25 - Health
Background Documents | Article 25 Background
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Working Group | References
Compilation of proposed revisions and amendments made by the members of the Ad Hoc Committee to the draft text presented by the Working Group as a basis for negotiations by Member States and Observers in the Ad Hoc Committee
(updated after the completion of the first reading at the Fourth Session, 26 August 2004)
Right to health [and rehabilitation — Mexico]1 (Access to healthcare and medical rehabilitation — EU) (Access to healthcare — South Africa)
Right to health and medical and paramedical rehabilitation — Lebanon
States Parties recognize that (the promotion of health and the prevention of disabilities is an immutable and essential responsibility of all health-care systems and that — Philippines) all persons with disabilities have (full access to and — Namibia) the right to the enjoyment of the highest attainable standard of health (free — Yemen) [without discrimination on the basis of disability — Costa Rica] (on an equal basis and considering human diversity — Costa Rica). States Parties [shall — Japan] (and for that purpose — Japan) strive to ensure no person with a disability is deprived of that right, and shall take all appropriate (and effective — Australia) measures [to ensure access2 — Japan] (affordability, adequacy and continuity when needed — Lebanon) (to create conditions which would assure to all persons with disabilities health and rehabilitation services — Japan) for persons with disabilities to health (health insurance — Uganda) (on an equal basis with others and without discrimination — Thailand) [and (medical — EU, Canada, Lebanon) (and paramedical — Lebanon) rehabilitation — Mexico] services. In particular, States Parties shall:
(a) [Provide — New Zealand] (Ensure — New Zealand) persons with disabilities (have access to — New Zealand) [with — New Zealand] the same [range and standard of — New Zealand] (all — Holy See) health (or healthcare — Holy See) [and (medical — EU) rehabilitation– Mexico] services (and information related to the health services — Guatemala) as provided [(to — Canada) other [citizens — Canada, New Zealand] (persons and to the same standard — New Zealand) —Mexico] (to persons without disabilities — Mexico), [including (rehabilitation as well as — South Africa) sexual and reproductive health services — Holy See, Trinidad and Tobago];
[(b) [[Strive to provide — South Africa] (Achieve the progressive realization of disability specific — South Africa) those (additional — New Zealand) health [and (medical — EU) rehabilitation — Mexico] services needed (and requested — Costa Rica) by persons with disabilities specifically because of their disabilities; — Namibia] (Develop understanding of disability rights, respect for diversity, non-discriminatory attitudes and realistic perception of the capacities of persons with disabilities as users of health services for health professionals at all levels, in line with the principles of this convention — Namibia)
(c) [[Endeavour — Uganda] (Ensure — Uganda) to provide these health [and (medical — EU) rehabilitation — Mexico] services [as close as possible — New Zealand] (in — New Zealand) to people’s own communities — Namibia];3 (including domiciliary attention and community-based rehabilitation — Costa Rica) (Involve persons with disabilities and their representative organizations in the development and monitoring of health policies and of a code of ethics for public and private health care in promoting quality, transparency and respect for human rights at national level — Namibia)
(c bis) Provide persons with disabilities with medical assistance including the provision of medicines on a free basis in accordance with the minimum social standards — Russian Federation)
[[[(d) [(Endeavour to — Australia) Ensure that health [and rehabilitation — Mexico] services include the provision of [safe — South Africa] respite places, to use on a voluntary basis, and counselling and support groups, including those provided by persons with disabilities — Namibia]; — Jordan] (Ensure that respect is afforded to persons with disabilities to give consent to or refuse medical interventions of all kinds, in accordance with their evolving capacities — Namibia)
((d bis) Endeavour to support facilities that are in the ownership or managed by persons with disabilities; — South Africa)
(e) [Provide programmes and services to prevent and protect against [secondary — Morocco] disabilities, including among children (adults — Chile) and the elderly;4 — Namibia] (Ensure appropriate training and support of sufficient number of rehabilitation — Namibia]
[[(f) [Encourage — Uganda] (Promote — Uganda) (biomedic, genetic and scientific — Chile) research and the development, dissemination and application of new knowledge and technologies that benefit persons with disabilities (involvement of organizations and establishments whose interest is to support research and spreading knowledge and awareness of preventive services — Bahrain);5 — New Zealand]
(g) [Encourage — Uganda] (Promote — Uganda) the development of [sufficient numbers of — Costa Rica] health [and rehabilitation — Mexico] professionals, including persons who have disabilities, covering all disciplines needed to meet the health [and rehabilitation — Mexico] needs of persons with disabilities, and ensure that they have adequate specialized (or continued — Morocco) training; — Canada] — Jordan]
[(h) [Provide — Canada] (Promote the appropriate education and training of all — Canada) [to all — Canada] health [and rehabilitation — South Africa, Mexico] professionals [an appropriate education and training — Canada] to increase (their knowledge and — Chile) their disability-sensitive awareness and respect for the rights, dignity and needs of persons with disabilities, [in line with the principles of this Convention;6 — Canada]
[(i) (Endeavour to — Australia) Ensure that a code of ethics for public and private health care, which promotes quality care, openness and respect for the human rights, dignity and autonomy of persons with disabilities, is put in place nationally, and ensure that the services and conditions of public and private health care and rehabilitation facilities and institutions are well monitored; — Canada, —New Zealand]
[(j) Ensure that health [and rehabilitation — Mexico] services provided to persons with disabilities, and the sharing of their personal health or rehabilitation information,7 occur only after the person concerned has given their free and informed consent (or with the application of other relevant legal safeguards — Japan, Argentina) (or their guardian or legal representative — Morocco) (in respect of each service offered — New Zealand) (Ensure that free and informed consent is given only after the person concerned has been told of the nature, consequence and risks of the health intervention in the language understandable to the specific person with disabilities and/or their immediate families and recognized guardians — Philippines),8 and that [health and rehabilitation professionals inform — Mexico] persons with disabilities of their [relevant — Mexico] rights;9 — EU]
(Promoting quality public and private healthcare that respects the human rights of persons with disabilities and ensuring that health and rehabilitation professionals are aware of, and respect, the rights, dignity and needs of persons with disabilities — EU)
[(k) [[Prevent — Costa Rica] (Impede — Costa Rica) unwanted medical and related interventions (rehabilitation — Chile) and corrective surgeries from being imposed on persons with disabilities (which are not authorized by them or their representatives. — Chile) — China] (ensure that medical and related interventions are in the best interests of persons with disabilities, and prevent unwanted medical and related interventions unless exceptional circumstances in accordance with the procedures established by law and with the application of appropriate legal safeguards — China);10 — Jordan, New Zealand]
(Prevent medical, surgical and other related interventions from being imposed on persons with disabilities without their free and informed consent. — New Zealand)
[[(l) Protect the privacy of health and rehabilitation information of persons with disabilities on an equal basis;11 — South Africa] — Australia, Mexico]
(Removing the barriers to access to health and rehabilitation services (as suggested by the Asia/Pacific forum of National Human Rights institutions) — for example, spousal consent being required, lack of convenient and affordable transport and affordability of services (on an equitable basis);
Equal access to public health programmes e.g. programmes aimed at preventing HIV/AIDS, ensuring provision of safe and potable water and sanitation and cervical and breast screening for women;
Rationing of health services should not be on the basis of disability;
Access to other health-related services, such as dentistry, — New Zealand)
[(m) Promote the involvement of persons with disabilities and their organizations in the formulation of health and (medical — EU) rehabilitation legislation and policy as well as in the planning, delivery and evaluation of health and (medical — EU) rehabilitation services.12 — EU] — Namibia] — Canada] — Jordan, Argentina] — Namibia, Mexico, New Zealand] — EU]
(Give priority to providing health services to persons with severe disabilities — Bahrain)
(States should promote rehabilitation programmes based on the community. — Chile)
(Remove barriers to the equal access to health services by persons with disabilities;
Ensure public health programmes, and programmes concerned with the underlying determinants of health, benefit persons with disabilities on an equal basis with all others;
Prevent the discriminatory allocation of health resources on the basis of disability;
Prevent the provision of a different standard of treatment or the discriminatory refusal to provide health services, including the refusal to treat or to provide the food and fluids necessary to sustain life, on the basis of disability — New Zealand)
(21 bis Right to Community Based Rehabilitation
1. States Parties recognize that all persons with disabilities have the right to rehabilitation. States Parties shall ensure that no person with disabilities is deprived of that right, and shall take all appropriate measures to ensure full access for persons with disabilities to rehabilitation services. In particular, States Parties shall:
(a) Endeavour to provide rehabilitation services within the community, based on the principles of community based rehabilitation;
(b) Ensure that health and rehabilitation services include the provision of safe respite places to use on a voluntary basis, counselling, and support groups including peer support;
(c) Provide programmes and services to protect against and cope with secondary disabilities including among children and the elderly;
(d) Encourage research and the development, dissemination and application of new knowledge and technologies relating to rehabilitation that benefit persons with disabilities in consultation with persons with disabilities.
2. States Parties shall recognize community based rehabilitation as a rights-based strategy to alleviate poverty and to address the direct and indirect socio-economic costs of disability at the level of the individual, family and the society at large
3. States Parties shall enhance rights, social and economic approach in the development of community based rehabilitation services
(a) Mobilizing awareness and responsiveness towards equal rights among disabled children and adults, authorities and the society at large;
(b) Removing attitudinal, financial and infrastructural barriers in society, and promoting inclusive public and private services for all, particularly for disabled children and adults;
(c) Consulting and strengthening representative organizations of disabled children, adults as well as their families as primary stakeholders in the full development of such strategies and services;
(d) Enabling disabled children and adults to reach their potential through the development of community based rehabilitation strategies and services at all levels, which are affecting attitude change at large and based upon priorities of disabled children, adults and caregivers themselves to achieve their rights
(e) Providing early intervention-, advisory-, functional training- and respite services to disabled persons, families and caregivers in the community aiming at self-reliance and full participation.
4. States Parties shall equip and empower a national coordinating disability body with the responsibility to manage community based rehabilitation at national and international level, assuring cohesiveness across national legislation, strategies and service provisions and in line with all other disability issues.
(a) The consultation of and best interests of disabled children and adults being paramount;
(b) Access, affordability and quality of such services is assured at all governmental levels for all children, adults and their families;
(c) Ensure community based rehabilitation is included in all community activities at all levels — Namibia).
(21 bis Persons with disabilities have a right to a comprehensive psychosocial rehabilitation in order to enable them to reach and sustain their optimum level of functioning and self expression and to live an independent life of their choice in their preferred community. Rehabilitation shall be understood as including habilitation and rehabilitation. Toward this end States parties undertake:
1. To maintain and develop a comprehensive and integrated range of functional rehabilitation services including occupational, vocational, housing, recreational, educational, and associated assistive technology and management and a self-supportive system, and to ensure that such rehabilitation is in alignment and continuity with medical and paramedical rehabilitation.
2. Take steps to ensure that information with respect to rehabilitation services and procedures are widely available and accessible to all persons with disabilities and, when appropriate, to their families.
3. To ensure that access to such services will be open to all persons with disabilities without discrimination of any kind, and particularly without regard to the kind or severity of the disability.
4. To take steps to ensure that the specific rehabilitation needs of women, girls, children, the elderly, and family members of persons with disabilities are appropriately addressed in order to ensure respect for their dignity and particular needs.
5. To base the design of rehabilitation programmes on the actual needs of the person concerned, through a process of individualized comprehensive assessment and intervention and, towards this end, to actively involve the person in the design, organization, and periodic review of their programme.
6. To prohibit the imposition of any programme of rehabilitation against the wishes of the person concerned.
7. To take steps to ensure that rehabilitation programmes are available locally in the individual’s own community in order to ensure that the rehabilitation process creates a meaningful and practical pathway into a life of full participation and inclusion, in accordance with personal choice and opportunities.
8. To involve persons with disabilities and their representative organizations in policy decision-making, the concrete rehabilitation process, and the evaluation of rehabilitation outcomes.
9. To ensure that all personnel involved in rehabilitation are sensitized to the rights and needs of persons with disabilities, and to ensure that their objective is to make the full inclusion of people with disabilities possible. — Israel)
(21 bis 1. States Parties recognize that rehabilitation is a prerequisite for the equalization of opportunities and the full inclusion of persons with disabilities. To that end, States Parties shall endeavour to ensure:
(a) Access to a continuum of rehabilitation services, including, inter alia, physiotherapy, occupational therapy, speech language and communication therapy, psychosocial counselling and therapies;
(b) These services are provided, to the extent possible, close to the communities in which persons with disabilities live;
(c) The development of appropriate and specialized human resources and training material to support the same;
(d) The production, usage and monitoring of good quality assistive devices at affordable prices, and the promotion of research and development of the same [removal of this clause from article 19 (e) and 20 (c)];
(e) Availability of programmes and services to prevent and protect against secondary disabilities;
(f) Active involvement of persons with disabilities and their families in matters of rehabilitation plans and policies; — India)
(21 bis Right to training and rehabilitation [Right to habilitation and rehabilitation — Lebanon]
1. The States ensure to include reference to psychological, social, physical and vocational rehabilitation in the chapeau of the article.
2. To include language on the need for consent of the person with disability before any rehabilitation begins.
3. To include reference to the participation of persons with disabilities and their representative organizations. — Yemen)
(21 bis Right to prevention
States Parties shall take all necessary measures particularly by offering programmes and services that are aimed at preventing and fighting congenital or accidental disabilities — Cameroon)
1. Some members of the Working Group considered that grouping “rehabilitation” with “health” was inappropriate, and that it would be better dealt with in a separate article, because “rehabilitation” includes more than “medical rehabilitation”, and should not be “medicalized”. Rehabilitation includes medical, physical, occupational, communication and psychosocial services as well as training in everyday skills and mobility. The term “rehabilitation” as used here includes those processes sometimes called “habilitation” (the gaining of skills that people have not previously had, rather than the regaining of skills lost). The Ad Hoc Committee may wish to include an explanation of this nature in draft article 3 on definitions. Rehabilitation for the purposes of work and education may be best covered in the relevant draft articles on work and education.
2. Some Working Group members suggested that affordability, and access to health insurance by persons with disabilities without discrimination on the basis of disability, should be addressed in the Convention.
3. There was general agreement in the Working Group that, as far as possible, health care and rehabilitation services should be decentralized, taking into account the degree of specialization. Some members of the Working Group also suggested that community-based rehabilitation programmes should be ensured, including the working in partnership with local communities and families to continue rehabilitation.
4. There were conflicting views among members of the Working Group on the issue of the prevention of disability. For some, the Convention has to do with the rights of existing persons with disabilities, and should mention only the minimization of the effects or progression of their disability, and the prevention of further, secondary disabilities. Others felt that the prevention of disability per se should be included.
5. Some members of the Working Group suggested there should be a specific mention of the fields of (bio)medical, genetic and scientific research, and its applications, and its use to advance the human rights of persons with disabilities.
6. Part of the intent of this subparagraph is to ensure that health and rehabilitation professionals providing services to persons with disabilities understand the ongoing effect disabilities have on a person’s life, as opposed to more immediate medical considerations.
7. Privacy issues have been also addressed in draft article 14 on the right to privacy.
8. Free and informed consent has wider application in this draft Convention than this paragraph alone. The Ad Hoc Committee may wish to consider whether the following wording should be included in this subparagraph or broadened to become a definition in draft article 3:
“Informed decisions can be made only with knowledge of the purpose and nature, the consequences and the risks of the treatment and rehabilitation supplied in plain language and other accessible formats.”
9. Some members of the Working Group considered that the subparagraph should spell out the rights.
10. Some members of the Working Group also considered that forced medical intervention and forced institutionalization should be permitted in accordance with appropriate legal procedures and safeguards (see also draft article 11).
11. Some members of the Working Group suggested that this subparagraph was redundant and should be deleted.
12. The involvement of persons with disabilities in formulating legislation and policy, as well as in the planning, delivery and evaluation of services, has wider applicability than this draft article. Some members of the Working Group suggested that it should be covered under draft article 4 on general obligations.