Trust is Not Enough

Book excerpt: 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.