Global Public Health through a Human Rights Lens

I’m going to start with another challenge to human rights, and then finish with a conclusion of the blog this quarter.  I’ll start by quoting one of my faithful readers’ comments from my blog last week (they were arguing against my stance that there are no ‘universal human rights’): “Does the fact there are resources available to some people give all people the right to those resources?”  I believe that this is, in effect, what the UN Declaration of Human Rights has done when it says that everyone has the right to certain things such as complete wellness, economic stability, etc.  It’s promising things to people that it doesn’t have the power to grant.

There may have been misunderstandings in what I meant, in general.  I was saying that, if one professes to believe in the universal human right to “just and favourable remuneration ensuring for himself and his family an existence worthy of human dignity, and supplemented, if necessary, by other means of social protection” (Article 23, section 3), to “own property” (Article 17, section 1), or to “Education.  Education shall be free…” (Article 26, section 1).  I’m just pointing out that this seems like a sort of Catch-22 to people who simply don’t have these things.  To me, that’s sort of like saying to someone in a prison cell, “You have the right to be free,” and then walking away.  Without an intention to get these entitlements to the people who supposedly have a right to them, what do “human rights” actually mean?

Does this mean that everyone theoretically has the right to certain things, but nothing is going to be done about it?  That’s the same as them not having those rights, frankly (and right now I’m only talking about the positive rights, as in, a right to a job, protection from unemployment, complete wellness and the best healthcare, etc.).  BUT, when (or if) you say, “No, them having the right to them means that we should get these things to them, even if they were born into slavery or into poverty or into ill health,” then doesn’t that always and inherently involve providing things for them that take money or manpower from other people?  Bottom line, you’re just not going to get something for nothing.  Ensuring resources to satisfy positive human rights involves a reduction in the resources of those who have had their “rights” fulfilled.

The whole difficulty all comes from human rights, especially universal human rights, being a completely human-made concept.  If they are only a human concept, they only have as much power as the people that make them.  They are not inherent to us as human beings from some other power.  Thus they only work when every single person agrees to abide by them (it’s sort of like the UN–if you don’t want to participate or abide by the rules that are made, you don’t have to, and no one can make you; there’s no inherent purpose or underlying meaning).

Human Rights has been an interesting topic about which to blog.  As many of my more eloquent and articulate colleagues have blogged about, there are many interesting contradictions and dilemmas with competing rights in the media about the concept of human rights.  As I’ve tried to show, both nations and individuals often fail to make decisions informed by their professed beliefs in certain types of human rights.  Honestly, I don’t need to defend my point especially about nations, just look for 10 minutes at the Human Rights Watch website.  I’m not saying that people violate human rights just because they’re evil; they simply find ways to justify it, or priorities that are higher than human rights.  For instance, can you tell me that the government didn’t know about this Russian general’s mass civilian killings in Chechnya in 1999 and 2000?  Of course they did, but to them it’s not as important as civil order and their political goals.  Take a look at Obama–yes, he’s shutting down Guantánamo, but now he wants to permanently detain people in the U.S., contrary to his election promises.  But hey, it’s justified for national security.  But I don’t want to end on a negative note–that just seems like the wrong way to end a year!  There are, for sure, many countries that have complied with the human rights stances that they purport to take.  The European Union, for example, seems to do a pretty good job.  Australia and New Zealand, too.  And there are many people who individually work to make sure that other people have access to the same rights as they themselves do.  Yay!  Okay, thanks for reading, have a great end of the year!

(P.S. I just want to address one other comment that was made last week from a very supportive reader, which gets into my beliefs about the non-existence of human rights.  The reader said “By saying that everyone should be treated to equal respect and care, aren’t you saying that they have a “right” to be treated that way? We have a “right” to be treated equally? So we do have human rights…”  I believe that no one has a right to anything, inherently, but I do believe everyone has an obligation to treat one another with equal respect and care.  They are two completely opposite concepts.  One is a demand for a certain type of treatment–a treatment which I don’t think we have the right to.  The other, the obligation to treat others with respect and care, is not a right but a duty inherent in being a human.  Why I believe this can be easily ascertained by emailing me at ndcass@stanford. edu.  Thanks for your support and the great questions!)

Up until now, nearly every post has been about human rights violations and the general lack of regard for human rights in many places around the world, particularly in developing countries and conflict zones. This is certainly appropriate since the majority of the world still lives under incredibly strenuous conditions and are prone to continuous human rights violations. However, in this final post, I would like to look ahead at the future of human rights and ask the question, just how far should we go?

I have noticed throughout this course that there has been a general trend to continually expand what qualifies as a human right. Throughout this course, I explored the rights that should be protected in order to reduce maternal mortality, and have noted that in doing so, I have included more and more necessities as fundamental human rights—the right to access, education, sanitation, etc. I do not take back anything that I have said. All of these “rights” are certainly needed in order to reduce maternal mortality, and should be considered human rights violations of the utmost priority, but can we ever go too far?

Arguably yes. Certainly not yet in this age, as there are far too many truly unarguable human rights violations occurring all around the world, but perhaps in a more civil world (which I personally believe will never exist though that is another topic all together). Many people already consider health a fundamental human right, but the problem is that the definition has expanded incredibly in the last decades. The WHO definition of health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Who can truly claim to be in a state of “complete well-being” even in the developed world? And if this is the definition of health, then should we have a right to such a state of complete well-being. Ironically, in order for everyone to be in such a state of well-being, it would probably require a “Brave New World” type of social infrastructure that actually ends up restricting our freedoms. This goes beyond health as well. How much education or access to certain goods is a right that must be protected? Where is the boundary between universal fundamental rights and practicality of being able to actually protect them?

Sources:

1. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

After spending the quarter blogging, I would like to conclude with a final note on the human rights issues involved in doing international health work abroad. I find this issue particularly relevant because I plan on going to Argentina this summer as a part of a service-learning trip. I understand the potential consequences of my actions, both positive and negative, and have been contemplating the benefits of participating in such a program. However, the question keeps coming up, exactly who do such volunteer programs help? Volunteers can come in with a very self-righteous attitude and believe they are doing good. However, intruding on a society, ignoring its traditions and cultural practices, and imposing western ideals on such communities are highly detrimental and in violation of their rights.

However, I would like to focus more on doing research in developing countries and the double standards that exist. This is highlighted by a very controversial U.S. AIDS study conducted in 1997, in which half of pregnant women were given AZT (zidovudine), whereas the other half were designated as a placebo-control group and were denied such treatment. At the time, it was known that AZT could greatly reduce perinatal transmission of HIV, and refusing to provide the drug to half the participants leads to some ethical dilemmas. Did the researchers have an obligation to provide the drug to all participants knowing that it could have prevented the transmission of HIV? Were the participants’ rights violated?

This practice has been justified by the idea that the poor African women would not have add access to treatment anyways so the researchers were not denying the participants of anything. Researchers argued that placebo groups are the quickest way of determining whether a treatment is effective and thus their practice was justifiable. This brings up the dilemma between human health rights versus the research advancements that could help people in the long run. Was the knowledge gained from the research able to justify the harms of it? Additionally, the fact that this experiment occurred in a developing country with non-white participants poses an interesting dilemma. Would this experiment have been allowed in the United States? Is it another example of western imperialism? I believe these are some interesting questions to end on.

http://www.nytimes.com/1997/09/18/us/us-aids-research-abroad-sets-off-outcry-over-ethics.html?sec=&spon=&pagewanted=all

Markle, Fisher, Smego. Understanding Global Health. McGraw Hill Medical. 2007.

For today’s blog I am going to focus on drug use and abuse and human rights. Although all areas of human rights and health are complicated, this area is particularly complicated by the fact that drug abuse is often illegal. This creates a similar dilemma to that discussed in my blog last week on prostitution, human rights, and health, because one must balance law enforcement with individual human rights and the best interests of the individuals breaking the law. Drug abuse can create serious physical and mental health problems for many people and is a huge public health concern worldwide. There are 185 million illicit drug users worldwide. Furthermore, drug abuse is a significant cause of death worldwide. A significant example of this is increases in HIV and AIDS worldwide due to spread via needles by injection drug users. This has led to large increases in the number of cases of HIV and AIDS in many countries, one of which is Russia. The cases of HIV in Russia have nearly doubled in the last 8 years, a large part of which is the result of injection drug use. A startling 12% of Russian injection drug users are HIV positive. Thus, it is clear that drug use has serious health risks that must be addressed. 

The incredible danger that drug abuses poses to the health of individuals and communities has led to significant legal restrictions on drug abuse. This has led to extreme regulation that the UN argues is a violation of the human rights of the drug abusers. For instance, governments have killed people in their efforts to enforce their drug laws. In 2003, 2800 people were killed in Thailand as part of their efforts to have better drug control. Furthermore, the death penalty is a punishment for drug offenders in many countries, despite the fact that the UN says this is a violation of international human rights. Even if drug users are not killed as punishment, they are often subjected to extreme violence at the hands of law enforcement officers. Even when violence is not afflicted upon these individuals, there are often very few efforts to treat the individuals for their drug abuse. Instead, they are simply punished, often with fines or jail time. Yet this does little, if anything to deter them from future drug use and does not address the health issues and addiction that are at the root of the problem.

Often, individuals are unfairly imprisoned without a fair trial in the effort to control drug use. In Russia, drug offenders are often incarcerated without trial. This has contributed to the increased rates of HIV in prisons, making prisons a very high-risk place for contraction of HIV. Once imprisoned, they are rarely given treatment for their drug addiction. Even if not imprisoned, drug abusers are often required to join “drug abuse registries,” discouraging these individuals from seeking medical help and removing all sense of confidentiality. All of these factors contribute to increases in drug dependency worldwide and are human rights violations. That being said, legal regulation is also crucial in lowering the rates of drug abuse. The solution then must be one that controls drug abuse, but in a way that aims to help individuals through treatment of their addictions. This provides the best solution from a human rights and public health perspective. As the UN General Assembly stated in 1998, “The ideal of a ‘drug free world’ (to quote from the declaration adopted by the UN General Assembly in 1998), and its required prohibitionist, punitive approach, may be based on an overarching concern for the ‘health and welfare of mankind.’ But in practice, the health and welfare of those in need of special care and assistance — people who use drugs, those most at risk from drug related harm, and the most marginalised communities — have not been a priority. They have instead been overshadowed, and often badly damaged, by the pursuit of that drug-free ideal.” 

Another issue related to drug abuse, health, law, and human rights, is the opinion of some that drug abuse should not be regulated by the government, because it is the individual choice of a person. Some even argue that it is a “human right.” This has created much controversy, but the UN and other worldwide organizations have always responded that this is not the case, as drug abuse “destroys the unique dignity of individuals, their freedom to think, and ability to evaluate the difference between right and wrong.” Thus, although drug abuse is an individual decision, it does negatively affect other members of society and thus can and should be controlled by society. This does not take away from the other human rights of individuals, which, as discussed earlier in the blog, are often violated. Thus, a human rights based approach may serve to address the issue of drug abuse we’re facing today.

There are several key elements of international human rights which, if adopted, would improve the treatment of drug abusers being prosecuted. One is the “principle of non-discrimination.” I discussed this principle in my blog on HIV and human rights. This principle states that you cannot discriminate against certain groups of people. Another important principle of international human rights i empowering the individuals to take action in their communities. With a human rights approach, drug abusers could be empowered to get treatment and help bring about positive change in their communities. Thus, it is important to consider the human rights of the individual drug abusers in the war on drugs if we want to find a solution that most positively affects public health globally. 

Sources: “Recalibrating the regime: The need for a human rights-based approach to international  drug policy.” (2008). The Beckley Foundation Drug Policy Programme 

UN Drug Summit: Undo a Decade of Neglect. (2009). Human Rights Watch. 

Resolution Concerning Drug Abuse and Human Rights (2006). International Task Force on Strategic Drug Policy. 

Management of Substance Abuse. World Health Organization website. <http://www.who.int/substance_abuse/en/>

According to a chapter in Rediscovering Biology, “the time (twelve to fifteen years) and cost (approximately 800 million dollars) of drug development are significant economic factors that limit the number of new drugs that come to market.” The reality of economics dictates that new drugs that may benefit only a few (or that may benefit millions of people too poor to pay for the new drug) will have a low priority for development.

Our blog title perfectly encompasses this week’s topic; global public health, ethics, and human rights are synergistically linked. I’d like to spend this final blog entry talking about global health ethics in the context of HIV/AIDS. As pointed out by Human Rights and Public Health in the AIDS Pandemic, “the AIDS pandemic presents a major challenge to public health and human rights, [because] the burden of HIV/AIDS is borne disproportionately by people and communities already suffering from poverty, hunger, homelessness, inadequate health care, discrimination, and stigmatization.” Seble Kassaye, a physician and HIV/AIDS researcher at Stanford University School of Medicine, gave a lecture this week for another course I’m taking. She suggested that we consider this set of questions when assessing the efficacy of an HIV treatment program:

1. Who is being tested, and in what venue?
2. When are we starting individuals on therapy?
3. At what rate are individuals developing toxicities and complications on treatment?
4. What is the rate of adherence?
5. What model of service delivery is being utilized, and to what effect?
6. Do we have venues for care and treatment?
7. Is the program cost-effective? Are the drugs cost-effective?
8. How can we determine individual responses to anti-retroviral therapy (ART)?

Sadly, most HIV treatment programs fail to critically evaluate their own efficacy. There is another problematic issue here: If one examines the distribution of revenues accrued by the global pharmaceutical industry, it becomes apparent that the largest percentage of money is spent on marketing, than on research and development (R&D). Accorded to Barlett et al., drug discovery and innovation is the result of “direct investment in the development of branded medications,” which is certainly a crucial process for future improvements in care. But the cost of branded medications is usually too high for resource-poor countries (incidentally where the majority of HIV/AIDS patients live).

This begs another question: should foreign aid be allocated to the purchase of proprietary drug cocktails (HAART, which has shown to be more effective than ART) or should funding be focused on purchasing generic ARVs? Proprietary drugs are less expensive than they once were, but most are still at least three times as expensive as generic drugs. On the other hand, there are no global standards for generic drugs, no rigorous requirements for import and export, and significant financial incentives for diversion and/or reimportation of ARVs.

According to David Katzenstein, another physician and HIV/AIDS researcher who serves as a mentor to Kassaye and others at the medical school, the world has never dealt with a moral commitment to provide a pill per day to the 40 million people living with HIV/AIDS. At a very basic level, is it possible for the world to commit to a process that will involve a great deal of chemicals, pills, and diagnostic tests? Is the infrastructure there? Is the political will there?

Works Cited:

1. “Ethics and the Economics of Drug Discovery.” Rediscovering Biology. Date unknown. 27 May 2009 <http://www.learner.org/courses/biology/textbook/proteo/proteo_15.html>
2. Bartlett J.A. and Muro E.P. (2007). Generic and branded drugs for the treatment of people living with HIV / AIDS. J. Int. Assoc. Physicians AIDS Care. 6, 15-23.
3. Blaschke, Terry. Class Lecture. Global HIV/AIDS. Stanford University, Stanford, CA. 28 May 2009.
4. Gostin, L. and Z. Lazzarini. “Human rights and public health in the AIDS pandemic.” Oxford University Press: New York, 1997.
5. Kassaye, Seble. Class Lecture. Global HIV/AIDS. Stanford University, Stanford, CA. 26 May 2009.

Imagine giving birth while handcuffed.

Yes, this actually happens.

Just last week there were several discussions in New York City addressing the issue of shackling women who have been incarcerated throughout their pregnancy. This discussion resulted in legislation that is currently looking to be passed, awaiting the signature of Governor David Paterson.
A woman who identified her first name as Tina, has shared her experience through a support group for incarcerated women known as Women on the Rise Telling Her Story (WORTH). Tina tells details of her traumatic experience in giving birth, telling that “the evening when I was to give birth, I was transported to [the] hospital in handcuffs … I was in labor … When I arrived at the hospital and was about to give birth to my son the doctor who was to deliver my child requested that shackles be removed … the correctional officer released one of my legs … I remained tethered to the gurney during labor and child birth and when my son was to be held in my arms, I only held him in one arm because that was all I was allowed by the officer who witnessed the birth of my son … I was not a flight risk! I felt dehumanized and unworthy to be treated in such a way.”
Meghan Rhoad, U.S. Researcher for Women’s Rights Division of the Human Rights Watch Organization, thinks this has gone too far. She claims that handcuffing women during labor is a direct violation of women’s rights. The use of handcuffs has an underlying logical reason and purpose: to prevent prisoners from attempting to run away and from committing wrongful actions while in jail. Handcuffs are put on a person as a sign of limitation and control – they are a symbol of the law’s power over an individual during certain circumstances. Yet is this really needed when a woman is giving birth? Is she going to commit harm or attempt to run away while in labor?
The health implications that come with giving birth while shackled are more serious than one may think. The physical symptoms are evident: according to the Meghan Rhoad, “pregnant women who are shackled are at risk of injury during transportation to medical appointments, can suffer added pain during delivery, and may be deprived of appropriate care during examinations and delivery.” It is clear that a shackled woman cannot be taken care of nor medically examinated as easily – an unfortunate fact that may not be worth the risk. The mental health implications are also just as severe. Women can develop full-fledged depression and can be deeply scarred by the humiliation of being handcuffed while giving birth. There is also the argument that the health of incarcerated women may not be that well, off to start with. Women in prison tend to have bad medical histories, as many are associated with substance abuse and have limited access to health care, in particular to prenatal care.
There are groups such as the Woman’s Prison Association who are the most adamant about this issue. With a mission statement that “believes that every woman has the potential and right to live a satisfying, productive life … at WPA, we believe that women who have made poor choices should not be forever limited by their mistakes.” Upholding the opinion that incarcerated women are unjustly tainted by their criminal status, the WPA has fought hard to return dignity to pregnant women in jail. What the opponents of shackling birth are the most appalled with is that “most women in prison have been convicted of non-violent offenses,” alluding to the fact that the handcuffs are not even necessary in the first place. These opponents are not just proponents of human rights or women’s rights organizations; medical authorities, legislators, everyday citizens, and penal systems are also against this inhumane procedure.
In October of 2008, the Federal Bureau of Prisons looked over its policies and decided to ban the procedure of handcuffing pregnant prisoners not just labor but in prison overall. So far four states (Illinois, California, Vermont, and New Mexico) have put the effort into passing laws that ban shackling while giving birth, giving the example to other states who have done so as well. The future of this issue is still to be determined …

Works Cited:
-    Chen, Stephanie Growing up is even harder when mom is in prison. CNN: May 7, 2009.
-    Rhoad, Meghan. Giving birth in Shackles. Human Rights Watch. May 27, 2009.
-    Women’s Prison Association http://www.wpaonline.org/
-    WPA, Incarcerated Mothers and Their Children: Highlights from the New Federal Report

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. - World Health Organization

As this blog series comes to a close, I felt that it was important to take the subjects that I have touched upon and the global public health issues that I have discussed in previous posts and end by looking at ways in which we can begin to work towards ameliorating these issues.  Since the final lectures in this class are about how we can all make a difference in global public health work, I felt that it is important to end on a more positive note, focusing on solutions to the problems instead just the problems themselves.  I begin again with the quote that the second half of my posts have focused on: the World Health Organization’s definition of health.  In this series of health as the most basic of human rights, the contradictions that arise from this definition, specifically from the inclusion of the phrase, “highest attainable standard,” have been central.  In looking at how this affects prenatal care, children’s health, and access to vaccinations in particular, I have seen that saying that people should have access to the “highest attainable standard” in places where that does not mean much just is not enough.  Therefore, it is up to us to raise that standard.

Some of the statistics I found, particularly regarding the vast numbers of women in the developing country who give birth without a trained health care professional present are more complicated to resolve.  As important and necessary as it is going to be to train more health care professionals in these regions, that is not the only issue at stake here.  Many of the people in less developed areas are wary of Western medicine and prefer traditional care and remedies instead.  While it is true that many of these births happen outside the care of a trained professional because of a lack of these professionals and the resources for people to get to them, many also occur because women try to deliver at home and do not go to see these doctors, or at least not until it is too late.  Education is perhaps as important in these regions.  Showing a woman the advantages to being in the presence of these professionals during this crucial time for her health and her child’s, as well as increasing the number of available doctors are going to be the only ways that we can begin to reduce the huge and unnecessary rates at which women die during childbirth.

However, when it comes to children’s health, the answer is much more simple and urgent.  There is no reason that children under the age of five should be dying at the rates that they are, particularly due to preventable and curable causes.  Intervention work to address this problem should be aimed at basic sanitation and health education programs.  Making sure that parents, particularly mothers, are aware of basic health practices as well as ensuring that they have access to even the simplest resources is crucial to improving children’s health.  Educating the public in these areas about things as simple as washing their hands or boiling their water can prevent huge amounts of deaths due to communicable diseases.  Not having access to the means necessary to insure decent health is terrible, but not having access to the information necessary is tragic.  Simply knowing which practices to stop or change with little extra effort could help numerous people, and we have a responsibility to make sure that they get access to this information.

Lastly, when it comes to vaccines, since this is not an issue of funding at all, it is an issue of making sure that the people who dictate resources know that people do care where they go.  Lobby your representative.  Send a letter to USAID.  Tell your friend who is interning at an NGO for the summer.  Start your own NGO.  Unfortunately, it is going to be up to us to change the system to make it work for these people, and to raise the “highest attainable standard.”  …or, fortunately, as some of may see it.  The attitude that we take towards this matter is going to be the determining factor towards whether or not we see these inequalities change and improve during our lifetime.

As I was perusing the NYTimes health section this morning, I ran across an article entitled, Health Spotlight Is on Diabetes, Its Control, and Its Complications, so I opened it up, expecting to find some commentary on how best to address the creeping epidemic of diabetes in our nation. Would it claim that we should promote healthier, more active lifestyles? Would it call for better access to information on how to live with diabetes? Would it call for physicians to play a bigger role in preventative care? Nope, none of these. Instead, the first line mentioned Obama’s recent pick for Supreme Court, Judge Sonia Sotomayor. What? How is she related to the diabetes epidemic?

She’s not. She has diabetes. She’s a public figure. And the public has a keen sense of curiosity and a strange sense of entitlement to the personal data of any public figure’s life. In fact, Dr. R. Paul Robertson, an endocrinologist at UDub and the diabetes association’s president for medicine and science, said that “given the seriousness of the disease and of the proposed job, the public had a right to know how the judge was controlling her diabetes–and how well.” A right. I understand that for a position as highly esteemed and influential as a Supreme Court judge, we only want individuals who can roll with the punches and stick around. But Sotomayor has been living just fine with diabetes for over 45 years. And we have a right to know if she can take care of herself? If a candidate had HIV, would it be acceptable to demand the right to know of his or her medical history, and  to keep tabs on how he or she is handling it?

In the medical field, confidentiality of patient information is nearly sacred. Compromise is not acceptable. Why is it then, that when a patient becomes a public figure, his or her health becomes the business of the public? Why is Sotomayor’s right to privacy deprioritized for our right to…information of her private medical records?

This hearkens back to the debate I’ve considered in past blogs, considering the balance between individual privacy and the interests of protecting public health. Should forcible testing of HIV/AIDS, TB, SARS, or other infectious diseases be established to protect public health? Or, should the right to privacy of individuals be upheld? Clearly, forcible quarantine is a touchy subject and in very few situations, justified. But how about testing? The right to know who’s infected with something, or the right to keep it a secret? Funny thing is, diabetes is not contagious. So, why is it so important to know about Sotomayor’s history? She’s been doing just fine without our help so far…Where do we draw the line?

Thank you all for your comments!  I am going to talk a little more about human rights, why I don’t really think they exist, and what I do think exists (and, of course, maybe hopefully, how this pertains to health…if I get around to it).

What is a right?  The little dictionary in my Mac dashboard says that a right is “a moral or legal entitlement to have or obtain something or to act in a certain way.”  So, a right is an entitlement to something.  Let’s say me and all of my consistent and loyal readers are in a box with nothing else.  Both of us say we have a right to life, complete health and well-being, a sufficient standard of living, et cetera.  However, we will soon die.  Because there’s nothing else in the box.  I argue that human rights as a completely human construct are completely resource-dependent.  How can I have a “legal entitlement” to something that does not exist?  If saying that someone has a “right” to something does not entail giving it to them, what does saying they have a “right” to it even mean then?

Ah, you say, but there is such important value in having the “concept” of universal human rights.  Are human rights a goal, then?  Do incremental steps toward human rights “count”?  Doesn’t that violate what human rights supposedly are?

(My explanation for my disbelief in negative human rights is not going to be explained.  As an example, I don’t believe that everyone has the right to not be killed, but I also don’t believe that anyone has the right to kill anyone else. If you really want to know, please email me at ndcass@stanford.edu)

Okay, on to the next step.  I believe that all people should be treated with equal respect and care.  I believe that if you have two jackets and someone is in need of one and you don’t give it to him, you’re responsible for him.  I’m working on putting this into action, like I said in the last blog.  But I don’t believe anyone should be treated unequally.  What does this take?  It takes the exact opposite of human rights.  It takes me saying I don’t have a right to anything I think is mine, because others may need it far more than I do.

I would like to once again relate human rights to the topic of this week’s lectures – war and civil conflict. Human rights concerns are particularly relevant in such a setting when hundreds of thousands of civilians are dying each day. I would thus like to discuss what role, if any, the United States should have in preventing such atrocities.

When such events as war and civil strife occur, the United States has intervened in some cases and not in others. However, in American foreign policy, the concern for human rights has never been at the forefront of our concerns. In every war we have entered into, so-called greater concerns have affected our decisions, most commonly those of national security. When national security has not been a factor, humanitarian intervention has rarely occurred.

Let’s take Rwanda for example. This is the classic example of U.S. nonintervention. Although most people know about the Rwandan genocide, I will go into a little more depth into exactly what happened. In a span of 100 days, 800,000 Rwandans were killed as civil strife erupted between the Tutsis and the Hutus. Historically, Rwandan politics was dominated by the minority Tutsi group. However, tensions remained high between the majority Hutus and minority Tutsi, and when Rwandan President Juvenal Habyariman, a Hutu, was shot down from a plane, Tutsi rebel groups were blamed. Thus, Hutus were urged to take vengeance against Tutsis for the alleged murder. Thus, the ethnic cleansing began.

In such a situation, I pose the question, should the U.S. have intervened? The conflict at stake is that between human rights and national security. It was not at all in the national security interest for the United States to intervene. In fact, had we intervened, U.S. soldiers would have been killed in the massacre without a doubt. However, how many Rwandan lives is the life of one U.S. soldier worth? According to Alan J. Kuperman, “a major intervention would have saved 275,000 Tutsi, compared to the 150,000 who actually survived.” Despite the fact that hundreds of thousands of Tutsi would have died regardless, the ability the United States had to save the lives of 125,000 Tutsi is remarkable. However, the U.S. refused to intervene for fear of casualties.

Additionally, as mentioned by Scott Smith, M.D., the majority of civilian deaths in war is not a result of war trauma but of other issues that result from conflict. For example, diarrheal diseases, malaria, and measles become more rampant in such a setting with little shelter or sanitation measures. Such problems last for years after a conflict has taken place, and caring for refugee and internally displaced populations is an integral part of dealing with the aftermath of such conflicts. Thus, could we and should we do more in the aftermath of such a conflict?

Kuperman, Alan J. (2000) Rwanda in Retrospect. Foreign Affairs, 79(1), 94-118.