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As the semester draws to an end, I find myself overwhelmed by the surplus of new ideas, realizations, and data I have acquired by taking this class.  In many regards, I find myself asking more questions than I had when we began: What are Human Rights?  Are Human Rights universal? Is healthcare or health a Human Right? 

There is another question I am struggling with, however… is healthcare a right or a responsibility? 

 Is it a fundamental right, one we are born with and one which cannot be denied, or is it something much more unstable and shifting?  We have bumped up against this question time and again.   

 I would like to argue, then, that healthcare is both a right and a responsibility.  The responsibility, it seems, is both on the part of the individual and on the part of society, globally.  From our numerous discussions, I believe we have come to agree that a great discrepancy exists between the “Have”s and the “Have- not”s in regards to healthcare access – the few seem to have a lot, while the many seem to have nothing. 

 Does it make sense that the “actual figure for U.S. foreign aid giving [is] about 1.6 percent of the discretionary budget,” less than one quarter of what industrialized countries pledged to give at the 1992 Rio Conference?  To me, it does not.  I cannot seem to justify this. 

Moreover, we have discussed various ways through which high-income countries profit from the poverty and disparity of low-income countries (outsourced clinical trials, sub-par healthcare, pharmaceutical companies, etc).  In a world that seems to be so extensively globalized, do we (as citizens of the world, and, particularly, as citizens of a high-income country) not incur a greater responsibility to give aid, if we have even the slightest possibility of doing so?  Perhaps, we do not.  Perhaps, it is fitting to say that we live in a world that is “unfair” and “doomed” and it is unlikely that a radical change will come in the future, making any attempt on the part of a single person is futile. 

I, however, am not comfortable with this.  I’d like to once again bring up Professor Alcabes’s argument, which forces us to really be honest with ourselves: either, we do NOT believe that human rights are universal, thus justifying their variance as a result of circumstance…OR, we believe that human rights ARE universal, therefore, causing us to address the many discrepancies we have discussed.  If the human right to be free from disease, to have healthcare and clean water, to be protected from exploitative research experiments, to have information, etc. is not merely a moral aspiration, then I believe that there is a universal responsibility on the part of all people to protect this right.

 I am not delusional about the sad realities of the world we live in; however, great things have been achieved by people who refused to accept these realities as being inescapable.  Perhaps, a persistent discomfort on our part may also bring about a change. 

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Once again, stringent drug law and anti-drug campaign action has resulted in a restriction of access to treatment.  A government anti-drugs agency in Russia has ordered that the Andrey Rylkov Foundation, a public health organization which deals with discussion of the drug methadone as a treatment for addiction, be shut down.  The motion was put into action because the organization was said to “[place] materials that propagandize (advertise) the use of drugs, information about distribution, purchasing of drugs and inciting the use of drugs.” 

 

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As we have discussed, methadone can be very successful in treating addiction, and, due to its tablet form, can prevent the spread of HIV through needle use.  Currently, there are nearly 1 million people in Russia living with HIV, many of which contracted the disease through unsanitary needle use.  Methadone, however, is illegal, and with the increasing control of the government on the information provided to the citizens, soon addicts will be unable to gain information on treatments alternative to “narcology” – an abstinence-based system, which has been shown to be largely ineffective, and even harmful. 

            While censorship has been an ongoing problem in Russia, it becomes even more concerning when it impedes upon the rights of citizens to access medicine and information on healthcare.  The right to information seems to be key here, as without knowing their options, heroin addicts are left stigmatized and forced to quit their habit “cold-turkey” (most, obviously, will not). 

            This example, along with the problem of access to morphine, demonstrates how tightly the war on drugs is wound with human rights and the global access to medicine.   We are, once again left asking the questions: do drug addicts have the same rights to healthcare and information as others?  Does the government have a right to withhold information, in fears that the information may lead to a rise in drug use, as opposed to a decrease? 

A CBS News Video explores the limited access to pain medications of people in more than 80% of the world, who only have access to 5% of world morphine.  For people in countries such as Uganda, this means that AIDS and cancer patients, who are suffering from terrible, long-term pain, will be unable to gain access to pain medication.  Diederik Lohman, the senior researcher with Human Rights Watch, has drawn a parallel between torture and global pain, stating that it is no less a violation of human rights to deny (or to not supply) a suffering cancer patient or burn victim with pain medication, than it is to torture a person.  Furthermore, he has gone on to say that while a torture victim has the opportunity to sign a confession and cease the torture, “the patient with pain does not have that option.”

While one may be quick to assume that the reason for a lack of access to pain medication comes from unavailability or lack of resources, this is not the case.  Morphine is, in fact, very cheap and easy to acquire.  The problem is more complicated, and has arisen as a side-effect of the war on drugs.  As the market for drugs (such as heroin, a morphine derivative) has expanded tremendously, the war on drugs has led many countries to instill new and rigid regulations on controlled substances, thus leading to a reduction of the availability of the same controlled substances for medicinal purposes. 

 This is especially a problem in countries such as Uganda, where there are very few doctors who are trained in the dosing and administration of morphine.  However, currently new protocols are in the works aiming to extend the laws to allow and train nurses to administer controlled pain medication.

 Unfortunately, the inevitability of collateral damage will always render us as having to choose the lesser of the two evils.  Especially when the topic revolves around allowing access to medication, the risk of a black market and drug abuse will continue to stifle availability.

     While I agree with Bianca in that I would also rather buy generic pharmaceutical products as opposed to drugs a college student cooked in his basement, I think that it is important to consider why there is a black market for drugs and other medical services in the first place.  Perhaps it is easier to consider organs on the black market as opposed to pharmaceuticals.  I, for one, believe that under the current regulations, a black market for organs is unavoidable and even necessary.  To quote a New York Times article, “More than 3,300 Americans died last year awaiting kidney transplants”.  That is 3,300 Americans, not 3,300 people in the world and not 3,300 people waiting for other organs (hearts, lungs, what have you).  Many of those people have been on multiple transplant lists, but have still been unable to get an organ.  If we are to look past the moral aspects of this situation, I believe that it is necessary to have a window of opportunity such as the black market if all other efforts have failed.

An article titled “Black Market Medicine: An Ethical Alternative to State Control,” states:

“Defying the law can sometimes be the only course left for the doctor faced with legislation contrary to his ethics. In so doing he is guilty of no crime other than that of non-cooperation with a morally empty institution”.

While this may be too reverent of an outlook, it does force us to think about why so many people turn to the black market for health care?  Is it the fact that the black market will exist regardless of how the system is organized, or is it the fact that, when faced with the choice of life or death, most people will go to immeasurable lengths to choose “life”?  Finally, can we ever fully shut down the black market?

This is another interesting article on surgeons’ take on the selling of human organs: http://www.independent.co.uk/life-style/health-and-families/health-news/sale-of-human-organs-should-be-legalised-say-surgeons-2176110.html

     A crisis is brewing in the Democratic Republic of Congo (DRC), where out of the 350,000 HIV-positive people who could potentially benefit from antiretroviral treatment, only 44,000 are receiving treatment.  This dangerously-low cover rate (such low percentage is currently seen only in Sudan and Somalia) combined with the high occurrence of mother-to-child HIV transmission, and the difficulty of access to medical treatment paints a very grim future for DRC. 

Despite this reality, however, the six year World Bank funding period ended in 2011 and the Global Fund aid is dwindling (funds are currently on round eight, and it has been reported that they will not be continued onto round nine and ten).   The director of an NGO in Kinshasa reports that since the funds for treatment have been cut, people are no longer coming in to get tested, since as many as 15,000 HIV-positive individuals are already unable to get treated. 

According to Médecins Sans Frontières (MSF), without the aid of donors and other humanitarian organizations, even a sustenance of the Global Fund aid will not be enough to provide all of those in need with treatment.  MSF is currently urging donors and existing partners to establish the issue in DRC as a priority –

 “With funding from the Global Fund, only 15 percent of people have access to ARVs, so we need others to contribute and we need the existing partners – UNITAID and PEPFAR – to honour their commitments to the people they are already supporting and to expand their programmes.”

In considering this issue, an important question arises – if so many people are still in need of treatment, why are funds being withdrawn?  Third world countries and countries of the developing world have the highest mortality rate for treatable diseases such as HIV, Malaria, Tuberculosis, Lower respiratory infections, and diarrhea; as providing funding for a limited period of time will not eradicate this issue, should more resources be allocated to provide disease epicenters with continuous treatment, indefinitely?