Trust Is Not Enough: Bringing Human Rights to Medicine

During the last half-century many international declarations have proclaimed health care to be a fundamental human right. But high aspirations repeatedly confront harsh realities, in societies both rich and poor. To illustrate this disparity, David and Sheila Rothman bring together stories from their investigations around the world into medical abuses. A central theme runs through their account: how the principles of human rights, including bodily integrity, informed consent, and freedom from coercion, should guide physicians and governments in dealing with patients and health care.

Over the past two decades, the Rothmans have visited post-Ceausescu Romania, where they uncovered the primitive medical practices that together with state oppression caused hundreds of orphans to develop AIDS. They have monitored the exploitative international traffic in organs in India, China, Singapore, and the Philippines. One of the most controversial questions they explore is experimentation on human beings, whether in studies of the effects of radioactive iron on pregnant women in 1940s Tennessee or in contemporary trials of AIDS drugs in the third world. And they examine a number of rulings by South Africa’s Constitutional Court that have suggested practical ways of reconciling the right to health care with its society’s limited resources.

Whether discussing the training of young doctors in the US, the effects of segregation on medicine in Zimbabwe, or proposals for rationing health care, David and Sheila Rothman conclude that an ethical and professional concern for observing medicine’s oldest commandment—do no harm—must be joined with a profound commitment to protecting human rights.

Addresses the issues at the heart of international medicine and social responsibility.

During the last half-century many international declarations have proclaimed health care to be a fundamental human right. But high aspirations repeatedly confront harsh realities, in societies both rich and poor. To illustrate this disparity, David and Sheila Rothman bring together stories from their investigations around the world into medical abuses. A central theme runs through their account: how the principles of human rights, including bodily integrity, informed consent, and freedom from coercion, should guide physicians and governments in dealing with patients and health care.

Over the past two decades, the Rothmans have visited post-Ceausescu Romania, where they uncovered the primitive medical practices that together with state oppression caused hundreds of orphans to develop AIDS. They have monitored the exploitative international traffic in organs in India, China, Singapore, and the Philippines. One of the most controversial questions they explore is experimentation on human beings, whether in studies of the effects of radioactive iron on pregnant women in 1940s Tennessee or in contemporary trials of AIDS drugs in the third world. And they examine a number of rulings by South Africa’s Constitutional Court that have suggested practical ways of reconciling the right to health care with its society’s limited resources.

Whether discussing the training of young doctors in the US, the effects of segregation on medicine in Zimbabwe, or proposals for rationing health care, David and Sheila Rothman conclude that an ethical and professional concern for observing medicine’s oldest commandment—do no harm—must be joined with a profound commitment to protecting human rights.

Doody Review Services

Reviewer:Mary Monsen Kunze, MBA,MA, PhD(ABD(Medical College of Wisconsin Health Policy Institute)
Description:This compelling book about human rights in medicine gives an international view of the growing corruption driven by the enormous economic gains to be gotten from many disciplines in medicine today.
Purpose:The authors take a straight and narrow approach to the doubtful benefit of utilitarian solutions to very complicated issues, particuarly in AIDS research and transplants. The book clearly lays out the challenges facing healthcare professionals relating to human rights.
Audience:The very credible authors clearly write to a number of audiences. Medical societies, IRBs, and hospital administrators as well as physicians and trainees would benefit from reading this worthwhile work.
Features:The chapter titled "The Shame of Medical Research" is especially intriguing. The author's point of view is clearly discussed. It is interesting to read another view put forth very dramatically by the dean of the Harvard School of Public Health, Dr. Bloom. The presentation is balanced and fair, leading readers to form their own thoughts on these important bioethical issues.
Assessment:It is unusual for a book that is basically academic in nature to be a page-turner, but this one is. I am sure my colleagues will enjoy reading this fine contribution to the ethical literature.

David J. Rothman is Bernard Schoenberg Professor of Social Medicine and History at Columbia University. Sheila M. Rothman is Professor of Public Health at Columbia University. Their books written together include The Willowbrook Wars: A Decade of Struggle for Social Justice and The Pursuit of Perfection: The Promise and Perils of Medical Enhancement. They live in New York City.