VniversitasPrint version ISSN 0041-9060Vniversitas no.131 Bogotá July/Dec. 2015https://doi.org/10.11144/Javeriana.vj131.vier Show
VACCINES, INFORMED CONSENT, EFFECTIVE REMEDY AND INTEGRAL REPARATION: AN INTERNATIONAL HUMAN RIGHTS PERSPECTIVE* VACUNAS, CONSENTIMIENTO INFORMADO, RECURSO EFECTIVO Y REPARACIÓN INTEGRAL: UNA PERSPECTIVA DEL DERECHO INTERNACIONAL DE LOS DERECHOS HUMANOS Juana I. Acosta** *Artículo de investigación. I would like to thank Professor Mary Holland for
her extraordinary useful guidance and support in developing this project. She has shed light on a vital topic that I truly neglected as a human rights issue. My admiration for her passionate work on this issue and her compassionate closeness with the affected families cannot be described in words. I would also like to thank my husband, whose patience; encouragement, help and advice were indispensable to the completion of this article and my wonderful assistants, Paola Patarroyo and Cindy
Espitia, for their hard work. Reception date: January 30 th, 2015 Acceptance date: September 18 th, 2015 Available online: November 30th, 2015 To cite this article / Para citar este artículo Acosta, Juana I., Vaccines, Informed Consent, Effective Remedy and Integral Reparation: an International Human Rights Perspective, 131 Vniversitas, 19-64 (2015). http://dx.doi.org/10.11144/Javeriana.vj131.vier ABSTRACT This paper critically addresses the public debate about vaccines' safety and vaccination choice, from a human rights perspective. It proposes a healthy balance between the legitimate goal of public health and the protection of individual rights, and suggests that this balance should be informed by the principles of international human rights law. Part I explains the default premise that informed consent is the general rule for any medical intervention and choice. Considering that compulsory medical interventions violate the right to privacy and the right to physical integrity, their limitation will be legitimate only if the State's compulsory vaccination policy is provided by law, and if strictly necessary and proportional. Part II sets the international standards of an effective remedy that must be provided if a State decides to adopt a compulsory vaccination policy and people are injured as a result of vaccination, even if injuries might be attributable to private conduct. Part III develops the international standards of integral reparation and explains why, if a compulsory vaccination policy is enacted without fulfilling the adequate criteria for the limitation of human rights, the State commits an internationally wrongful act and it has the duty to provide integral reparation. Keywords: vaccines; informed consent; public health and human rights; Inter-American System of Human Rights; freedom of choice RESUMEN Este artículo evalúa críticamente el debate sobre la seguridad de las vacunas y la libertad de elección desde una perspectiva de derechos humanos. Propone un balance entre la salud pública como interés legítimo y la protección de los derechos individuales, y sugiere que este debate debe ser informado por los principios del derecho internacional de los derechos humanos. La sección I explica la premisa básica de que el consentimiento informado es la regla general para cualquier intervención médica y que la libertad de elección frente a la vacunación es un derecho humano. Partiendo de la base de que las intervenciones médicas violan el derecho a la privacidad y la integridad física, la limitación a estos derechos es legítima solo si la política de vacunación del Estado está provista por ley, y es estrictamente necesaria y proporcional. La sección II describe las obligaciones internacionales en relación con los recursos efectivos que un Estado que decide adoptar una política de vacunación debe ofrecer en relación con posibles daños, aun cuando estos sean atribuibles a conductas de particulares. La parte III desarrolla el concepto de reparación integral y explica por qué si una política de vacunación obligatoria es promulgada sin cumplir los criterios para la limitación de derechos humanos, se produce un hecho ilícito internacional y surge un deber de reparar. Palabras clave: vacunas; consentimiento informado; Salud Pública y Derechos Humanos; Sistema Interamericano de Derechos Humanos; libertad de elección SUMMARY Introduction.- I. Informed consent: vaccination choice as a human right.- A. Informed consent to vaccination as a preventive medical treatment.- A. Armed Conflict in Common Article 3.- 1. The UNESCO Declaration of 2005.- 2. The Oviedo Convention of 1997.- B. Public health and human rights restrictions: criteria for the limitation of individual rights. - Il. The right to an effective remedy for vaccination injuries.- III. Compulsory vaccination, injuries and integral reparation.- A. General criteria.- B. Integral reparation due to vaccines injuries. - C. Guiding principles check list. - Conclusion.- Bibliography. INTRODUCTION Public debate about vaccines' safety and vaccination choice has been increasing lately in several countries. Human rights activists, scientists, doctors and parents have warned about several unanswered questions regarding vaccine injuries, including the real necessity of compulsory vaccination programs, and the lack of sufficient liability of the pharmaceutical industry.1 At the same time, legitimate reasons have driven the international community and several actors to be concerned about expanding vaccination policies to prevent disease,2 especially in children and not to create an unreasonable fear regarding vaccines risks.3 Ultimately the concern is the same: the well-being of children.4 However, no one would disagree that a healthy and lawful balance must exist between the legitimate goal of public health and the protection of individual rights. Good guidance for protecting that balance is provided by international human rights law, as recognized by the Universal Declaration on Bioethics and Human Rights.5 Despite the fact that vaccination is a widespread preventive medical intervention, there is scientific consensus that a number of vaccines might produce serious injuries6 to some people, and that these two facts create evident competing interests for any Government between public health, individual rights and even the economic interest of some actors; a comprehensive study of the human rights framework for public policies regarding vaccinations has not been done, and it seems that it has been given low priority for the human rights scholarly agenda. This paper aims precisely to provide a useful international human rights framework to be applied in a case-by-case analysis of compulsory vaccination policies, in order to initiate a responsible scholarly dialogue regarding this important topic. Part I explains the default premise which is that informed consent is the general rule for any medical intervention and that therefore vaccination choice is a human right. Considering that compulsory medical interventions also violates the right to privacy and the right to physical integrity, limitation of these rights will be legitimate only if the State's compulsory vaccination policy is provided by law, and if it is strictly necessary and proportional. Part II sets forth the international standards of an effective remedy that must be provided if a State decides to adopt a compulsory vaccination policy and people are injured as a result of vaccination. States must be in compliance with all of these standards, even if injuries might be attributable to private conduct. Part III develops the international standards of integral reparation and explains why, if a compulsory vaccination policy is enacted without fulfilling the adequate criteria for the limitation of human rights, the State commits an internationally wrongful act7 and it has the duty to provide integral reparation for the victims. It also presents a proposal for adequate reparation measures regarding vaccine injuries. Beforehand I would like to clarify that my approach by no means suggests that I am against vaccines. I am not. On the contrary, I believe that vaccines have brought great benefits, and that enhanced immunization programs and plans to control infectious diseases are vital, particularly in developing countries. Nor do I pretend to define the health risks of vaccines, as I am limited by my capacity as a lawyer, and this medical task would be irresponsible. This article intends to give only an initial insight of the international human rights framework that can eventually be applied to the vaccination choice debate. However, I must admit that if there are no sufficient grounds for restricting human rights and especially the right to informed consent, I am a faithful defender of vaccination choice. I am also a faithful defender of vaccination accessibility, particularly for vulnerable populations. However, the question of accessibility of vaccination does not exclude the possibilities of freedom of choice. Also, in the analysis I will use different human rights standards, some binding and others non-binding. In particular, some of the international instruments and jurisprudence may be binding for some particular States and not for others. Although several arguments could be made to prove that many of the international standards referred to are a part of customary international law, this is not the objective of this piece and I do not argue that every norm or standard is mandatory for every State. However, I do argue that almost every principle stated in the article could be a useful guidance for any State in designing and implementing vaccination public policies. That is my final purpose: to provide useful guidance to address a very difficult debate. Thus, my hope is to start a more serious discussion about how human rights can guide public policies regarding this preventive medical intervention. I. INFORMED CONSENT: VACCINATION CHOICE AS A HUMAN RIGHT A. Informed consent to vaccination as a preventive medical treatment Promoting health involves three levels of prevention: primary prevention or pure prevention (preventing the health problem from occurring at all), secondary prevention (management of the treatment to avoid actual damages to the person's health) and tertiary prevention (to limit the impairment, increase the quality of life and prolong life).8 One clear example of pure prevention treatment is vaccination.9 All medical treatments, including preventive medical treatment, can only be carried out with informed consent, except under very extraordinary circumstances. This rule is developed in international bioethics declarations, human rights instruments and human rights jurisprudence and doctrine. After World War II, in 1947, the world embraced the Nuremberg Code.10 The first principle of this Code states that the voluntary consent of the human subject in a medical procedure is absolutely essential. The goal was to prohibit experimentation on human subjects without free and informed consent. Since then, several international instruments have protected directly and indirectly the right to free and informed consent for medical and scientific experimentation.11 Particularly important are the Universal Declaration on Bioethics and Human Rights or UNESCO Declaration of 200512 and the Oviedo Declaration of 1997,13 instruments that explicitly develop the right to informed consent in medical interventions. 1. The UNESCO Declaration of 2005 In 2005, the United Nations Education, Scientific, and Cultural Organization (UNESCO), adopted the Universal Declaration on Bioethics and Human Rights (UNESCO Declaration). Article 6 of the Declaration provides that:
The provision means that "no interference in the human body must be undertaken without the permission of the person concerned."14 The legislative history of the UNESCO Declaration does not explain the inclusion of the word preventive in article 6. In fact, articles 6 and 7 were the result of the division and addition of article 10, a provision that initially did not include the word preventive. Thus, this key word was added in the last Declaration discussion in June 2005, without a particular explanation.15 Although some governments16 were of the opinion that informed consent should only be a requisite for particularly invasive treatments, this proposal was not accepted in the final draft. The Declaration entrusts UNESCO to seek the assistance of the International Bioethics Committee (IBC), as well as the Intergovernmental Bioethics Committee (IGBC), to promote and disseminate the principles set out in the Declaration. In 2008, the IBC issued the Report on Consent (which interprets article 6 and 7 of the Declaration). This Report is perhaps the best document available to analyze and interpret the Declaration's provisions. The Report on length affirms that:
It seems that the Report considers the possibilities of compulsory vaccination, even without epidemic danger, but always under the limitation principles of article 27 of the UNESCO Declaration.18 These principles, as I will show below, are complemented by the development of the additional principles governing the limitation of rights under international human rights law. Although the UNESCO Declaration is not a binding document, it is worth mentioning that it was adopted by the acclamation19 of all Member States. It was the United States who urged that acclamation vote:
Thus, the principles embodied in the Declaration are undoubtedly very important to the design and implementation of public policies in the field of public health. 2. The Oviedo Convention of 1997 The Council of Europe approved the Convention on Human Rights and Biomedicine (Oviedo Convention) in 1997. Although this Convention is only enforceable for European countries which have signed it, it provides useful guidance for the correct interpretation and application of the principle of informed consent, considering that it is not only a binding international treaty, but also that it sets forth established rules of interpretation in the field. Regarding consent, article 5 of the Convention affirms:
The legislative history of the Oviedo Convention is summarized in the Explanatory Report (ER) to the Convention, drawn up under the responsibility of the Secretary General of the Council of Europe, at the request of the Steering Committee on Bioethics (CDBI). This ER takes into account the discussions held in the CDBI and its Working Group entrusted with the drafting of the Convention, as well as the remarks and proposals made by the States' delegations. Although the ER is not an authoritative interpretation of the Convention, it covers the main issues discussed in the preparatory work and provides information to clarify the object and purpose of the Convention and to better understand the scope of its provisions.22Regarding consent, the ER affirms, among other things, that:
The ER also explains that the patient's consent is considered to be free and informed if it is given on the basis of objective information from the responsible health care professional "as to the nature and the potential consequences of the planned intervention or of its alternatives, in the absence of any pressure from anyone"24(emphasis added). According to the ER, information must include (i) the purpose of the treatment, (ii) the nature and consequences of the intervention and (iii) the risks involved (not only the inherent risks but also risks related to the individual characteristics of each patient). Finally, requests for additional information made by patients must be adequately answered. The European Court of Human Rights has reaffirmed that informed consent is required for any medical intervention under the Oviedo Convention. In M.A.K. and R.K. v. United Kingdom, a case involving, among other things, a blood test of a 9 years old girl without her parent's permission, the Court stated that:
Thus, the European Court concluded that "the decision to take a blood test and photograph the girl against her parents' express instructions gave rise to an interference with her right to respect for her private life and, in particular, her right to physical integrity."26 The principle of informed consent in medical interventions has also been considered as an important human rights standard by the Inter-American Human Rights System.27 Thus, current international standards require that any medical intervention, including preventive medical treatment, must be accompanied by informed consent. Therefore, vaccination, as a preventive treatment, requires the previous informed consent of any patient. Informed consent includes not only information about the general inherent risks of vaccines, but also information of risks related to the individual characteristics of each patient. This does not mean that compulsory vaccination programs are completely prohibited. However, it means that if a compulsory vaccination program is established, the legislature must determine that the criteria for the limitation of individual rights are fulfilled, considering that by its face, a compulsory vaccination policy limits the right to informed consent, the right to privacy and the right to physical integrity. B. Public health and human rights restrictions: criteria for the limitation of individual rights Considering that potential benefits and burdens on human rights may occur in the pursuit of the major purposes of public health,28 a human rights framework provides a useful approach for analyzing and responding to public health challenges.29 Under this framework, some authors have even considered that "health policies and programs should be considered discriminatory and burdensome on human rights until proven otherwise."30 As we have seen, medical interventions might particularly restrict human rights such as the right to a private life and the right to physical integrity.31 In addition to the limitation of these rights, the lack of information and the absence of choice of the subject to any medical intervention constitutes a restriction of the right to informed consent. Finally, if injuries result from compulsory medical interventions and redress and compensation are not available, then there might also be a restriction of the right to an effective remedy and the right to integral reparation.32 Public health is of course a legitimate goal of any State. The question is under what circumstances compulsory medical intervention is the proper means to achieve that legitimate aim. Article 27 of the UNESCO Declaration affirms that:
Thus, to answer the question of legitimate limitations to the Declaration, review of international human rights law must be taken. International human rights courts have developed a test to analyze if measures restricting the rights of human beings are legitimate and lawful. This test studies whether the measure is provided by law, and whether it was strictly necessary and proportional.33In principle, the State that is adopting or supporting the measure bears the burden of proof.34 Legitimate goal. As affirmed above, public health is a legitimate goal. However, as Lawrence Gostin and Jonathan M. Mann affirm, the Government has the responsibility to articulate the public health purpose as clearly as possible.35 Only clearly articulated goals would help to "identify the true purpose of intervention, facilitate public understanding and debate around legitimate health purposes, and reveal prejudice, stereotypical attitudes, or irrational fear."36 For instance, a compulsory vaccination policy, which restricts informed consent, personal integrity and the right to privacy, would have to be articulated under a clear purpose, such as the eradication of a specific epidemic, and not just generally for the prevention of disease. Also, a clearly articulated goal assists with the analysis of the legitimacy of the purpose of the policy. Provided by law. As the Inter-American Court of Human Rights has affirmed, the word law for the legitimate restriction of rights "means a general legal norm tied to the general welfare, passed by democratically elected legislative bodies established by the Constitution, and formulated according to the procedures set forth by the constitutions of the States Parties for that purpose."37 In a very eloquent way the Court explains that:
Also, the meaning of the word laws "must be sought as a term used in an international treaty. It is not, consequently, a question of determining the meaning of the word laws within the context of the domestic law of a State Party."39 Thus, an executive decree, for instance, would not be in compliance with this requirement. Strict necessity. When a State invokes reasons of general interest or public welfare to limit human rights, those reasons "will be subjected to an interpretation strictly limited to 'just demands' of a 'democratic society' that takes into account the balance between the different interests at stake40 and the existence of a truly compelling public interest."41 According to the European Court of Human Rights, this test requires that States prove the existence of a "pressing social need."42 The strict necessity element must also be analyzed according to available alternatives.43 In other words, the measures must be the least restrictive alternative to achieve the public health objective.44Noncoercive approaches should always be considered first.45 Thus, there is a need to show that a less restrictive alternative is not feasible. In an epidemic, for instance, an alternative to compulsory vaccination could be quarantine. Both measures restrict human rights in different degrees, but informed consent could be protected by the opportunity to choose between the alternatives, with full information about the possible risks. Proportionality. The measure must be proportional to the legitimate aim.46 In evaluating proportionality, the legislature must consider the individual risk posed by each individual case. In order to restrict human rights, a coercive approach might be sustained only when there is an "individual determination that the person poses a significant risk to the public."47 The risk to the public must be probable and not merely speculative or remote.48 The possible harm must also be substantial.49 The European Court of Human Rights has affirmed that all limitations must entail a reasonable relation of proportionality between the means employed and the aim sought.50 Also, proportionality implies the balance between the interests of the community and the protection of individual rights.51 Moreover, the Inter-American Court has affirmed that "there is a need to look behind the mere appearances, in order to ascertain the real situation behind the reported situation."52 For instance, the legislature should investigate the existence of a real risk for the population behind the compulsory vaccination policy, and not a private economic interest or other illegitimate interest.53 Thus, before establishing a compulsory vaccination policy, any State must first test every measure adopted under the above criteria. This is a necessary process in order to protect an adequate balance between public health and individual rights. II. THE RIGHT TO AN EFFECTIVE REMEDY FOR VACCINATION INJURIES If a State decides to adopt a compulsory vaccination policy and people are injured as a result of vaccination, the State has a duty to provide an effective remedy54 for victims. Moreover, if the criteria for a lawful limitation of rights were not fulfilled and information was not available, the remedy must be provided not only for the injury, but also for a violation of the right to privacy, the right to physical integrity and the right to informed consent. The guarantee of an effective remedy "constitutes one of the basic pillars (...) of the rule of law in a democratic society."55 The indisputable universality of this right is evidenced by its recognition by the most important universal and regional international human rights instruments, as follows. Article 8 of the Universal Declaration of Human Rights provides that "Everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted him by the Constitution or by law." Article 2 of the International Covenant on Civil and Political Rights provides that:
The three most important regional human rights systems also recognize the protection of an effective remedy. Article 13 of the European Convention for the Protection of Human Rights and Fundamental Freedoms provides that "Everyone whose rights and freedoms as set forth in this Convention are violated shall have an effective remedy before a national authority notwithstanding that the violation has been committed by persons acting in an official capacity."56 Article XVIII of the American Declaration on the Rights and Duties of Man provides that "Every person may resort to the courts to ensure respect for his legal rights. There should likewise be available to him a simple, brief procedure whereby the courts will protect him from acts of authority that, to his prejudice, violate any fundamental constitutional rights."57 Article 25 of the American Convention on Human Rights provides that:
Finally, article 7 of the African Charter of Human and People's Rights58 provides that:
Human Rights tribunals and organs have developed a detailed jurisprudence and doctrine that sets forth the international standards for the guarantee of the right to an effective remedy. This right implies the obligation of States to provide simple, prompt, and effective remedies against violations of human rights. Amongst the most important international human rights standards for guaranteeing an effective remedy we find that: A. States must have a simple and prompt recourse "in particular of a judicial nature, although other recourses are admissible provided they are effective for the protection of fundamental rights."59
One very important aspect of the standards of judicial protection for the Inter-American System is that judicial recourses to remedy human rights violations must also comply with the minimum due process guarantees set forth in article 8 of the American Convention.73 The Inter-American Commission and Court have stated that due process elements apply not only to criminal procedures, but also to any judicial procedure, and even administrative procedures,74 and in any other procedure whose decisions may affect the rights of persons.75 Also, article XVIII of the American Declaration of the Rights and Duties of Man is not confined to criminal procedures.76 According to the Inter-American Commission this right is not confined to persons accused of crimes, and is applicable to administrative procedures.77 Thus, any judicial or administrative procedure must respect the minimum guarantees of due process. These minimum guarantees include, amongst others, that the review allowed with remedies must always be "thorough and comprehensive;"78 that cases must be decided in a reasonable time;79 and that judges must be competent, independent80 and impartial.81 Also, every administrative decision must be subject to some form of judicial control that allows the State to determine whether it respects the minimum human rights guarantees.82 This control is more essential when domestic administrative bodies "have broad powers" that could be used, without adequate control, to favor particular or partisan objectives.83 Regarding accountability of medical professionals, the European Court has affirmed that in public health issues States have a positive obligation to make regulations that compel hospitals, whether private or public, to adopt appropriate measures for the protection of patients' lives.84 To enforce positive obligations in public health, recourse to criminal law provisions could be required. However the Court has affirmed that:
Hence, higher and stricter international human rights standards have been developed regarding the right to an effective remedy. States must be in compliance with all of these standards, even if conduct might be attributable to a private actor, because the State has to provide an effective remedy, even if it is the private entity that is called to provide for an integral reparation. III. COMPULSORY VACCINATION, INJURIES AND INTEGRAL REPARATION It is a recognized norm of customary international law86 that "all violations of human rights entail the right to redress and reparation."87 Although the European Human Rights System has been important in the development of the concept of integral reparation, the Inter-American Human Rights System has built a true doctrine on reparations,88which goes far beyond the simple reiteration of the traditional compensation measures. A. General criteria For the establishment of reparations, the Inter-American Human Rights System has developed the following general criteria:89
Thus, the System has developed a doctrine of reparations according to the different damages: pecuniary damage, non pecuniary damage, damage to the family state95 and damage to the life plan.96 These damages are restored not only by compensation, but also by satisfaction measures and guarantees of non-repetition (which may be described as "a positive reinforcement of future performance."97) Regarding the non-pecuniary damage, for instance, the Court has affirmed that:
Particularly interesting in our case, is the damage to the life plan, explained by the Inter-American Court in Loayza Tamayo v. Peru, a case concerning unlawful deprivation of liberty, torture, cruel and inhuman treatment, violation of the judicial guarantees, and double jeopardy to María Elena Loayza-Tamayo. The Court affirmed that:
Accordingly, damages must be restored not only by monetary compensation, but also by what the Court calls "measures of satisfaction, rehabilitation and guarantees of non-repetition."100 Some of the most common measures of satisfaction ordered by the Inter-American System are the publication of judgments,101 a ceremony for the public acknowledgment of international responsibility,102 measures to commemorate and render homage to the victims,103 erect appropriate and proper monuments104 and provide scholarship funds.105 Especially important for the Inter-American System are the rehabilitation measures. The Court has ordered on many occasions medical and psychological care for the victims, including also adequate medical or psychological care for the next of kin.106 The treatment is very broad. For example, in the Pueblo Bello case the Court ordered the following:
In addition, guarantees of non-repetition have included the modification of legislation108 (even the modification of national constitutions109), human rights courses for public officials, and many others. Particularly relevant to our analysis is one guarantee of non-repetition ordered by the Court in the case of Albán-Cornejo v. Ecuador,110 a case concerning medical malpractice in a private health institution. In this case, the Court ordered a campaign for the rights of patients and education and training of those in charge of the administration of justice, as follows:
Finally, the Court ordered a full investigation, prosecution and eventual punishment of those individually responsible for the violations. These measures respond in particular to the right to truth. Although international human rights treaties do not explicitly provide for a right to know the truth, "such a right may be considered to arise from the States' conventional duty to ensure human rights."113 According to the Inter-American Court, knowing the truth benefits not only the victims, the next of kin of the victims and society but also prevents violations occurring again in the future. In a very eloquent manner, the Final Report of the Truth and Reconciliation Commission of Sierra Leone affirms that:
B. Integral reparation due to vaccines injuries If a State adopts a compulsory vaccination policy without adequately fulfilling the criteria for the limitation of human rights, the State commits an internationally wrongful act115 and it has the duty to provide integral reparation for the victims. Note that a different treatment will be needed if: (i) the State has fulfilled all the criteria and injuries have nonetheless occurred; or (ii) the State has implemented a vaccination policy based on free and informed consent with adequate information available for patients, and injuries occur. In these last two scenarios, a State might not be obliged to compensate, or at least its obligation to compensate would not be the consequence of an internationally wrongful act, but, for instance, as part of a public policy designed by the State to compensate these injuries. Damages for injury from a vaccine as a consequence of an internationally wrongful act might include pecuniary damage, non-pecuniary damage and damage to the life plan. If this is so, some of the reparation measures that could be adopted by any State are:
The degree and nature of each reparation measure depends on the cause and nature of the injury and the degree in which the State has complied with the criteria for the lawful limitation of human rights. In any case, perhaps the most important measures are the guarantees of non-repetition, because only the right to truth (especially regarding vaccine safety), is able to prevent future violations, and this is the ultimate goal that should concern all States. C. Guiding principles check list The following check list could help those responsible in designing public policies regarding vaccination, to properly apply the principles set forth above. CONCLUSION International human rights principles are extremely useful to frame public health policies that might restrict individual rights. In re-designing vaccination policies, States must test every measure. Only those measures that are adopted under clearly articulated legitimate purposes and that are strictly necessary and proportional may overcome the human rights test. If the test for a compulsory vaccination policy is not fulfilled, then freedom of choice should be the rule. Otherwise, the state commits an international wrongful act and is oblige to provide full reparation. Even when the human rights' test is fulfilled, if compulsory policies restrict individual rights and harm human beings, the State has to provide for adequate redress and reparation for injuries. This analysis must be applied in a case-by-case basis and according to the particular context in each country. Therefore, it is not possible to design a globally applicable compulsory vaccination scheme, considering that risks and vulnerability to epidemics may vary in every country. However, general human rights principles are applicable to all situations and are useful to concretize the measures in particular contexts and situations. This article includes a proposed guiding principles' check list, as a didactic tool that can be extended according to domestic laws and domestic case law. An adequate balance between public vaccination policies and individual rights is vital for the legitimacy of the measures adopted, the confidence of parents in their children's treatments and the strengthening of a democratic society. Several questions still remain regarding the correct application of a human rights framework to the vaccine safety debate. Yet, instead of promoting confrontational debates, communities should build constructive spaces for an open and transparent dialogue. States have the duty and the right to design and implement public health policies. However, the strongest policies will be built if (i) different points of views are considered; (ii) the decisions are made based on the best possible and adequate research and, above all; (iii) and the respect and promotion of human rights is the desired objective. I hope I have contributed with some guidance to these legitimate purposes. FOOTNOTES 1Louise Kuo Habakus & Mary Holland, eds., Vaccine Epidemic: How Corporate Greed, Biased Science, and Coercive Government Threaten Our Human Rights, Our Health, and Our Children (Skyhorse Publishing, Inc., New York, 2011). Arthur Allen, Vaccine: the Controversial Story of Medicine's Greatest Lifesaver (WW Norton & Company, New York, 2007). Stephanie
Cave & Deborah Mitchell, What Your Doctor May Not Tell You aboutTM Children's Vaccinations (Warner Books, New York, 2001). Robert W. Sears, The Vaccine Book: Making the Right Decision for Your Child (Little, Brown and Company, New York, 2007). Randall Neustaedter, The Vaccine Guide: Risks and Benefits for Children and Adults (2nd ed., North Atlantic Books, Berkeley, 2002). Andreas Moritz, Vaccine-Nation: Poisoning the Population, One Shot at a
Time (Ener-Chi Wellness Center, Morris, Illinois, 2011).
3. A confession of guilt by the accused shall be valid only if it is made without coercion of any kind. BIBLIOGRAPHY Books Allen, Arthur, Vaccine: the Controversial Story of Medicine's Greatest Lifesaver (WW Norton & Company, New York, 2007). [ Links ] Cave, Stephanie & Mitchell, Deborah, What Your Doctor May Not Tell You aboutTM Children's Vaccinations (Warner Books, New York, 2001). [ Links ] Corte Interamericana de Derechos Humanos, CtIDH, La Corte Interamericana de Derechos Humanos: un cuarto de siglo: 1979-2004 (Corte Interamericana de Derechos Humanos, San José, Costa Rica, 2005). Available at: http://www.corteidh.or.cr/sitios/libros/todos/docs/cuarto-siglo.pdf [ Links ] Crawford, James, The International Law Commission's Articles on State Responsibility: Introduction, Text and Commentaries (Cambridge University Press, Cambridge, New York, 2002). [ Links ] Habakus, Louise Kuo & Holland, Mary, eds., Vaccine Epidemic: How Corporate Greed, Biased Science, and Coercive Government Threaten Our Human Rights, Our Health, and Our Children (Skyhorse Publishing, Inc., New York, 2011). [ Links ] Have, Henk A. M. J. ten & Jean, Michèle S., eds., The UNESCO Universal Declaration on Bioethics and Human Rights: Background, Principles and Application (UNESCO, Paris, 2009). Available at: http://unesdoc.unesco.org/images/0017/001798/179844e.pdf [ Links ] Mnookin, Seth, The Panic Virus: A True Story of Medicine, Science, and Fear (Simon & Schuster, New York, 2011). [ Links ] Moritz, Andreas, Vaccine-Nation: Poisoning the Population, One Shot at a Time (Ener-Chi Wellness Center, Morris, Illinois, 2011). [ Links ] Neustaedter, Randall, The Vaccine Guide: Risks and Benefits for Children and Adults (2nd ed., North Atlantic Books, Berkeley, 2002). 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Paraguay, Preliminary objections, Merits, Reparations and Costs, Judgment, Serie C No. 112 (September 2, 2004). Available at: http://www.corteidh.or.cr/docs/casos/articulos/seriec_112_ing.pdf [ Links ] Inter-American Court of Human Rights, IACtHR, Loayza-Tamayo v. Peru, Reparations and Costs, Judgment, Serie C No. 42 (November 27, 1998). http://www.corteidh.or.cr/docs/casos/articulos/seriec_42_ing.pdf [ Links ] Inter-American Court of Human Rights, IACtHR, Lori Berenson v. Peru, Serie C No. 119 (November 25, 2004). Available at: http://www.corteidh.or.cr/docs/casos/articulos/seriec_119_ing.pdf [ Links ] Inter-American Court of Human Rights, IACtHR, Manuel Cepeda-Vargas v. Colombia, Preliminary Objections, Merits, Reparations and Costs, Judgment, Serie C No. 213 (May 26, 2010). Available at: http://www.corteidh.or.cr/docs/casos/articulos/seriec_213_ing.pdf [ Links ] Inter-American Court of Human Rights, IACtHR, Maritza Urrutia v. 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Colombia, Merits, Reparations and Costs, Judgment, Serie C No. 140 (January 31, 2006). Available at: http://www.corteidh.or.cr/docs/casos/articulos/seriec_140_ing.pdf [ Links ] Inter-American Court of Human Rights, IACtHR, Ricardo Canese v. Paraguay, Merits, Reparations and Costs, Judgment, Serie C No. 111 (August 31, 2004). Available at: http://www.corteidh.or.cr/docs/casos/articulos/seriec_111_ing.pdf [ Links ] Inter-American Court of Human Rights, IACtHR, Rochela Massacre v. Colombia, Merits, Reparations and Costs, Judgment, Serie C No. 163 (May 11, 2007). Available at: http://www.corteidh.or.cr/docs/casos/articulos/seriec_163_ing.pdf [ Links ] Inter-American Court of Human Rights, IACtHR, Salvador Chiriboga v. Ecuador, Preliminary Objections and Merits, Judgment, Serie C No. 179 (May 6, 2008). Available at: http://www.corteidh.or.cr/docs/casos/articulos/seriec_179_ing.pdf [ Links ] Inter-American Court of Human Rights, IACtHR, Serrano-Cruz Sisters v. El Salvador, Merits, Reparations and Costs, Judgment, Serie C No. 120 (March 1, 2005). Available at: http://www.corteidh.or.cr/docs/casos/articulos/seriec_120_ing.pdf [ Links ] Inter-American Court of Human Rights, IACtHR, The Last Temptation of Christ (Olmedo-Bustos et al.) v. Chile, Merits, Reparations and Costs, Judgment, Serie C No. 73 (February 5, 2001). Available at: http://www.corteidh.or.cr/docs/casos/articulos/seriec_73_ing.pdf [ Links ] Inter-American Court of Human Rights, IACtHR, Tibi v. Ecuador, Preliminary objections, Merits, Reparations and Costs, Judgment, Serie C No. 114 (September 7, 2004). Available at: http://www.corteidh.or.cr/docs/casos/articulos/seriec_114_ing.pdf [ Links ] Inter-American Court of Human Rights, IACtHR, Velásquez-Rodríguez v. Honduras, Merits, Judgment, Serie C No. 4 (July 29, 1988). Available at: http://www.corteidh.or.cr/docs/casos/articulos/seriec_04_ing.pdf [ Links ] Inter-American Court of Human Rights, IACtHR, Yatama v. Nicaragua, Preliminary Objections, Merits, Reparations and Costs, Judgment, Serie C No. 127 (June 23, 2005) . Available at: http://www.corteidh.or.cr/docs/casos/articulos/seriec_127_ing.pdf [ Links ] What is the patient's bill of rights quizlet?A patient's bill of rights is a list of: guarantees for those receiving medical care. It may take the form of a law or a non-binding declaration. Typically a patient's bill of rights guarantees patients. information, fair treatment, and autonomy over medical decisions, among other rights.
Which of the following processes involved in active listening seeks to summarize or simplify the sender's thoughts and feelings or to resolve any confusion in the message?Clarification seeks to summarize or simplify the sender's thoughts and feelings and to resolve any confusion in the message.
Which of the following components of the medical history provides a guide to the patientâ € ™ s general health?Providing uninterrupted privacy. Which of the following components of the medical history provide a guide to the patient's general health? System review.
What are some guidelines you should follow for patient teaching to be successful?Five strategies for patient education success. Take advantage of educational technology. Technology has made patient education materials more accessible. ... . Determine the patient's learning style. ... . Stimulate the patient's interest. ... . Consider the patient's limitations and strengths. ... . Include family members in health care management.. |