Article Text

Health and human rights: an area of neglect in the core curriculum?
  1. Joseph Robert Fitchett1,
  2. Elena Ferran2,
  3. Katherine Footer3,
  4. Natasha Ahmed4
  1. 1Imperial College London, School of Public Health, Wright–Fleming Institute, St Mary's Hospital, London, UK
  2. 2University College London, London, UK
  3. 3London School of Hygiene and Tropical Medicine, London, UK
  4. 4University College London, Institute for Human Rights, London, UK
  1. Correspondence to Mr Joseph Robert Fitchett, Imperial College London, School of Public Health, Wright–Fleming Institute, St Mary's Hospital, 56 St Dunstan's Road, London W6 8RA, UK; joseph.fitchett{at}

Medical ethics and law education in the UK is undergoing continuous transformation. In parallel, human rights teaching with respect to health is expanding as a distinct field. Yet a resistance to the inclusion of human rights in the medical ethics and law curriculum persists. In response to Stirrat and colleagues, this article seeks to highlight the mutual benefit that could be derived from an integration of human rights into the already established medical ethics and law teaching in medical schools. It proposes that incorporating human rights into the curriculum would add value to traditional medical ethics and law teaching and provide a promising opportunity to enhance the interest from the student body.

  • Consensus statement
  • education for healthcare professionals
  • education/programmes
  • human rights
  • medical education
  • medical ethics and law
  • medicine curriculum
  • tomorrow's doctors

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Ever since the General Medical Council (GMC) published their 1993 recommendations on undergraduate medical education, entitled Tomorrow's Doctors,1 various parties including policy makers, academics, clinicians and medical ethics and law educators have been contemplating the most effective methods of training compassionate and ethically minded medical professionals of the future. Five years after the GMC report, a consortium of teachers of medical ethics and law published a consensus statement entitled ‘Teaching medical ethics and law within medical education: a model for the UK core curriculum’.2 The consensus statement has been judged highly impactful on the education of medical ethics and law in UK medical schools,3 and recently the Journal of Medical Ethics published a timely update of the consensus statement by Stirrat et al.4 The update coincides with the GMC's 2009 Tomorrow's Doctors update report, to be applied from 2011.5 The update on the consensus statement mentions human rights once and only in the context that students should demonstrate an ability to differentiate between ‘moral, legal and human rights and how these impact on professional practice’.4 In the same paragraph, there is mention of the need to understand the ‘rights and responsibilities of patients and possible justifications for limiting their rights’, an area in which human rights play a key role.4 Tomorrow's Doctors does not mention human rights at all. The nearest the GMC comes is by recommending that doctors ‘recognise the rights and the equal value of all people and how opportunities for some people may be restricted by others' perceptions’.5 So why the silence on an issue that forms the core values of the United Nations (of which the United Kingdom of Great Britain and Northern Ireland is a founding member state) and a legal obligation for governments worldwide to fulfil the right to the highest attainable standard of health?

Why are human rights important?

Human rights are moral and legal entitlements that, by definition, are considered to ‘belong justifiably’ to all persons.6 Human rights refer to the basic rights and freedoms to which all humans are universally entitled, and are often related to the relationship between state and individual with the aim of protecting the vulnerable. With regards to the right to health, this places a duty on the state and gives individuals power against the much stronger state. On the other hand, medical ethics is rooted, but not exclusively, in the four principles of autonomy, justice, non-maleficence and beneficence, and relates to the study and practice of moral values and judgements in medicine and the doctor–patient relationship.7 First expressed in the Universal Declaration of Human Rights,8 the right to health is enshrined in the constitution of the WHO.9 With the influence of interlinked and interdependent underlying determinants on health, the right to health encompasses more than just access to health care.10 11 Furthermore, a right to health approach neither equates to a right to be healthy, nor to the overriding privilege of an individual's rights over those of the general public. Ensuring availability, accessibility, acceptability and quality of healthcare systems are central to the human rights-based approach.12 The benefits of a human rights-based approach, particularly to public health, include the pursuit of legal accountability, to advocacy work, to actual practice in terms of design, implementation and monitoring of health programmes.

The fundamental principles contained within human rights treaties relate to fairness, respect, equality, dignity and autonomy, and can complement, and in some settings supersede, traditional notions of medical ethics. Human rights are highly relevant to the principles of social justice already taught in the medical ethics and law curriculum, but differ in that they are the pillars for social justice, and are a powerful, internationally recognised instrument for dialogue through which social justice can be achieved. Medical ethics and human rights both have the common goal of protecting the vulnerable patient, yet their approaches differ depending on who has the duty of protection; whether the state or the doctor. Therefore, it is important for students to be made aware of both approaches in order to be able to protect their patients whether during a consultation or with respect to healthcare policy.

Knowledge of human rights in daily practice was exemplified in 2008 when the government reviewed whether failed asylum seekers could continue accessing primary health care. An open debate was initiated in the medical community; the Royal College of General Practitioners issued a position statement13 and societies such as Medical Justice published correspondence articles in the Lancet.14 The decision would have affected the everyday workings of primary care, and the debate was firmly rooted on an infringement of human rights. In 2008, the UK Department of Health systematically applied a human rights approach in 10 NHS primary care trusts. The evaluation of the landmark project indicated a positive impact on the provision of health care,15 and based on evidence gathered the report summarised that ‘a human rights based approach to health and social care can, and will increasingly in the future, have a tangible impact on the treatment and care of service users’.

Why human rights teaching would enhance medical ethics and law teaching

A study by Johnston and Haughton16 at King's College London documents the natural disparities between students and perceptions of their teaching. As children growing up during the UN Decade for Human Rights Education (1995–2004), human rights principles and language in a world characterised by migration and globalisation may provide a missing link in the current medical ethics and law curriculum. Medical students in particular have a growing awareness that health is global, highlighted by the oversubscription of intercalated global health BSc courses, student publications on The Lancet student website ( and student-run organisations such as Medsin-UK ( The article by Stirrat et al4 highlights the challenges of delivering the teaching of medical ethics; human rights could be a way of raising interest in the subject. For example, understanding how and why the WHO has adopted a human rights-based approach to health,9 18 and what this involves both in daily practice and on a global scale, would be of great interest and paramount importance. The doctors of today and of tomorrow will work increasingly within international settings and health strategies in which a human rights approach will be relevant not only to the larger health strategy but also to their individual practice.

Evaluation feedback from a recent conference for medical students and junior doctors, held at the Royal Society of Medicine with support from the WHO, Royal Society of Tropical Medicine and Hygiene and the Institute of Medical Ethics, stressed the desire, albeit from an interested audience, and the need to incorporate human rights into the curriculum. The right to health is a notion that strikes a chord with medical students and appeals to them on an educational basis. These examples are but a few that illustrate how knowledge of human rights would be both of interest and of benefit to medical students.

The content of this teaching has already been outlined by the Unesco bioethics core curriculum, agreed to by the UK, which is mentioned by Stirrat et al,4 and includes one chapter on human dignity and human rights.19 The curriculum follows on from the Universal Declaration on Bioethics and Human Rights first adopted by Unesco's General Conference on 19 October 2005.20 Although the newly revised consensus statement by Stirrat et al4 involved a process of reassessment and revision, which included the Unesco curriculum, the ‘Core curriculum and methods of assessment’ 2009 conference report does not make reference to the document, suggesting that it played little part in the deliberations.21


Healthcare professionals comprise part of the spine supporting society and are exposed to patients at their most vulnerable. Educating medical students in the practical applications of the human right to health offers an unparallelled opportunity to teach both the values and principles underpinning human rights as well as the legal aspects enshrined in national and international law. Although the community of medical ethics and law educators are commendable for their consistent endeavours to communicate with students regarding their views on subjects addressed, assessments and teaching methods, there is still some division regarding how and what students want to learn and the reality in practice. Adding a further dimension to the curriculum and ensuring a direct means of communication between educators and their students may provide a step to improving interest in a field so crucial to the training of future doctors as well as offering an ethically sound approach capable of transcending borders worldwide for the improvement of health.

While ethics is a recognised core element of medical education, health professionals and those responsible for health education need to engage with the intrinsic value of health and human rights education.


The authors would like to thank Carolyn Johnston for her constructive comments.


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  • All four authors contributed equally.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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