The Oviedo Convention of the Council of Europe on Human Rights and Biomedicine (27) speaks about " equitable access to health care ". The Declaration of Hawaii (28) is also concerned with the common good and a just allocation of health resources. The APA is also looking into questions of abuse by managed-care organizations of psychiatry and into those touching on parity (International Commission for Parity, American Psychiatric Association), and has recently published a recommendation that the United States Congress enact certain legislated standards to protect the rights of patients against certain abusive managed-care practices.

3.3. Persons with Disabilities

When speaking of equity and while seeking to avoid discrimination, differentiation must also be demanded, in the sense of seeking to ensure the right to equal treatment of disadvantaged persons. Differentiation, however, becomes discriminatory when its purpose or effect is to deny or restrict the equal enjoyment of human rights.

Apart from being a condition inherent in a person, disability is, to a large degree, based on societal attitudes . There is empirical evidence of discriminatory practices towards disabled people in the areas of access to education; meaningful participation in the labor force and in the statistics on physical and sexual abuse. Promoting and protecting the rights and dignity of disabled people require legal approaches, diminishing societal barriers, and modifying negative attitudes towards disability.

The United Nations called attention in 1982 to the fact that more than 500 million people in the world are disabled as a consequence of mental, physical or sensory impairment. They are entitled to the same rights as all other human beings and to equal opportunities. Too often their lives are handicapped by physical and social barriers in society which hamper their full participation. Because of this, millions of children and adults in all parts of the world often face a life that is segregated and debased.

Disability, from a medical perspective, was seen as a " deficit " inherent in the person with an impairment that could be eventually cured following successful intervention. This approach did not recognize the possibility of potential adaptations of the patient and undervalued the importance of physical environment and social attitude towards the experience of disability. Disability was then redefined as a statistical deviance from the norm, redefining social attitudes and situating disabled people within the normal range of human experience, when disabled people themselves began speaking about their issues in terms of rights. Finally, disabled people began advocating for their own human rights, identifying environmental and social barriers as forms of discrimination requiring a response based on social justice. The issue became one of social oppression. Disabled people must be treated by society as " equal in dignity and rights " (UDHR). Differences in mental capability can be accommodated without discrimination. Promoting and protecting the rights and dignity of disabled people will require a combination of : legal approaches ; attention to the concrete realities of disability ; removing societal barriers ; modifying the perception of, and cultural attitudes towards, persons with disabilities.

References

1. The U.N. Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (1991).

2. The Recommendation on the Situation of the Mentally Ill of the Council of Europe (1977).

3. General Assembly of the United Nations, Resolution 2856/XVI, Declaration on the rights of mentally retarded persons (20th December 1971).

4. General Assembly of the United Nations, Resolution 3447/XXX, Declaration on the rights of disabled persons (9th December 1975).

5. General Assembly of the United Nations, Resolution 48/95, Standard rules on the equalization of opportunities for persons with disabilities (20th December 1993).
Committee on Economic, Social and Cultural Rights, General Comment on People with Disabilities, UN Doc. E/C. 12/1993/WP.13 (25 November 1994)

6. Degener, T., Koster-Dreese, Y. (eds) Human Rights and Disabled Persons (Dordrecht : Martinus Nijhoff Publishers), 1995

7. Hannum, H. : " The HUDHR in National and International Law ", Health and Human Rights Vol 3, No. 2, 145-160

8. The report on the protection of human personality and its physical and intellectual integrity, in the light of advances in biology, medicine and biochemistry (E/CN.4/1172 and Add.1-3 and Corr.1) was prepared.

9. Hendriks, A., Degener, T., " The Evolution of a European Perspective on Disability Discrimination ", European Journal of Health Law 1 (4) (1994) :343-366

10 " Geneva Initiative on Psychiatry "

11. " Association pour les droits de l'homme en psychiatrie "

12. Bazelon Center for Mental Health Law : bazelon@tidalwave.net

13. "The François-Xavier Bagnoud Center for Health and Human Rights " at the Harvard School of Public Health

14. Molnar, B.E. : " Juveniles and Psychiatric Institutionalization : Toward better due process and treatment review in the United States ", Health and Human Rights, vol. 2, n. 2, 98-117 (1997)

15. WPA Interventions (known as the Daes Report) in the Working Group, established by the Economic and Social Council on " The question of persons detained on the grounds of mental health or suffering from mental disorder " (1983)

16. Compendium Statistics on Special Population Groups, Series Y, No. 4. Author, Department of International Economic and Social Affairs Statistical Office : New York, 1990, 342 pp.

17. Jacobson, J.W.: Dual Diagnosis Services : history, progress and perspectives, in Bouras, Ed.: "Psychiatric and Developmental Disorders in Developmental Disabilities and Mental Retardation, Cambridge University Press, 1999, pp329-359

18. Sovner, R.: Limiting factors in the use of DSM III with mentally retarded persons. Psychopharmacology Bulletin, 22, 1055-9

19. Moss, S. Assessment: Conceptual issues. In Bouras, Ed. : "Psychiatric and Developmental Disorders in Developmental Disabilities and Mental Retardation, Cambridge University Press, 1999, pp 18-38

20. Gostin, L.O., " The Americans with Disabilities Act and the U.S. Health-Care System ", Health Affairs 11 (3) (1992) : 248-257.

21. Jacobson, A. and Richardon, B : Assault experiences of 100 psychiatric inpatients : evidence for the need for routine enquiry. American Journal of Psychiatry. 144 (1987) :908-913. Cited in D. Sobsey and T. Doe (1991) ibid.

22. Geiger, H.J. : " Inequity as Violence: Race, Health and Human Rights in the United States ", Health and Human Rights, vol. 2, no. 3, pp 7-13.

23. Neufeldt, A. and R.Mathieson : Empirical Dimensions of Discrimination against Disabled People, Human Rights and Health

24. Alleyne, G.A.O. : " Health and Human Rights: the Equity Issue " Health and Human Rights, vol. 2, no. 3, pp 65-71

25. Hahn, H., " Towards a politics of disability : definitions, disciplines and politics ", The Social Science Journal 22 (4) (1985) : 87-105.

26. Finkelstein, V. : Attitudes and disabled people (New York : World Rehabilitation Fund, 1980) 92 pp.

27. The Covenant of the Council of Europe on Human Rights and Bio-medicine (Articles 25 and 27) (Oviedo, 1997)

28. The World Psychiatric Association, Declaration of Hawaii (1983)