1 PASKAITA

HR human rights
Why people have human rights? Because they are people.
US constitution not contain HR of health, so US do not recognise HR of health!
HR are universal, individual, fundamental, protectional rights. HR says, that all people are
equal.

HUMAN RIGHTS
CIVIL AND POLITICAL RIGHTS
CULTURAL RIGHTS
(right to vote, to free speech,
workers to organise, rights
to do process in justice system...)
disabilities...)

ECONOMIC, SOCIAL AND

(right to health, right of
of people with

Main documents of HR:

*UDHR - Universal Declaration of Human Rights (1948) Article 25
*ICESCR - International Covenant on Economic, Social and Cultural rights (1966) Article 12
(includes much more than UDHR article)
*ICCPR International Covenant on CIvil and Political rights (1966) (reikia inoti skirtum nuo
ICESCR). This convention established a HR Comity.
ie dokumentai kartu apima visas HR, exept disabilities. Also establish monetory and
enforcement mechanisms. It contain an idea of HR.
Other documents, that contain HR of health:
*Convention on the elimination of all forms of racial discrimination. Article 5.
Esm: no discrimination on race, public health, medical care, social security and social
services.
*Convention on the Elimination of all forms of discrimination agains women. Article 11.1(f)
and 12.
Esm: especially realted to family planning, special protection for motherhood.
*Convention on the rights of Child. Article 24
Esm: very expansive protection for children and women, women services around
motherhood. Very protective
and huge convention.
*Convention on the rights of persons with disabilities. Article 25.
Esm: no discrimination on a basis of disabilities. HR and health care rights are overlaped
(labai panas). Especially
provided to those people services. People with disabilities
are very vulnerable and very specific.
International documents
Regional documents
National documents
Explaining the right to health. General comment No. 14 (2000).
This comment expanses the idea of HR. Extends to the underlying determinants of health:

*food
*shelter
*safe and clean water (sanitation system)
*safe work invironment
*Access to medical care and information (pvz praneimai apie siauianias alyje ligas,
virusus ir pan)
*freedom of discrimination
Esm: right to health is incredible huge, it is a lot of things which influenced by a state. alis
turi apsaugoti be gali daug dalyk, kad atitikt pasaulin standart. Standartas yra labai
auktas, todl alys turi stengtis kaip manoma labiau atitikti standart, nes visai j pasiekti ne
visada manoma pagal alies galimybes.
Elements of HR of health (from General comment No. 14):
*availability. Are there enough services to health? Facilities? People to work in health system?
*accessibility. Can you make use of those services? It may be available, but not accessible,
because of discrimination form. Accesible contains of: phisical and affordable. One more
problem with accessibility: Is the information available to understand for everyone?
*acceptability. Are those services acceptable? Is it culturally appropriate? Including sensitivity
of gender.
*quality. Are the system appropriate? Is medicine using a good drugs to people care of health?
Nediskriminavimo sistemos veikimas:
*non-discrimination
*progressive realisation of non-discrimination right
*stop working tour (prevencija)
*reprogressive measures
Sic cores obligations (nusako vis esm HR of health)
*non-dicrimination
*Access to food
*Access to basic shelter, housing, sanitation system
*provision of essential drugs
*equible distribution of all health facilities, goods and services
*national public health strategy and plan of action (public health k turi valstyb daryti, kad
visuomen bt sveika. Pvz.: seatbelts in cars)
HR of health special goals:
*to respect.
*to protect (by creating laws prevent of hard work conditions)
*to fulfill (they create conditions that allow people exersice their HR of health)

2 PASKAITA
Comparative health care systems
HC health care
Transparent HC you can tell how it works
Accountable HC can you make a claim in HC?
US health care system

In US there is no healthcare system, they are focusing more on political and civil rights rather
in social rights. There are no federal constitutional rights to HC. There are some federal rights
that gives HC for some people: children, elderly, people with disabilities. US are more focusing
on health insurance rather than HC. If u loose your job, u loose your health insurance. With
Patient protection and affordable care act (2010) state seeks to expand health insurance
system. US sees health care system as a commercial good like any other thing, rather than
human right.
Patient protection and affordable care act:
*universality in US HC system. Everyone must have Access to affordable HC.
*garantees Access to affordable health insurance by reforming private health insurance and
expanding federal programs.
If state do not recognize HC system as a human right, state has a permission to permit other
rights that supports HC system and then lawyers can work with these rights to support HC
system. EX. Housing right, right to education, legal statuse (access to certain programs, as
example for imployment); family law (wills, marriages, adoption).
Universality in US HC system.
Question: Does anyone has an Access to HC?
Answer: no, there are only a few groups of people: prisoners, elderly, children, ppl with
disabilities. Patien protection act seeks to expand these groups. It means, US is making a
progress in HC system !
Equity in US HC system.
Question: does the system treat HC as a public good? Or a private interest?
Answer: as a private good.
Question: does the system allocate (paskirsto) resources equitably according to health needs?
Answer: ?
Transparency and accountability in US system.
Question: do people have information to understand and navigate the system easily?
Answer: No, it is very difficult to understand. It is very complex and huge system, but US is
trying to fix it.
Question: are patients and communities provided with the information they need to make
decisions?
Answer: YES, US system is very strong on patient rights and NO, because system is too
complicated for people to understand.
Public participation.
Question: do people has a voice in US?
Answer: Yes
Lithuanian Health care system
Article in moodle talks about:
*participation in HC reform proccess
*communication and cooperation among HC professionals
*ethical issuess in doctor and patient relationship (decentralisation)
Universality.
Question: does the system provides HC to all?
Answer: more universal than in US, but not 100% at all.

Equity.
Question: does the system treat HC as a public good? Or private interest?
Answer: public good?
Transparency and accountability:
Question: do people have information to understand and navigate the system easily?
Answer: much more understandable than in US system.
Big transparency issue unofficial payments.
Public participation.
Question: do people has a voice in US?
Answer: Yes.

3 PASKAITA
Patient care
Patient care includes these stages:
Preventative care (when u are being well)

Currative care (when u are sick and u need medicines)

Palliative care (when u are at the end of your life and all you need is to help relief your pain)
It is a realationship between a doctor and a patient. Patient is rely on doctor to help
understand the information. Patient care can be influenced by social determinants: water,
food, sanitation system...
How is patient care?
*right to information
*to privacy and confidentiality
*to inform consent to treatment
*access to essential medications
Right to information.
Pacientai danai neino, jog turi toki teis. Tai apima: treatments, results of treatment,
diagnosis...
Right to privacy.
Teis neleisti dalintis bet kokia informacija apie savo sveikat. Ypa svarbu toms alims, kurios
propoguoja electronic records rather than in paper.
Right to informed consent.
Patient has all the information tam, kad galt pasirinkti sprendim. inoti kitus galimus ligos
sprendimo bdus, galim rizik ir pan. Also right to refuse treatment. Medical information
could be difficult to understand, so this right is quite difficult to realize.
Access to essential medications.
There are multiple reasons why people have not have this right (cost, states policy and etc).
Most influentional document European Charter of Patients rights. Not legally binding
document which has taken by individual group of people.

Be pagrindini dokument sveikatos apsaugos sistemai, kiekviena alis turi papildom

dokument. Law can be a perfect tool to solve problems as long as u are specific. Lietuvoje
yra Patient rights and health damage compensation document (1996m.).
3 straipsnis. Teis kokybikas sveikatos prieiros paslaugas
1. Pacientas turi teis kokybikas sveikatos prieiros paslaugas.
2. Kokybik sveikatos prieiros paslaug rodiklius ir j turinio reikalavimus nustato
sveikatos apsaugos ministras.
3. Pacientas turi teis savo garbs ir orumo neeminanias slygas ir pagarb
sveikatos prieiros specialist elges. Pacientui turi bti suteikiamos mokslu pagrstos
nuskausminamosios priemons, kad jis nekentt dl savo sveikatos sutrikim. Pacientas turi
teis bti priirimas ir numirti pagarboje.
4

straipsnis. Teis pasirinkti sveikatos prieiros staig ir sveikatos

prieiros specialist
1. Pacientas teiss akt nustatyta tvarka turi teis pasirinkti sveikatos prieiros
staig.
2. Pacientas turi teis pasirinkti sveikatos prieiros specialist. Sveikatos prieiros
specialisto pasirinkimo tvark nustato sveikatos prieiros staigos vadovas.
3. gyvendinant teis pasirinkti sveikatos prieiros staig, paciento teis gauti
nemokam sveikatos prieir teiss akt nustatyta tvarka gali bti ribojama.
4. Pacientas turi teis kito tos paios profesins kvalifikacijos specialisto nuomon.
gyvendinant i teis, paciento teis gauti nemokam sveikatos prieir Sveikatos
apsaugos ministerijos ar jos galiot institucij nustatyta tvarka gali bti ribojama.
5. Pacientams usienyje teikiam sveikatos prieiros paslaug kompensavimo slygas
ir tvark nustato Sveikatos apsaugos ministerija ar jos galiota institucija.
5 straipsnis. Teis informacij
1. Pacientas turi teis gauti informacij apie sveikatos prieiros staigose teikiamas paslaugas, j kainas ir
galimybes jomis pasinaudoti. ios informacijos teikimo tvark nustato sveikatos prieiros staigos vadovas.
2. Pacientas turi teis gauti informacij apie jam sveikatos prieiros paslaugas teikiant sveikatos prieiros
specialist (vard, pavard, pareigas) ir informacij apie jo profesin kvalifikacij.
3. Pacientas, pateiks asmens tapatyb patvirtinanius dokumentus, turi teis gauti informacij apie savo
sveikatos bkl, ligos diagnoz, sveikatos prieiros staigoje taikomus ar gydytojui inomus kitus gydymo ar tyrimo
bdus, galim rizik, komplikacijas, alutin poveik, gydymo prognoz ir kitas aplinkybes, kurios gali turti takos
paciento apsisprendimui sutikti ar atsisakyti silomo gydymo, taip pat apie padarinius atsisakius silomo gydymo. i
informacij pacientui gydytojas turi pateikti atsivelgdamas jo ami ir sveikatos bkl, jam suprantama forma,
paaikindamas specialius medicinos terminus.
4. io straipsnio 3 dalyje nurodyta informacija pacientui gali bti nesuteikta tik tais atvejais, jeigu tai
pakenkt paciento sveikatai ar sukelt pavoj jo gyvybei arba kai pacientas io statymo nustatyta tvarka atsisako ios
informacijos. Sprendim neteikti pacientui informacijos, kuri gali pakenkti paciento sveikatai ar sukelti pavoj jo
gyvybei, priima gydantis gydytojas, iskyrus atvejus, kai statymai nustato kitoki tokio sprendimo primimo tvark.
Apie sprendimo neteikti informacijos primim ir jo motyvus paymima medicinos dokumentuose. Tais atvejais, kai
praneimas bt prielaida alai pacientui atsirasti, visa iame straipsnyje numatyta informacija pateikiama paciento
atstovui ir tai prilyginama informacijos pateikimui pacientui. Informacija pacientui pateikiama, kai inyksta alos
atsiradimo pavojus. Paciento psichikos ligonio teiss gauti informacij ypatumus nustato Psichikos sveikatos
prieiros statymas.
5. Jeigu paciento tolesnis buvimas sveikatos prieiros staigoje nra medicinikai pagrstas, prie iraant i
sveikatos prieiros staigos namus ar siuniant kit sveikatos prieiros staig, pacientui arba io ir kit statym
nustatytais atvejais jo atstovui turi bti isamiai paaikintas tokio sprendimo pagrstumas ir tolesns sveikatos
prieiros tstinumas. Gavs toki informacij, pacientas arba io ir kit statym nustatytais atvejais jo atstovas
patvirtina tai parau. Kai pacientas, kuris jo hospitalizavimo metu negali bti laikomas gebaniu protingai vertinti
savo interes, iraomas i sveikatos prieiros staigos ar siuniamas kit sveikatos prieiros staig, ioje dalyje
nurodyta informacija turi bti pateikta paciento atstovui, jeigu jis pasiraytinai nurodytas paciento medicinos
dokumentuose arba jeigu paciento atstovas sveikatos prieiros staigai yra pateiks atstovavim patvirtinant
dokument, atitinkant iame ir kituose statymuose nustatytus reikalavimus.
6 straipsnis. Teis neinoti

1. Informacija apie paciento sveikatos bkl, ligos diagnoz, sveikatos prieiros staigoje taikomus ar
gydytojui inomus kitus gydymo ar tyrimo bdus, galim rizik, komplikacijas, alutin poveik, gydymo prognoz
negali bti pacientui pateikiama prie jo vali. Atsisakym informacijos pacientas turi aikiai ireikti ir patvirtinti
parau.
2. io straipsnio 1 dalyje nurodyti informacijos pateikimo pacientui apribojimai netaikomi, kai dl paciento
atsisakymo gauti informacij gali atsirasti aling padarini pacientui ar kitiems asmenims.
7 straipsnis. Teis susipainti su raais savo medicinos dokumentuose
1. Paciento pageidavimu jam turi bti pateikti jo medicinos dokumentai. iame straipsnyje nurodyt
medicinos dokument pateikimas pacientui gali bti ribojamas, jeigu juose esanti informacija pakenkt paciento
sveikatai ar sukelt pavoj jo gyvybei. Sprendim neiduoti pacientui medicinos dokument priima gydantis
gydytojas. Apie sprendimo neiduoti medicinos dokument primim ir jo motyvus paymima medicinos
dokumentuose.
2. Sveikatos prieiros specialistas pagal savo kompetencij privalo paaikinti pacientui ra jo medicinos
dokumentuose prasm. Jeigu paciento reikalavimas yra pagrstas, netikslius, neisamius, dviprasmikus duomenis
arba duomenis, nesusijusius su diagnoze, gydymu ar slauga, sveikatos prieiros specialistas per 15 darbo dien turi
itaisyti, papildyti, ubaigti, panaikinti ir (ar) pakeisti. Sveikatos prieiros specialisto ir paciento gin dl ra jo
medicinos dokumentuose itaisymo, papildymo, ubaigimo, panaikinimo ir (ar) pakeitimo sprendia sveikatos
prieiros staigos vadovas.
3. Paciento psichikos ligonio teiss susipainti su paciento medicinos dokumentais ypatumus nustato
Psichikos sveikatos prieiros statymas.
4. Su nepilnameio paciento iki 16 met medicinos dokumentais turi teis susipainti jo atstovai.
5. Pateikus asmens tapatyb patvirtinanius dokumentus, pacientui pageidaujant, jo lomis sveikatos
prieiros staiga privalo padaryti ir iduoti sveikatos prieiros staigos patvirtintas paciento medicinos dokument
kopijas, taip pat iduoti diagnozs ir gydymo apraymus. i paciento teis gali bti ribojama tik Lietuvos Respublikos
statym nustatyta tvarka.
8 straipsnis. Teis privataus gyvenimo nelieiamum
1. Paciento privatus gyvenimas yra nelieiamas. Informacija apie paciento gyvenimo faktus gali bti renkama
tik su paciento sutikimu ir tuo atveju, jei tai yra btina ligai diagnozuoti, gydyti ar pacientui slaugyti.
2. Sveikatos prieiros staigose duomenys apie paciento buvim sveikatos prieiros staigoje, jo sveikatos
bkl, jam taikytas diagnostikos, gydymo ir slaugos priemones raomi nustatytos formos ir ri paciento
medicinos dokumentus. Nustatant i dokument form, turin ir naudojimo tvark, turi bti utikrinama paciento
privataus gyvenimo apsauga.
3. Visa informacija apie paciento buvim sveikatos prieiros staigoje, gydym, sveikatos bkl, diagnoz,
prognozes ir gydym, taip pat visa kita asmeninio pobdio informacija apie pacient turi bti laikoma konfidencialia
ir po paciento mirties. Teis gauti informacij po paciento mirties turi pdiniai pagal testament ir pagal statym,
sutuoktinis (partneris), tvai, vaikai.
4. Konfidenciali informacija gali bti suteikiama kitiems asmenims tik turint raytin paciento sutikim,
kuriame yra nurodyta tokios informacijos suteikimo pagrindas ir naudojimo tikslai, iskyrus atvejus, kai pacientas
medicinos dokumentuose yra pasiraytinai nurods, koks konkretus asmuo turi teis gauti toki informacij, taip pat
tokios informacijos teikimo mast ir terminus. Pacientas turi teis nurodyti asmenis, kuriems konfidenciali
informacija negali bti teikiama. Asmenims, tiesiogiai dalyvaujantiems gydant ar slaugant pacient, atliekantiems
paciento sveikatos ekspertiz, be paciento sutikimo konfidenciali informacija gali bti suteikiama tais atvejais ir tiek,
kiek tai btina paciento interesams apsaugoti. Kai pacientas laikomas negaliniu protingai vertinti savo interes ir
nra jo sutikimo, konfidenciali informacija gali bti suteikiama paciento atstovui, sutuoktiniui (partneriui), tvams
(tviams) ar pilnameiams vaikams tiek, kiek tai btina paciento interesams apsaugoti.
4 PASKAITA
Children health
Svarbiausias dokumentas Convention on the rights of child (1989).
Vaikams taip pat galioja ir European convention on HR.
Includes other sociable rights: water, sanitation system, safe condition of school...
Children 18 and younger.

Children are uniqly vulnerable, because they have less options of violation of their rights.
The best interest of the Child, Article 3:
*participation. Evolving capacity kuo vyresnis vaikas, tuo daugiau turi galimybi priimti
sprendimus on their own. Convention seeks to improve this.
*protection.
*prevention from harm.
*provision of assistance.
Some specific rights of Children:
*right to life, survival, development.
*right to non-discrimination. Based o nage, racial, ethic groups, belonging to minority groups.
States need to work actively, need to take special measures.
*right to information. How it looks on children? Dl savo amiaus danai jiems prijimas prie
informacijos yra ribotas, apimant informacij apie ntum, ukreiamas ligas ir tt.
*right to education.
*freedom from abuse, torture and ill-treatment.
*freedom from economic or sexual exploitation. Children are particularly vulnerable because
they have less chances to deny from it. Nedraudia vaikam apskritai dirbti, bet draudia dirbti
baisiomis slygomis. alis gali nustatyti ami nuo kurio vaikams galima dirbti, kiek valand
dirbti, kokiu grafiku ir pan., tai nebus paeidimas.
*freedom from harmful traditional practices. Kai kurios teiss yra contravertional, because it
can change the states policy. Ex. Marriages of very young girls some states permit it. State
has an obligation to stop policy that violating harmful trational practices. HR perspective is
panaikinti traditional practices on violating childrens rights.
Byla Siliadin vs. France.
Mergait ivyko kit al. Jai nebuvo leista mokytis, nes ji buvo emigrant, niekas
nepasirpino pakeisti jos statuso, nors ir adjo, tuo paiu paimdami jos pas. Ji gyveno
neturdama asmens dokumento, negaldama mokytis. Ji buvo darbinta pas mones dirbti
namuose baisiomis slygomis. Ji bijojo skstis policijai, todl pasak kaimynams, kurie ikviet
policij. Byla nukeliavo Pranczijos teism, teismas nuteis mergaits darbdavius 2 metam
kaljimo because they did find an expoitation of this girl. Nuteistieji apsiskund apeliacijai.
Apeliacija sprendim pakeit, kaljim pakeit baud. Mergait apsiskund ECHR. ECHR
pasak, kad pranczai nebuvo nustat tiesykli prie slavery.
Question: Did French criminal law provide sufficient and effective protection against child
slavery, servitude, or compulsory labor, as required by the European Convention on Human
Rights?
Answer: No.
Important key terms:
Vulnerability paeidiamumas.
Servitude vergov, katorga.
Slavery vergov.
Evolving capacitys kuo vyresnis vaikas, kuo daugiau turi galimybi priimti sprendimus savo
galva.
Traditional practices alies nustatytos taisykls, tapusios tradicijomis, kurios paeidia
mogaus teises.

6 PASKAITA
People with disabilities

In US HC is not one of peoples rights. So US is not a party of convention on people with disab.
Who are these people? Includes those who have long-term physical, mental, intellectual or
sensory impairments which in interaction with various barriers may hinder their full and
effective participation in society on an equal basis with others.
Models of disab.:
*moral model. The oldest model. Esm: disability is a reflection of individual sin.
*medical model. Defines disab. as smth physical or medical problems. As an issue of
medicine. Response of disab. should be treat or cure that disability. This model was popular in
Western cultures almost 200 years. Problem with this model: if u think that disab. is physical
problem, then population has very less obligation to cure it.
*economic model. Esm: person with disab. is out of labour market. Problem: a lot of ppl who
have disab. can and do work.
*social model. Convention on ppl with disab.. Problem is with the environment and social,
not with exact people with disab. Society and a state does have an obligations. Ex. Pavyzdys
su laiptais, kai j nra.
*civil rights or HR model. This is the next step if u believe in social model. HR model
convention on the rights of ppl with disab. These people has a right to non-discrimination on a
basis of disab. HR model goal: eliminate irrational points.
Convention on people with with disab. provides:
*article 25. Distinction between disability and illness. Person with disab. can be healthy in
fact. Convention seeks to change assumption that ppl with disab. cannot participate in life in
any aspect.
*non-discrimination means also economic accessibility of HC. States cant exclude these ppl
from accessibility of HC system. Ex. vairs informaciniai bukletai turi bti prieinami ir akliems
monms, t.y. parayti brailio ratu.
*Informed consent. Vulnerability of ppl with disab. emphasize, that these ppl has a right of
informed consent as any other person. Convention seeks to promote in making decisions for
ppl with disab.
*sexual and reproductive care. Turi alys traukti tuos mones taip pat, kaip ir visus kitus. It is
assumed that these people has not any sexual life, but they has it. Forced sterilization or
abortions is a particular vulnerability. It is a big violation.
Special issue quality HC and specialized services. Women with disab. are in bigger risk of not
to be diagnosiad of cancer.
Rights that supports a right to health:
*social determinants of helath education, work and employment. Svarbu aprpinti vaikus
isilavinimu, kad jie galt suprasti, k sako gydytojai.
*freedom from violence, abuse and exploitation. Convention provides very detailed directives
about that problems.
*freedom from torture.
Institutionalisation.
These ppl segregated in institutions because of their mental and physical issues. Poor
conditions in hospitals is very big problem.
Convention provides community living instead institutionalisation. Not every person can do
this, but convention seeks to change an assumption that ppl with disab. CANT live in
cummunities. This can be a difficult decision for a state, but states can make a commitment,
thay can develop national strategy to promote community living and etc. So
institutionalization can be stopped. Institutionalisation is a form of discrimination. Esm: jei

mogui i tikrj nereikia gultis ligonin dl savo negalios arba jei jis neireik noro j
gultis, tai ir neturi ten gulti.
Keyterms:
*reasonable accomodations exeptions from general rule for ppl with disab.
*informed consent not being permitted to make own decision.
*capacity ability of making decision on their selfs.
*guardianship/substituted decision making sprendimas labiausiai atitinkantis ppl with disab.
interesus.
Right to equality. Violations: deny of not to marry, deny of not taking them ID cards and etc.
Byla H.M. vs. Sweden.
H.M. had physical disab., but shes living in her house and she wants to stay there. Her doctor
recommended her to go to hospital. It is difficult for her, so doctor recommended her to build
a therapy pool near her house. Problem: planning and building act of Sweden that deny that
pool. She asked for permission. They said NO. She appeals, appeal was denied. She asks HR
comity for help. They said: this is denial of reasonable accomodations. Esm: skirtingose
situacijose esantys mons turi bti vertinami skirtingai nuo bendros taisykls,
because states are responsible to providing reasonable accomodations. State may
have a rule that may seem fair, but applying this rule to ppl with disab. could be not very fair,
because they need special help. This case shows social model of disability. Also shows
equal treatment that means that sometimes equal means differently applying rule for
different people.

8 PASKAITA
Palliative care
World Helath Organisation rpinasi itos teiss gyvendinimu.
Palliative care helps ppl at the end of life live in dignity rather in pain.
Groups of ppl which includes palliative care:
*cancer group. The biggest group.
*ppl living in IV or AIDS (they have challenges, because progressive depends on patient
individually).
*children with terminal illness and deseases (by developing their activity, education state can
help them.
Palliative care cal include spiritual help for person with illness and for him/her family.
Palliative care is raleted with legal measures.
Right to health includes palliative care. Palliative care in internationally.
Denial of palliative care:
*denial freedom from torture.
*if a person can not have medication to relief his pain, it is a violation.
Palliative care also includes right to life, right to non-discrimination and etc.