ANOTHER VOICE
A commentary on the lead feature article.

Bioethics and Human Rights

by George Annas

Bioethicists have tended to be more attuned to Brave New World, with its vision of commodification and dehumanization of life, than to 1984, a world based on perpetual war and fear. Our post-9/11 war on terrorism has altered the world view of at least some bioethicists, as essays in this issue attest, especially about how to construe what the common good requires from individuals. And in the context of war and global terrorism and epidemics, human rights language seems more powerful than the primarily individual-based language of bioethics. As Jonathan Mann observed years ago, the language of bioethics seems best suited to issues encountered in medical practice, whereas the language of human rights (which are universal and obligate governments to act) seems better suited for public health and populations.

The health and human rights field aims to develop the insight that governments promote health by promoting human rights, and vice versa: the two are "inextricably linked." It initially appeared to me that adopting the health and human rights framework required abandoning, or at least marginalizing, bioethics; but in this I was almost certainly wrong. It now seems to me much more likely that in the global arena human rights and bioethics are themselves inextricably linked, and act (or at least can act) synergistically. Physicians for Human Rights and Global Lawyers and Physicians, both human rights organizations, have found, for example, that they must also use basic bioethics concepts to help define the obligations of physicians in prisons, and as related to torture and executions, as well as in the context of treating and counseling asylum seekers.

Of international human rights instruments, bioethicists are most familiar with the Nuremberg Code, articulated by U.S. judges who tried Nazi physicians for concentration camp-based murder and torture done under the rubric of human experimentation. Although London, in his essay on wartime research, does not directly reference the Nuremberg Code, his conclusions summarizing the standards for justifiable research during war echo the Code's provisions.

Other human rights documents merit the attention of bioethicists, especially the Universal Declaration of Human Rights and the two subsequent human rights treaties: the International Covenant on Civil and Political Rights, and the International Covenant on Economic, Social, and Cultural Rights. The Declaration adopts what London characterizes as the "generic interests" concept of the common good (rather than the more abstract "corporate conception") by putting primacy on the human rights and human dignity of every individual. The civil and political rights treaty permits states to infringe on the civil rights of citizens in a public emergency that "threatens the life of the nation." Nonetheless, some actions are never justified, even by war or a national emergency, including slavery, genocide, murder, torture, religious persecution, and human experimentation without consent. London arrives at the same bottom line, but international human rights law would have gotten him there quicker.

London also cites the Nobel prize-winning economist Amartya Sen, and this reference helps to universalize his analysis. Sen has argued that we make a mistake in arbitrarily separating political and economic rights, and that humans need both to flourish. In his analysis, freedom is not just a goal of economic development, it is also a critical means to achieving it. Economic development (and economic and social rights) are not either-or when compared to political rights; rather (like health and human rights) they are linked and synergistic.

As London notes of the common good, so Mann noted of health and human rights in the context of the HIV/AIDS epidemic: they are not opposed but can much more fruitfully be analyzed as supporting each other in a non-zero sum game that has win-win (and loss-loss) outcomes. London does not refer to Mann's health and human rights analysis directly, but his essay provides an additional theoretical foundation for it. The bottom line deserves repetition: bioethicists who work either at the international level, or on the national level during wartime, would do well to anchor their work in international human rights law. Ultimately, I believe, a synthesis of bioethics and human rights will emerge.

George Annas teaches health law, bioethics, and human rights at the Boston University School of Public Health, School of Medicine, and School of Law. He is also cofounder of Global Lawyers and Physicians. The third edition of his The Rights of Patients will be published in January by Southern Illinois University.

This essay appears in the September-October 2003 issue of the Hastings Center Report.