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Back to: Third Session | Draft Article 21

Comments on the draft text
Draft Article 21: Right to health and rehabilitation

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National Human Rights Institutions

Ontario Human Rights Commission

The Commission is supportive of this Article. The notion, “shall take appropriate measures to ensure access” is in essence the duty to accommodate persons with disabilities in accessing health and rehabilitation services. The Supreme Court of Canada has made a landmark decision in this regard. In the case of Eldridge v British Columbia,1 deaf individuals successfully challenged being denied sign language interpreters while attending at a hospital for medical services. The Court found:
Para.94 …Given the central place of good health in the quality of life of all persons in our society, the provision of substandard medical services to the deaf necessarily diminishes the overall quality of their lives. The government has simply not demonstrated that this unpropitious state of affairs must be tolerated in order to achieve the objective of limiting health care expenditures. Stated differently, the government has not made a “reasonable accommodation” of the appellants’ disability. …

(b)

The Commission is supportive of this paragraph. Also see the Commission’s comment above under draft Article 16.

NGOs

European Disability Forum

This article might be clearer if it is divided into two articles: one dealing with the access of disabled people to general healthcare issues and a second one dealing with the specific (re)habilitation issues which some disabled people require.

As referred to in footnote 74 of the draft Convention, (re)habilitation goes beyond medical issues. A definition of both concepts (rehabilitation and habilitation) in the article 3 seems to be appropriate.

EDF is against a reference to prevention of impairments, but supports a reference to the prevention of secondary impairments as included in paragraph e).

Indian NGO Consultative Meeting

Minor additions are suggested to the text of article 21 for example- add “disability NGOs” after the word ‘monitored’ in article 21-i).

In 21-j) addition of “his/her guardian” after the word ‘persons concerned’.

Similarly in 21-k) add “ without the consent of the person or their guardians as the case may be” after the word ‘disabilities’.

Some participants strongly felt that in Article 21- Health and Rehabilitation should be separated in two articles to give prominence to each area.

Landmine Survivors Network

Draft Article 21 addresses health and rehabilitation/habilitation, and as noted in Footnote 74, these issues are of a complexity and depth such that it may be more appropriate to elaborate them in separate articles, as is done in the UN Standard Rules. (Cf. UN Standard Rules on the Equalization of Opportunities for Persons with Disabilities, Rules 2 and 3) In whatever format these rights are addressed, it will be important to place a greater emphasis on the importance of choice throughout the article(s), so that people with disabilities are empowered to accept or refuse health care and rehabilitation of their choosing.

Draft Article 21(a) makes reference to “other citizens.” Given that the individual in question may not be a citizen of the relevant State Party, it may be preferable to utilize the broader term “other members of society.” (Cf. UN Standard Rules on the Equalization of Opportunities for Persons with Disabilities, Rule 2, para. 3)

Draft Article 21(c) relates to the proximity of services to a person’s community. Given the challenges that many people with disabilities face accessing transportation, the provision of services at the local level is of great importance. (Cf. UN Standard Rules on the Equalization of Opportunities for Persons with Disabilities, Rule 3, para. 5)

Draft Article 21(d) references the need for “counseling and support groups, including those provided by persons with disabilities.” During the Working Group meeting a number of members suggested that it would be valuable for “peer support” to be incorporated in this provision, ie. the concept of those with similar shared experiences offering each other mutual support. Although “including those provided by persons with disabilities” might encompass the concept of peer support, it might not necessarily do so. Therefore, the Ad Hoc Committee may wish to consider the explicit inclusion of that term in paragraph (d).

Draft Article 21(j) addresses issues of privacy related to the health or rehabilitation information of people with disabilities. Paragraph (j) requires health and rehabilitation professionals to inform people with disabilities of their “relevant rights.” Such language is rather vague. It may be more appropriate to state “inform persons with disabilities of these rights.”

Draft Article 21(l) again relates to the issue of privacy of information. This paragraph seems repetitive of issues already addressed in paragraph (j) and should perhaps be deleted.

Draft Article 21(m) addresses the involvement of people with disabilities and their organizations in the formulation and implementation of health and rehabilitation legislation and policies. These important concepts find precedent in the UN Standard Rules. (Cf. UN Standard Rules on the Equalization of Opportunities for Persons with Disabilities, Rules 3(7) and 14(2)).

Physical Disability Council of Australia Ltd

This section needs to be strengthened in relation to equity of access regardless of culture.

World Blind Union

Rehabilitation must be separated from health and divided into two separate articles. It is time to see that rehabilitation as a social and human right, which appear after the health aspect of a disability.

There is a need to focus on what disability specifically is and try not to spread it out to all kind of aspects of health and rehabilitation. The focus is missing.

Habilitation should be mentioned on its own since it differs from rehabilitation. Habilitation is gaining skills that people (young persons) have not previously had, rather than the regaining of skills lost. A new definition might be needed. Habilitation could be referred to Article 3, Definitions.

Access to health insurance by PWD without discrimination must be targeted as a right.

Community based rehabilitation (CBR) programs should be ensured, including the working in partnership with local communities and families.

Para (d), should be deleted. No service provided to the public should be offered on a voluntary base for PWD.

Para (e), should be deleted. WHO or other UN organs could deal with prevention of disabilities, it should not be dealt with in this convention.

Para (f), should be deleted. Bio-medical, genetic, and scientific research, cannot bee seen as a right for PWD in this kind of Convention texts.

Para (g) and (h), continue to see health as part of rehabilitation, which is a level which would have been abundant for long ago.

Para (j), to share information in the health sector about a person with a disability without the consent from the person in question, is a right could be spelled out here or be formed as a praxis by a Monitoring Committee.

Para (k), no forced medical intervention and forced institutionalisation should be permitted.

Para (l), no forced medical intervention and forced institutionalisation should be permitted on the ground of disability.

Para (m), could be referred to in Article 4, General Obligations.

World Network of Users and Survivors of Psychiatry

(j)
“…occur only after the person concerned has given their free and informed consent ADD: with respect to each service offered, and that health and rehabilitation professionals…”

The addition in paragraph (j) is necessary to prevent the practice of “bundling of services” which effectively deprives people with disabilities of the right to free and informed choice and protection from unwanted interventions.

Footnotes

Footnote 1: Eldridge v. British Columbia (Attorney General), [1997] 3 S.C.R. 624

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