UCT's Department of Public Health and Primary Health Care is part of an international collaborative research project that has released guidelines and strategies on how to resolve the pervasive problem of dual loyalty and human rights in health practice.
The international working group is comprised of medical ethicists, human rights experts, and health practitioners and is convened by Physicians for Human Rights. The proposals are contained in a report, Dual Loyalty and Human Rights in Health Professional Practice: Proposed Guidelines and Institutional Mechanisms
The issue of dual loyalty was also addressed last week at a workshop on health ethics and human rights, a joint project between the health sciences faculties of UCT, Stellenbosch and UWC. UCT's Associate Professor Leslie London (Department of Public Health and Primary Health Care) addressed the gathering on the issue of dual loyalties.
The research report defines dual loyalty as a conflict between a health practitioner's professional duties to a patient and perceived or real obligations to the interests of a third party. It focuses on instances where patients' human rights are in jeopardy and provides extensive examples of health professionals succumbing to government pressure to:
- determine the fitness of detainees to withstand torture;
- skew medical evaluations of refugees to support a government's interest in repatriation;
- deny women information on reproductive health; and
- provide a lower standard of health care to members of disfavoured ethnic or racial groups.
â€œThough the problem of dual loyalty and human rights is pervasive in health practice, this report is the most comprehensive attempt to analyse the problem and provide practical solutions,â€ said Leonard Rubenstein, executive director of Physicians for Human Rights and lead co-ordinator of the project.
â€œWhile the connection between human rights and ethics has been discussed in the past, this project broke new ground in showing how pressures from the state in a variety of practices can be addressed within an accepted framework of international human rights.â€
The report proposes general practice guidelines for all health professionals. It includes guidelines tailored for difficult settings in which health professionals are most at risk: where health care is provided to prisoners or military personnel, workers, immigrants and refugees, or where health professionals provide medical evaluations for courts, administrative bodies and employers.
The report notes that the circumstances around issues of dual loyalty are enormously varied. However, they arise frequently in societies that demand that health professionals become part of the machinery of repression.
Examples also abound in open societies. In South Africa, a provincial health minister suspended Dr Matthys von Mollendorf, a physician at a health clinic, after he had provided free anti-retroviral drugs to rape survivors. He was later re-instated.
The South African Truth and Reconciliation Commission report documents how physicians were complicit in human rights violations under apartheid. â€œThe phenomenon, however, exists worldwide, in democratic as well as repressive societies, and we hope the report will stimulate wide discussion of the problem,â€ London noted.