[Patients' rights - human rights].
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Immediately after the liberation of Kuwait by a coalition of allied forces in March 1991, representatives of Physicians for Human Rights traveled to Kuwait and conducted an inquiry into human rights violations allegedly perpetrated by Iraqi forces. The inquiry focused on the abuses that were said to have occurred in health care institutions. Human rights abuses by the Iraqis in Kuwaiti hospitals were documented, but certain allegations proved to be unfounded. However, Kuwaiti abuses of those accused of collaborating with the Iraqi invaders, in particular Palestinian citizens of Kuwait, were also observed. The trip and inquiry generated questions about the scope and applicability of medical ethical principles to physicians in different cultures and in situations unlike those in which medicine is normally practiced. In light of the Kuwait experience, Physicians for Human Rights has drawn tentative conclusions about the universal nature of medical ethics.
American parents and health care professionals are faced with medical/ethical dilemmas regarding whether or not to respect the natural integrity of the male newborn's body. In the English-speaking countries, where circumcision of infants was initially adopted to prevent masturbation, medical "reasons" were postulated to justify a practice most of the world has never considered. This resulted in a spectrum of medical recommendations for surgical removal of normal genital tissue in all male newborns to prevent diseases (foreskin inflammation, urinary tract infections, and sexually transmitted diseases) that could be effectively treated medically without the risks of surgery. Only by denying the existence of excruciating pain, perinatal encoding of the brain with violence, interruption of maternal-infant bonding, betrayal of infant trust, the risks and effects of permanently altering normal genitalia, the right of human beings to sexually intact and functional bodies, and the right to individual religious freedoms can human beings continue this practice.
The advances made in life sciences are one of the most significant features of the 20th century scientific revolution and human rights obviously enjoy prominence among the legal issues affected by the development of medicine. The case law of the organs of the European Convention on Human Rights arising from developments in the biomedical sciences is reviewed. The approach of especially the European Commission on Human Rights to the consequences of advances in the life sciences on the protection of the individual's physical integrity and the protection of freedom of thought and private and family life is analysed. 'Contrary to what we are led to believe, it is not from the starting-point of biology that a particular idea of man can be formed; on the contrary, it is from the starting-point of a particular idea of man that biology can be used to serve him': F Gros, F Jacob & P Royer Life Sciences and Society (1979) 288.
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The problem of biomedical research and human rights is reviewed from the perspectives of current issues, historical events, and other sciences. Government control of research, reactions to and possible consequences of that control, and the concern for consent from members of vulnerable populations are examined. The nature of research is discussed and the origins of opposing ethical views are described in an attempt to clarify the issues within the problem.
The effects of 5-carboxamidotryptamine (5-CT) and the gastrokinetic benzamides renzapride and cisapride on contractile force were investigated using isolated paced right atrial appendages from patients treated with beta-adrenoceptor blocking agents who were undergoing open heart surgery. These effects were compared to those of 5-hydroxytryptamine (5-HT). The effects of the drugs on atrial cyclic AMP levels and cyclic AMP-dependent protein kinase ratios were also investigated. The drugs all increased contractile force of rank order of potency was 5-HT greater than renzapride greater than cisapride greater than 5-CT. The maximum responses, expressed as a fraction of the response to 200 mumol/l (-)-isoprenaline, were 5-HT 0.6, 5-CT 0.6, renzapride 0.4 and cisapride greater than or equal to 0.2, suggesting that the latter two are partial agonists. 5-HT, 5-CT and renzapride but not cisapride caused significant shortening of time to peak force. The effects of the four drugs were blocked by mumolar concentrations of ICS 205-930, suggesting an involvement of 5-HT4 receptors. As expected of partial agonists both renzapride and cisapride caused simple competitive antagonism of the positive inotropic effects of 5-HT. The estimated equilibrium dissociation constants pKP (-log mol/l KP) were 6.7 for renzapride and 6.2 for cisapride. 5-CT at concentrations up to 10 mumol/l did not antagonise the effects of 5-HT. In the presence of (+/-)-propranolol 0.4 mumol/l, 5-HT 10 mumol/l, 5-CT 100 mumol/l, renzapride 10 mumol/l and cisapride 40 mumol/l significantly increased cyclic AMP levels. 5-HT and renzapride also significantly increased cyclic AMP-dependent protein kinase activity, whereas 5-CT caused only marginal stimulation and cisapride was ineffective. The results confirm the existence of a human right atrial 5-HT receptor that is similar in nature to, but not necessarily identical with, the 5-HT4 receptor of mouse embryonic colliculi neurones. The main difference is that in human right atrium the benzamides are less potent and efficacious than 5-HT and that cisapride is less potent and less efficacious than renzapride while in mouse embryonic colliculi these two benzamides are equipotent with and more efficacious agonists than 5-HT. We designate the human right atrial 5-HT receptor 5-HT4-like. The human right atrial 5-HT4-like receptor greatly resembles porcine sinoatrial and left atrial 5-HT4-like receptors and also appears to be similar to 5-HT4-like receptors of guinea-pig ileum and rat oesophagus.
This article examines the relationship between human rights and the pattern of capital accumulation in the Third World. The repressive authoritarian State increasingly constitutes the means for enforcing the intensive exploitation of labor in Third World industrial enclaves and commercial agriculture. While the development of center capitalism has evolved toward "the Welfare State" and a framework of liberal sociodemocracy, the "peripheral State" is generally characterized by nondemocratic forms of government. This bipolarity in the state structure between center and periphery is functionally related to the international division of labor and the unity of production and circulation on a world level. The programs and policies of the center Welfare State (health, education, social security, etc.) constitute an input of "human capital" into the high-technology center labor process. Moreover, welfare programs in center countries activate the process of circulation by sustaining high levels of consumer demand. In underdeveloped countries, the underlying vacuum in the social sectors and the important allocations to military expenditure support the requirements of the peripheral labor process. Programs in health in the center and periphery are related to the bipolarity (qualification/dequalification) in the international division of labor. The social and economic functions of health programs are intimately related to the organic structure of the State and the mechanics whereby the State allocates its financial surplus in support of both capitalist production and circulation.
We used a combination of radioreceptor binding and autoradiographic techniques to study the pharmacological characteristics and anatomical localization of [3H]-quinuclidinyl benzilate (QNB) binding sites in the human right coronary artery. The ligand was bound to sections of the human right coronary artery in a manner consistent with the labelling of muscarinic receptors. The addition of pirenzepine or of carbachol to the incubation medium to generate displacement curves was indicative of the presence of M1 and M2 receptors in the right coronary artery. Autoradiography showed the localization of M1 sites primarily in the medial layer of the right coronary artery. M2 sites were located primarily in the adventitia. No [3H]-QNB binding sites were observed in the endothelium. A possible role of muscarinic receptors in the pathogenesis of coronary vasospasm is discussed.
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Alleged reports from the warfronts over the past few years have been shocking: bombing of hospitals and ambulances, health workers refusing to care for wounded members of the opposition, medical involvement in the torture of prisoners, etc. Such conduct is in violation of professional codes of conduct and the Geneva Conventions. Yet the combatants and health care personnel in too many instances remain impervious. In many economically and politically unstable countries, where uprisings and war can explode any day, anyone can become involved, but particularly health care professionals because of the nature of their work. When confronted with a dilemma in a conflict situation, nurses must remember that they are accountable for their own professional actions and as such must be aware of patient/client rights and of their rights and obligations under the terms of the Geneva Conventions of 1949 and the Additional Protocols of 1977. To assist nurses in making the right decisions, ICN developed a Code for Nurses and in 1984, with the League of Red Cross and Red Crescent Societies, prepared an educational package for nurses on the Geneva conventions and the principles of humanitarian law. Subsequently ICN, with its member nurses' associations, developed position papers on the role of nurses in caring for prisoners and detainees and in safeguarding human rights. And today in face of daily reports of humanitarian violations, ICN urges NNAs to reconfirm their commitment and to take concrete moves to assure that their members fully understand what is expected of nurses in conflict situations. Extracts of the Geneva Conventions' essential provisions and ICN's position statements are provided below as one step in bringing about this awareness.