Health and Human Rights:
Liberation Medicine and Oppression Medicine
"Health is a fundamental human right indispensable for the exercise of
other human rights. Every human being is entitled to the
enjoyment of the highest attainable standard of health conducive to
living a life in dignity."
[From General Comment 14: The right to the highest attainable standard of health (article 12) of the
UN Committee on Economic, Social and Cultural Rights (CESCR)]
Those concerned for human rights and health share the common goals of
alleviating suffering and promoting well-being of all people.
Conceptually one can point to the rising incidence of HIV/AIDS, to women's
health issues, including gang rapes and the sex trade in
Burma, and to the blatant violations of human rights in Burma's prisons
as having brought attention to the intrinsic connections that exist
between health and human rights. Medicine is the conscious,
conscientious use of health to promote social justice and human dignity.
In their book The Virtues in Medical Practice, Edmund Pellegrino, MD, and David
Tomasma, PhD, present the concept of medicine as a moral community:
"These three things - the nature of illness, the non proprietary
character of medical knowledge, and the oath of fidelity to the patient's
interests - generate a strong moral bond and a collective
responsibility... Medicine cannot, and should not, undertake all of this
alone. It can join with other health professionals, concerned people and
People have been practicing Medicine for a long time, over
2000 years perhaps, without being aware that they were practicing it
in two different ways one way that I call "liberation medicine" and the other way that I call "oppression medicine."
Liberation Medicine implies caring, compassion and humility three
qualities too seldom seen in clinical medicine or in the training of
health professionals. The patient wants to know how much you care before
they care how much you know. The caring relationship requires nurturing
the patient and caring about what happens to them. Compassion means
"suffering with." The best doctors feel as their own the suffering of
their patients and the patients' loved ones. Compassion means empathy
and kindness, which patients need much more than they need another test.
Doctors usually have strong egos, strong self-confidence. But to truly
understand a person requires a feeling of equality.
There are still physicians in some parts of the world who continue to
comply with governments in supporting the use of torture or other
inhumane punishment as a means of exercising state control, repression
or terror. During apartheid, 73,000 people were incarcerated for
indefinite periods without being charged with any crime. Many were
tortured. African surgeons who were responsible for providing medical
care to detainees were pressured not to examine detainees who had been
assaulted or tortured and not to report any injuries they did find.
Health professionals have a strong positive influence on the promotion
and protection of human rights within the populations they serve. Yet
violations of human rights perpetrated by health professionals regularly
occur. Often they occur because the health professionals fear the consequences of refusal
especially if they hold a high position in the medical field or
are employees in the military. This is oppression medicine.
How can we promote liberation medicine?
If we look at the South African experience, there still were a lot of
South African physicians who stood up to fight against apartheid
because they believed it was their moral and professional obligation to
do so. The anti-apartheid National Medical and Dental Association had
more than 1000 members by 1989. These physicians saw the suffering and
injustice of apartheid in its many manifestations. Many took significant
personal risks and suffered damage to their careers. However, it is from
their values that an ethic of health and human rights may
Liberation medicine is to forge a path for hope. Like the hope
found in Paulo Freire's Pedagogy of the Oppressed, "The dehumanization
resulting from an unjust order is not a cause for despair but for hope,
leading to the incessant pursuit of the humanity denied by injustice.
Hope, however, does not consist in crossing ones arms and waiting."
Our leader Aung San Suu Kyi has stated in the Voice of
Hope ....."Yes, I do hope because I'm working. I'm doing my bit of try
and make the world a better place, so I naturally have hope for it. But
obviously, those who are doing nothing to improve the world have no hope
for it. Why should they? They are not doing anything to improve it any
way. But I think that there are many people who are working really hard
to improve the situation. I don't mean by this politicians or leaders of
social or religious movements. I mean ordinary people. And those who are
working to bring about positive changes are always more powerful, than
those who are sitting and letting things take their course."
This means we must strive to work for liberation, make every effort to
overcome obstacles and honor the Hippocratic oath. Individuals, groups and
countries who do not believe that Health is a fundamental Human Right
will not of themselves give up the position in which they negatively
affect lives. The only way for them to do so is to receive pressure
to do so, pressure from within their own base of support (which, of
course, is also affected due to the inter-relatedness of the world as
Martin Luther King said, "you are not free until I am free").
Dr Khin Saw Win (Alice)
This commentary is based on a posting Dr. Khin Saw Win
made in the soc.culture.burma newsgroup and the FreeBurma Yahoo! Group on 2001-04-23. The posting has been edited for inclusion on the Burma Watch
International Web site.