.

Challenges in medically assisted reproduction - Ethics, law and society: An invited scientific review by the European Board and College of Obstetrics and Gynaecology (EBCOG)

Τhe methods of medically assisted reproduction (MAR) are being widely applied all over the world ever since the birth of Louise Brown, the first child conceived after in vitro fertilization (IVF) of a human oocyte and subsequent transfer into the uterus of the ensuing embryo. The possible risks associated with the application of the different MAR methods have given rise to a debate concerning the necessity of a regulatory framework regarding the application of these methods especially in view of the crucial and ambiguous legal and ethical issues attached.