Encyclopedia of Bioethics, 4th Edition

Editor-in-Chief: Bruce Jennings

Board Editors: Lisa Eckenwiler, Gregory Kaebnick, Barbara Koenig, Sheldon Krimsky,
Stephen R. Latham, Mark R. Mercurio
 
Human  Rights  
Stephen  P.  Marks  (2004,  2014)  
SEE  ALSO:  Death  Penalty;  Ethics:  Normative  Ethical  Theories;  Genetic  Discrimination;  Harm;  
Human  Nature;  Justice;  Law  and  Bioethics;  Law  and  Morality;  Natural  Law;  Pain  and  Suffering;  
Reproductive  Technologies;  Warfare;  Women,  Historical  and  Cultural  Perspectives  
Relations between Bioethics and Human Rights
Human   rights   constitute   a   set   of   norms   governing   the   treatment   of   individuals   and  
groups   by   states   and   nonstate   actors   on   the   basis   of   ethical   principles   incorporated   into  
national  and  international  legal  systems.  Bioethics  and  human  rights  share  a  concern  for  
just   behavior   and   apply   ethical   principles   to   the   treatment   and   well-­‐being   of   human  
beings.   Human   rights   include   the   right   to   health   and   refer   to   essential   social  
determinants   of   health   and   well-­‐being   of   people   and,   therefore,   overlap   with   many  
principles   and   norms   of   bioethics.   Human   rights   and   bioethics   differ,   however,   in   scope,  
moral  foundation,  sources,  legal  nature,  and  the  mechanisms  of  monitoring  and  applying  
the  norms.  
Scope  
Bioethics  regulates  individual  clinical  encounters  with  patients  and  research  subjects,  as  
well   as   population-­‐level   health   issues   on   the   basis   of   philosophical   principles   (Wikler  
and   Brock   2008),   extending   to   “global   health   ethics,”   which   draws   attention   to   the  
relations   between   social   justice   and   international   justice   and   the   implications   of  
inequalities  among  and  within  societies  from  the  perspective  of  global  health  (Benatar  
and   Brock   2011).   In   contrast,   the   scope   of   human   rights  covers  the  specific  standards  or  
norms  agreed  upon  in  a  given  society  to  achieve  justice  and  well-­‐being,  including  health,  
among   other   issues.   More   specifically,   they   involve   the   claims   individuals   and   groups  
can   legitimately   make   against   states   and   nonstate   actors   to   respect   their   dignity,  
freedom,  integrity,  autonomy,  and  basic  needs.    
Moral  Foundations  
Regarding   moral   foundations,   bioethics   tends   to   distinguish   between   utilitarian   and  
deontological   approaches,   the   former   stressing   the   moral   consequences   of   action   or  
inaction   with   the   ultimate   purpose   of   maximizing   the   greater   good   for   the   greatest  
number   in   society,   while   the   latter   focuses   on   treating   human   beings   as   ends   in  
themselves   rather   than   as   means.   Numerous   variations   on   these   approaches   include  
liberalism,   egalitarianism,   communitarianism,   and   post-­‐modernist   and   feminist  
approaches   (Roberts   and   Reich   2002).   The   moral   foundations   of   human   rights,   on   the  
other   hand,   draw   on   concepts   such   as   human   flourishing,   dignity,   duties   to   family   and  
society,   natural   rights,   individual   freedom,   equality,   social   justice,   and  
nondiscrimination.   All   of   these   moral   arguments   for   human   rights   are   part   of   ethical  
discourse   and   draw   on   the   concept   of   human   dignity,   which   is   thought   to   be  
foundational   to   both   human   rights   and   bioethics   and   yet   carries   a   wide   number   of  
potential  meanings  (Chapman  2011).    
The  tension  between  political  liberalism  and  democratic  egalitarianism,  between  
Locke  and  Rousseau,  between  liberty  and  equality,  between  civil  and  political  rights  and  
Marks         Human  Rights   2  

economic,   social,   and   cultural   rights,   have   been   part   of   the   philosophical   and   political  
ambiguity  of  human  rights  since  the  beginning  of  the  modern  era.  Human  rights  theory  
also  distinguishes  between  natural  law  and  positive  law  foundations.  The  former  refers  
to  rights  deriving  from  the  natural  order  or  divine  origin,  which  are  inalienable,  innate,  
immutable,   and   absolute,   whereas   in   positive   law   rights   are   recognized   through   a  
political   and   legal   process   that   results   in   a   declaration,   law,   treaty,   or   other   normative  
instrument,   which   may   vary   over   time   and   be   subject   to   derogations   or   limitations  
designed  to  optimize  respect  for  human  rights  rather  than  impose  an  absolute  standard.  
Thus   human   rights   emerge   from   claims   of   people   suffering   injustice   and   are   based   on  
moral   sentiment,   culturally   determined   by   contextualized   moral   and   religious   belief  
systems.  
Sources  
If   by   “source”   we   mean   where   one   looks   to   find   authoritative   formulations   of   ethical  
norms,  in  bioethics  this  tends  to  be  published  opinions  of  leading  academic  philosophers,  
guidelines   and   decisions   of   institutional   review   boards,   and   deliberations   or  
professional  codes  developed  by  health  and  medical  associations.  The  source  of  human  
rights   norms   is   typically   a   bill   of   rights   in   a   national   constitution,   a   treaty   or   declaration  
adopted  by  an  international  organization,  or  interpretative  documents  relating  to  these  
sources.   Thus   they   emerge   when   an   authoritative   deliberative   body   (i.e.,   one   invested  
with  law-­‐making  powers)  proclaims  them,  and  they  attain  universality  to  the  extent  that  
they   become   common   across   national   laws   and   widely   ratified   international   treaties,  
binding  virtually  every  nation.  The  International  Bill  of  Human  Rights  (consisting  of  the  
Universal  Declaration  of  Human  Rights  [UDHR]  of  1948  and  the  International  Covenant  
on   Civil   and   Political   Rights   [ICCPR]   and   the   International   Covenant   on   Economic,   Social  
and  Cultural  Rights  [ICESCR],  both  of  1966),  along  with  the  other  human  rights  treaties  
of  the  United  Nations  (UN)  and  of  regional  organizations,  constitute  the  primary  sources  
and   reference   points   for   recognized   human   rights.   Occasionally   human   rights   and  
bioethics   share   a   common   source,   as   when   an   instrument   of   international   law   directly  
addresses  an  issue  of  bioethics  and  human  rights  (e.g.,  provisions  on  informed  consent  
to  human  experimentation  in  the  ICCPR,  echoing  the  Nuremberg  Code,  or  the  Universal  
Declaration   on   Bioethics   and   Human   Rights,   adopted   by   the   United   Nations   Educational,  
Scientific  and  Cultural  Organization  [UNESCO]  in  2005).  Some  have  argued  that  human  
rights   offer   an   internationally   accepted   moral   and   legal   framework,   to   which   bioethics  
should  increasingly  refer  (Annas  2005).  
Legal  Nature    
Bioethics  standards  tend  to  rely  on  their  persuasive  value,  although  they  can  have  legal  
significance,  such  as  the  denial  of  approval  or  requirement  for  modification  of  a  research  
protocol,   the   binding   obligations   of   a   treaty   (e.g.,   the   European   Convention   on   Human  
Rights  and  Biomedicine),  and  tort  or  civil  liability  for  failure  to  comply  with  standards  of  
care.  The  legal  nature  of  human  rights  norms  ranges  from  aspirational  claims  (such  as  
the   UDHR)   to   justiciable   and   enforceable   legally   binding   obligations   (such   as   human  
rights  treaties).  Treaty  obligations  are  typical  of  human  rights  but  highly  exceptional  in  
bioethics.    
An  important  distinction  may  also  be  made  between  “rights”  and  “human  rights.”  
In   ethics   and   moral   philosophy   a   right   refers   to   any   entitlement,   the   moral   validity   or  
legitimacy  of  which  depends  on  the  mode  of  moral  reasoning  the  ethicist  is  using.  In  law,  
a   right   is   any   legally   protected   interest.   In   human   rights   discourse,   a   human   right   is   a  
higher-­‐order  right  authoritatively  defined  as  a  “human  right”  (or  its  equivalent)  with  the  
expectation   that   it   carries   a   peremptory   character   and   thus   prevails   over   other  
(ordinary)   rights.   There   is   some   disagreement   regarding   the   need   for   law.   Amartya  Sen,  
for   example,   considers   human   rights   as   “primarily   ethical   demands,”   although,   in   his  

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Marks         Human  Rights   3  

view,  they  “can,  and  often  do,  inspire  legislation,  [but]  this  is  a  further  fact,  rather  than   a  
constitutive  characteristic  of  human  rights”  (Sen  2004,  319–320).    
Methods  of  Monitoring  Compliance  
The   methods   of   monitoring   compliance   with   codes   of   bioethics   and   official  
pronouncements  of  professional  bodies  include  scrutiny  of  proposals  and  evaluation  of  
results  that  may  affect  research  design  or  policies  and  allocation  of  resources  affecting  
the  health  of  populations.  The  methods  used  in  human  rights  include  moral  judgments  
made   in   the   context   of   advocacy,   investigation   and   fact-­‐finding   leading   to   official  
pronouncements   of   political   bodies,   and   enforceable   judicial   decisions.   The   salient  
features   of   human   rights   become   clearer   in   the   sections   below   on   the   emergence   of  
human   rights   in   political   and   legal   discourse,   the   normative   content   of   human   rights,  
and  the  means  of  promotion  and  protection  of  human  rights.    
Emergence of Human Rights
The   early   formulation   of   the   norms   that   are   characterized   today   as   human   rights   is  
inseparable   from   our   understanding   of   human   nature   and   human   striving   for   justice.  
Ultimately,   human   rights   derive   from   basic   human   instincts   of   survival   of   the   species  
and   behavior   of   empathy   and   altruism   that   evolutionary   biology   is   only   beginning   to  
address.   Because   human   evolution   is   driven   by   reproductive   selfishness,   one   could  
wonder   why   the   human   species   would   develop   any   ethical   system,   like   that   of   human  
rights,   according   to   which   individuals   manifest   feelings   for   the   suffering   of   others  
(empathy)  and—even  more  surprisingly—act   in   self-­‐sacrificing  ways  for  the  benefit  of  
others  without  achieving  any  apparent  reproductive  advantage  (altruism).  E.  O.  Wilson  
explains   altruism   and   moral   behaviour   in   this   way:   “Human   beings   are   prone   to   be  
moral—do   the   right   thing,   hold   back,   give   aid   to   others,   sometimes   even   at   personal  
risk—because   natural   selection   has   favored   those   interactions   of   groups   members  
benefitting  the  group  as  a  whole”  (Wilson  2012,  247).  
Religion  and  law  have  an  ambiguous  role  in  this  historical  process.  The  history  of  
religions   is   replete   with   advances   in   the   moral   principles   of   behavior—many   of   which  
directly  influenced  the  drafting  of  human  rights  texts—but  also  in  crimes  committed  in  
the   name   of   a   Supreme   Being.   Similarly,   the   emergence   of   the   rule   of   law   has   been  
critical   both   to   advancing   justice   and   human   rights   against   the   arbitrary   usurpation   of  
power  and  to  preserving  the  impunity  of  oppressors.    
Scholars   trace   the   current   configuration   of   international   human   rights   norms  
and   procedures   to   the   revolutions   of   freedom   and   equality   that   transformed  
governments   across   Europe   and   North   America   in   the   eighteenth   century   and   that  
liberated   subjugated   people   from   slavery   and   colonial   domination   in   the   nineteenth   and  
twentieth  centuries.  Enlightenment  philosophers  derived  the  centrality  of  the  individual  
from   their   theories   of   the   state   of   nature.   Social   contractarians,   especially   the  
eighteenth-­‐century  philosopher  Jean-­‐Jacques  Rousseau,  predicated  the  authority  of  the  
state  on  its  capacity  to  achieve  the  optimum  enjoyment  of  natural  rights,  that  is,  of  rights  
inherent  in  each  individual  irrespective  of  birth  or  status.  Rousseau  wrote  in  A  Discourse  
on   the   Origin   of   Inequality   (1762)  that  “it  is  plainly  contrary  to  the  law  of  nature  …  that  
the   privileged   few   should   gorge   themselves   with   superfluities,   while   the   starving  
multitude   are   in   want   of   the   bare   necessities   of   life”   (117).   Equally   important   was   the  
concept   of   the   universalized   individual   (“the   rights   of   Man”),   reflected   in   the   political  
thinking  of  Immanuel  Kant,  John  Locke,  Thomas  Paine,  and  the  authors  of  the  American  
and   French   declarations   of   1776   and   1789,   respectively.   Much   of   this   natural   law  
tradition  is  secularized  in  contemporary  human  rights.    
World  War  II  was  the  defining  event  for  the  internationalization  of  human  rights,  
anticipated  by  Roosevelt’s  “Four  Freedoms”  speech  (1941),  confirmed  by  the  inclusion  

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Marks         Human  Rights   4  

of   human   rights   in   the   UN   Charter   (1945),   and   applied   through   bedrock   human   rights  
texts   adopted   in   the   aftermath   of   the   war   (the   Genocide   Convention   and   the   UDHR   in  
1948   and   the   Geneva   Conventions   in   1949,   followed   in   1966   by   the   two   international  
covenants)  and  greatly  expanded  by  numerous  UN  and  regional  human  rights  treaties.  
Nongovernmental  organizations  (NGOs)  played  a  role  in  all  these  developments  and  in  
subsequent   drafting   of   treaties,   as   well   as   in   the   creation   of   investigative   and  
accountability  procedures  at  the  intergovernmental  level  and  at  the  national  level.  These  
processes   were   instrumental   in   bringing   down   South   African   apartheid,   transforming  
east-­‐central   Europe,   restoring   democracy   in   Latin   America,   and   promoting   the   Arab  
Spring.  Human  rights  NGOs  are  now  active  on  all  continents  (Korey  1998;  Neier  2012).  
This   emergence   of   global   human   rights   was   contemporary   with   that   of   bioethics  
in  the  immediate  aftermath  of  World  War  II,  as  exemplified  by  the  trial  of  Nazi  doctors,  
leading   to   the   Nuremberg   Code   (1946).   Annas   (2009,   135)   argues   that   American  
bioethics—and  one  can  generalize  to  bioethics  more  broadly—was  born  from  this  trial  
but   was   “separated   at   birth”   from   international   human   rights   and   that   it   is   “time   to  
reunite  the  estranged  twins  who  can  work  much  more  effectively  together  in  the  global  
health  arena  than  they  can  separately.”  Even  those  who  criticize  Annas’s  application  of  
this   agenda   to   genetic   technology   acknowledge   that   “bioethicists   should   begin   to  
incorporate  an  appreciation  of  human  rights  perspective  and  methods  into  their  work”  
(Fenton  and  Arras  2009,  132).    
The Normative Content of Human Rights
The   current   catalogue   of   human   rights   begins   with   those   enumerated   in   the  
international  bill  of  human  rights.  They  have  been  expanded  by  a  score  of  specialized  UN  
treaties,   a   half-­‐dozen   regional   human   rights   treaties,   and   hundreds   of   international  
normative  instruments  in  the  fields  of  labor,  refugees,  armed  conflict,  and  international  
criminal   law.   The   core   human   rights   of   the   international   bill   of   human   rights   are  
summarized  in  Table  1.  
TABLE  1    
 
religious  belief  
Group  Rights  
9. Freedom  of  expression  
1. Self-­‐determination  
10. Right  to  privacy  
2. Permanent   sovereignty   over   natural  
resources   11. Nonimprisonment  for  debt  
3. Right  to  enjoy  one’s  culture   12. Fair   trial   (subdivided   into   16  
enumerated  rights)  
4. Right  to  practice  one’s  religion  
13. Right  to  personhood  under  the  law  
5. Right  to  speak  one’s  language  
14. Equality  before  the  law  
Civil  and  Political  Rights  (CPR)  
15. Freedom  of  assembly  
1. Right  to  life  
16. Freedom  of  association  
2. Freedom  from  torture  
17. Right  to  marry  and  found  a  family  
3. Freedom  from  slavery  
18. Rights  of  children  
4. Freedom   from   arbitrary  
arrest/detention   19. Right  to  practice  a  religion  
5. Right  to  humane  treatment  in  detention   20. Prohibition  of  war  propaganda  and  hate  
speech  constituting  incitement  
6. Freedom  of  movement  and  residence  
21. Right  to  hold  office  
7. Prohibition  of  expulsion  of  aliens  
22. Right  to  vote  in  free  elections  
8. Freedom   of   thought,   conscience,   and  
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Marks         Human  Rights   5  

23. Right  to  be  elected  to  office   7. Adequate   standard   of   living   (including  
food,  clothing,  and  housing)  
24. Equal  access  to  public  service  
8. Right  to  the  highest  attainable  standard  
Economic,   Social,   and   Cultural   Rights  
of  physical  and  mental  health  
(ESCR)  
9. Right   to   education   toward   the   full  
1. Right   to   gain   a   living   by   work   freely  
development  of  human  personality  
chosen  and  accepted  
10. Free   and   compulsory   primary  
2. Right   to   just   and   favorable   work  
education  
conditions  
11. Availability  of  other  levels  of  education  
3. Right  to  form  and  join  trade  unions  
12. Participation  in  cultural  life  
4. Right  to  strike  
13. Protection   of   moral   and   material   rights  
5. Social  security  
of  creators  and  transmitters  of  culture  
6. Assistance   to   the   family,   mothers,   and  
14. Right   to   enjoy   the   benefits   of   scientific  
children  
progress  

For   bioethicists,   the   most   salient   of   these   rights   is   the   right   to   health,   which   is  
enunciated   in   Article   25   of   the   UDHR   (“Everyone   has   the   right   to   a   standard   of   living  
adequate  for  the  health  of  himself  and  of  his  family,  including  food,  clothing,  housing  and  
medical  care  and  necessary  social  services”)  and  in  Article  12  of  the  ICESCR  (“the  right  
of  everyone  to  the  enjoyment  of  the  highest  attainable  standard  of  physical  and  mental  
health”).  Variations  on  these  definitions  are  found  in  most  of  the  core  UN  and  regional  
human  rights  treaties.  In  2000,  the  Committee  on  Economic,  Social  and  Cultural  Rights  
(CESCR),  which  was  created  to  monitor  the  ICESCR,  analyzed  the  normative  content  of  
the   right   to   health   in   terms   of   availability,  accessibility,  appropriateness,   and   quality   of  
care   and   specified   the   duties   of   the   state   to   respect,  protect,  and  provide   this   right.   The  
committee   also   listed   fourteen   human   rights   as   “integral   components   of   the   right   to  
health.”  These  related  rights  define  to  a  large  extent  the  determinants  of  health  (United  
Nations   2000;   Zuniga,   Marks,   and   Gostin   2013).   The   summary   below   seeks   to  
underscore  the  function  of  human  rights  as  determinants  of  health  by  highlighting  their  
normative  content  and  their  relation  to  health.    
Health-Related Human Rights
Health  is  profoundly  related  to  human  rights  both  because  human  rights  violations  have  
health   impacts—such   as   sequelae   of   torture   survivors—and   because   human   rights  
concern  the  dignity,  integrity,  autonomy  of  action,  and  conditions  of  social  functioning  of  
people.  Some  examples  will  be  provided  in  each  of  these  areas.    
Foremost  among  the  human  rights  relating  to  physical  and  mental  integrity  is  the  
right   not   to   be   arbitrarily   deprived   of   life.   As   defined   in   the   ICCPR,   this   right   does   not  
rule   out   death   resulting   from   lawful   acts   of   warfare   or   capital   punishment,   although  
international   humanitarian   law   limits   the   former,   and   newer   protocols   and   regional  
conventions,  supported  by  UN  resolutions  and  social  movements,  define  the  latter  as  a  
violation   of   human   rights.   Special   treaties   and   procedures   exist   for   prevention   and  
repression   of   torture,   disappearances,   summary   and   extrajudicial   executions,   crimes  
against   humanity,   genocide,   slavery,   racial   discrimination,   and   various   forms   of  
terrorism.   Most   of   these   are   also   dealt   with   in   international   humanitarian   law,   which  
was   established   to   protect   victims   of   armed   conflict   (sick,   wounded,   detained,   or  
otherwise  disabled  combatants  who  are  “hors  de  combat”;  prisoners  of  war;  and  civilian  
populations,  notably  under  occupation)  and  codified  in  the  four  Geneva  Conventions  of  
1949  and  the  Additional  Protocols  of  1977.    
The   right   to   “a   standard   of   living   adequate   for   the   health   and   well-­‐being”   of  
oneself  and  one’s  family  was  defined  in  the  UDHR  as  including  “food,  clothing,  housing  

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Marks         Human  Rights   6  

and   medical   care   and   necessary   social   services”   as   well   as   “the   right   to   security   in   the  
event   of   unemployment,   sickness,   disability,   widowhood,   old   age   or   other   lack   of  
livelihood  in  circumstances  beyond  [one’s]  control.”  Subsequently,  the  rights  to  health,  
work,   safe   and   healthy   working   conditions   (occupational   health),   adequate   food   and  
protection   from   malnutrition   and   famine,   adequate   housing,   and   social   security   (i.e.,   a  
regime   covering   long-­‐term   disability,   old   age,   unemployment,   and   other   conditions)  
have   been   further   elaborated   by   the   International   Labour   Organisation,   the   UN  
Commission   on   Human   Rights,   the   Human   Rights   Council,   and   the   work   of   UN   special  
rapporteurs  and  treaty  bodies.    
Dignity   tends   to   be   mentioned   as   both   the   basis   for   all   human   rights   and   a  
human   right   per   se.   The   great   civil   liberties—freedom   of   oral   and   written   expression,  
conscience,  opinion,  religion,  or  belief—as  well  as  freedom  from  arbitrary  detention  or  
arrest,   rights   to   a   fair   hearing   and   an   effective   remedy   for   violations   of   human   rights,  
and  protection  of  privacy  in  domicile  and  correspondence,  all  support  the  autonomy  of  
individuals  to  act  without  interference  from  the  state  or  others.    
Equality  and  nondiscrimination  are  human  rights  that  are  at  the  same  time  cross-­‐
cutting  principles  for  the  application  of  all  other  human  rights  because  they  require  that  
all  persons  be  treated  equally  in  the  enjoyment  of  their  human  rights  and  that  measures  
be   taken   to   remove   discriminatory   practices   on   prohibited   grounds.   Freedom   of  
movement   means   the   right   to   reside   where   one   pleases   and   to   leave   any   country,  
including  one’s  own,  and  to  return  to  one’s  country.  This  right,  like  many  others,  is  not  
absolute;   limitations   may   be   imposed—for   example,   in   times   of   epidemics—as   long   as  
certain   safeguards,   defined   in   human   rights   law,   are   observed.   The   right   to   seek   and  
enjoy   asylum   from   persecution   is   also   a   human   right,   which   has   been   developed   and  
expanded   by   international   refugee   law,   the   practice   of   the   UN   High   Commissioner   for  
Refugees,  and  recent  codes  relating  to  internally  displaced  persons.    
Social   well-­‐being  depends  in  large  measure  on  group  identity,  education,  family,  
culture,   political   and   cultural   participation,   gender   and   reproductive   rights,   scientific  
activity,   the   environment,   and   development,   all   of   which   are   the   subject   of   specific  
human   rights.   The   basic   human   rights   texts   affirm   a   limited   number   of   group   rights,  
notably   the   rights   of   peoples   to   self-­‐determination,   that   is,   in   the   terms   of   the   ICCPR   and  
the  ICESCR,  to  “determine  their  political  status  and  freely  pursue  their  economic,  social  
and  cultural  development”  and  to  permanent  sovereignty  over  natural  resources.  They  
also   enumerate   the   rights   of   persons   belonging   to   minorities   to   practice   their   religion,  
enjoy  their  culture,  and  use  their  language.  Indigenous  peoples  have  defined  rights  that  
take  into  account  their  culture  and  special  relation  to  the  land.    
The   right   to   education   is   defined   in   the   ICESCR   and   by   the   CESCR,   as   well   as  
specialized   instruments   of   UNESCO.   Other   rights   of   the   child   have   been   codified   in   the  
1989  Convention  on  the  Rights  of  the  Child.    
Political   rights   include   the   right   to   run   for   office   and   to   vote   in   genuine   and  
periodic   elections.   Cultural   rights   refer   primarily   to   the   right   to   participate   in   the  
cultural  life  of  the  community;  the  protection  of  writers,  artists,  and  performers;  and  the  
preservation  of  cultural  heritage.    
Women’s   rights   were   reaffirmed   and   expanded   by   a   specialized   Convention   on  
the   Elimination   of   All   Forms   of   Discrimination   against   Women   (CEDAW)   of   1979.  
Considerable   advances   in   mainstreaming   women’s   rights   as   human   rights   were   made   at  
international  conferences,  a  1993  Declaration  on  Violence  against  Women,  the  work  of  a  
special   rapporteur   on   this   problem,   and   statements   and   programs   on   traditional  
practices  harmful  to  health,  such  as  female  genital  mutilation.  Reproductive  and  sexual  
rights   include   the   right   of   “men   and   women   …   to   decide   freely   and   responsibly   on   the  
number  and  spacing  of  their  children”  (CEDAW,  Article  16)  and  “to  be  informed  and  to  
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Marks         Human  Rights   7  

have   access   to   safe,   effective,   affordable   and   acceptable   methods   of   family   planning   of  
their   choice”   (United   Nations   1994).   Various   internationally   approved   programs   and  
plans  of  action  have  set  out  in  considerable  detail  the  specific  ways  in  which  this  right  
can   be   realized.   Rights   of   sexual   minorities,   which   are   not   mentioned   in   the   major  
human   rights   treaties,   have   been   resisted   by   many   countries   for   religious   and  
ideological   reasons,   although   they   have   ben   articulated   in   a   2007   nongovernmental  
initiative   called   the   “Yogyakarta   Principles   on   the   Application   of   International   Human  
Rights   Law   in   relation   to   Sexual   Orientation   and   Gender   Identity”   and   they   have   been  
supported   by   the   UN   Secretary-­‐General   and   High   Commissioner   for   Human   Rights,   as  
well  as  the  major  treaty  bodies.    
Bioethical  concerns  overlap  with  human  rights  with  respect  to  the  right  to  enjoy  
the  benefits  of  scientific  progress  and   rights  in   scientific  research.   The   former   refers   to   the  
positive   and   equitable   use   of   scientific   advances,   while   the   latter   protect   freedom   to  
conduct   research   and   disseminate   results   and   the   requirement   of   informed   consent   of  
human  subjects.    
Occasionally,   scholars   refer   to   solidarity   or   third-­‐generation   rights   (first   and  
second   generations   being,   respectively,   civil   and   political   rights   and   economic,   social,  
and   cultural   rights)   to   certain   global   values   such   as   peace,   a   healthy   environment,  
development,  communication,  and  humanitarian  intervention  or  assistance.  Two  rights  
in   this   category   have   become   more   systematically   developed   and   enshrined   in  
authoritative   texts:   the   rights  to  a  healthy  environment  and  to  development.   The   former  
has   been   recognized   in   many   national   constitutions   and   in   the   regional   human   rights  
texts.   The   latter   has   been   recognized   in   numerous   UN   resolutions   and   specifically   in   a  
1986   declaration,   as   well   as   in   the   African   Charter   on   Human   and   Peoples’   Rights   and  
the  Arab  Charter  on  Human  Rights.  The  1986  Declaration  on  the  Right  to  Development  
defines  the  right  to  development  as  “an  inalienable  human  right  by  virtue  of  which  every  
human   person   and   all   peoples   are   entitled   to   participate   in,   contribute   to,   and   enjoy  
economic,   social,   cultural   and   political   development,   in   which   all   human   rights   and  
fundamental  freedoms  can  be  fully  realized.”    
Finally,  Article  28  of  the  UDHR  proclaims  the  right  of  everyone  to  “a  social  and  
international  order  in  which  the  rights  and  freedoms  set  forth  in  this  Declaration  can  be  
fully  realized.”  This  right  is  perhaps  the  broadest  provision  insofar  as  it  seeks  to  define  
human   rights   as   a   criterion   for   the   legitimacy   of   national   policies   and   international  
relations.   The   required   social   order   suggests   a   democratic   constitutional   regime   in  
which   human   rights   of   all   categories   are   recognized   in   law   and   effectively   observed   in  
practice.  It  also  suggests  that  international  relations  provide  support  for  global  efforts  to  
further  human  rights  and  to  establish  means  of  accountability  for  persons  and  groups  to  
obtain  redress  from  countries  that  fail  to  fulfill  their  human  rights  obligations.    
The  Enforcement  and  Implementation  of  Human  Rights    
The   term   enforcement   refers   to   coerced   compliance,   whereas   implementation   refers   to  
supervision,   monitoring,   and   the   general   effort   to   hold   duty-­‐holders   accountable.  
Implementation   is   further   subdivided   into   promotion—preventive   measures   to   ensure  
respect   for   human   rights   in   the   future—   and   protection—responses   to   violations   that  
have   occurred   in   the   past.   The   means   and   methods   of   implementation   may   be  
summarized  in  three  forms  of  promotion  and  five  forms  of  protection.    
Promotion  of  human  rights  is  achieved  through  developing  awareness,  standard-­‐
setting  and  interpretation,  and  creating  national  institutions.  Awareness  of  human  rights  
is   a   precondition   to   acting   on   them   and   is   advanced   though   dissemination   of   knowledge  
and  human  rights  education  at  all  levels,  for  which  the  UN  proclaimed  a  decade  of  action  
for  the  period  from  1995  to  2004.  Standard-­‐setting  means  the  drafting  of  human  rights  
texts,   for   which   the   UN   Commission   on   Human   Rights,   established   in   1946,   and   the  
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Marks         Human  Rights   8  

Human   Rights   Council,   its   successor   since   2006,   have   played   a   central   role,   along   with  
other   UN   and   regional   organizations.   These   norms   are   interpreted   by   various  
international  courts  and  treaty-­‐monitoring  bodies.  The  third  preventive  or  promotional  
means  of  implementation  is  national   institution-­‐building,  which  includes  improvements  
in  the  judiciary  and  law  enforcement  institutions  and  the  creation  of  specialized  bodies  
such  as  national  commissions  for  human  rights  and  offices  of  an  ombudsman.    
The   protection   of   human   rights   involves   a   complex   web   of   national   and  
international  mechanisms  to  monitor,  judge,  denounce,  and  coerce  states,  as  well  as  to  
provide  relief  to  victims.  Monitoring  compliance  is  carried  out  through  the  reporting  and  
complaints  procedures  of  the  UN  treaty  bodies  and  regional  human  rights  commissions  
and  courts.  “Special  procedures,”  consisting  of  working  groups  and  special  rapporteurs,  
study  countries  or  issues,  taking  on  cases  of  alleged  violations,  reporting  back  on  their  
findings,   and   requesting   redress   from   governments.   Among   the   thematic   rapporteurs,  
one  is  specifically  mandated  to  study  the  right  to  health,  and  others  deal  with  a  variety  
of   health-­‐related   issues.   The   second   means   of   protection   is   adjudication   of   cases   by   fully  
empowered   human   rights   courts,   the   main   ones   being   the   European   Court   of   Human  
Rights  of  the  Council  of  Europe,  the  American  Court  of  Human  Rights  of  the  Organization  
of  American  States  (OAS),  and  the  African  Union’s  African  Court  of  Human  and  Peoples’  
Rights.    
Political   supervision,  the  third  means  of  protection,  refers  to  resolutions  judging  
the   policies   and   practices   of   states   adopted   by   the   Human   Rights   Council,   the   UN  
General   Assembly,   the   Committee   of   Ministers   of   the   Council   of   Europe,   the   Assembly   of  
OAS,   and   other   political   bodies   that   denounce   governments   for   violations   of   human  
rights   and   demand   that   they   redress   the   situation   or   provide   compensation   to   the  
victims.    
A   fourth   means   of   protection   is   humanitarian  relief   or   assistance,   which   involves  
provision  of  food,  blankets,  tents,  medical  and  sanitary  assistance,  and  other  forms  of  aid  
to   save   lives   and   improve   the   health   of   persons   forcibly   displaced,   often   as   a   result   of  
large-­‐scale   human   rights   violations   or   natural   disasters.   Refugees   and   internally  
displaced  persons  come  under  the  protection  of  the  UN  High  Commissioner  for  Refugees  
(UNHCR),   who   deploys   massive   amounts   of   aid,   along   with   the   International   Committee  
of   the   Red   Cross,   UNICEF,   the   World   Food   Program   (WFP),   the   United   Nations  
Development   Programme   (UNDP),   the   UN   Office   for   the   Coordination   of   Humanitarian  
Affairs,   and   other   agencies,   as   well   as   major   NGOs   such   as   Oxfam   International,   CARE,  
and  the  International  Rescue  Committee.    
The  final  means  of  responding  to  human  rights  violations  is  the  use  of  coercion,  
which   is   available   only   to   the   UN   Security   Council   acting   under   Chapter   VII   of   the   UN  
Charter   to   impose   sanctions,   cut   off   communications,   create   ad   hoc   criminal   tribunals,  
and  authorize  the  use  of  force  by  member  states  or  the  deployment  of  UN  troops  to  put  
an   end   to   a   threat   to   international   peace   and   security,   which   it   has   on   occasion  
interpreted   to   include   human   rights   violations   (e.g.,   during   conflicts   in   Haiti,   Somalia,  
Bosnia,  Iraq,  and  Libya).  This  forceful  means  of  protecting  human  rights  is  complex  and  
dangerous   and   can   have   harmful   health   consequences,   as   has   been   the   case   with  
sanctions  imposed  on  Haiti  and  Iraq.  If  used  properly  it  can  be  a  modern  and  legitimate  
form   of   the   nineteenth-­‐century   doctrine   of   humanitarian   intervention,   according   to  
which   states   used   armed   force   to   halt   atrocities   committed   in   another   state   while  
respecting  the  principles  of  necessity,  proportionality,  disinterestedness,  and  collegiality.  
The   North   Atlantic   Treaty   Organization   (NATO)   sought   to   employ   such   a   doctrine   in  
Kosovo   in   1999   but,   without   the   necessary   authorization   from   the   Security   Council,  
engaged  in  what  most  scholars  consider  a  legitimate  but  illegal  use  of  force.  Each  case  of  
action  (e.g.,  no-­‐fly  zones  over  Iraq  imposed  in  1991)  or  inaction  (e.g.,  Rwanda  in  1994)  
regarding   the   use   of   armed   force   for   human   rights   purposes   has   complex   ethical   and  
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Marks         Human  Rights   9  

legal  difficulties.  A  2005  UN  Summit  endorsed  the  “responsibility  to  protect,”  a  doctrine  
that   reaffirms   the   international   community’s   role   to   prevent   and   stop   genocides,   war  
crimes,   ethnic   cleansing,   and   crimes   against   humanity   when   the   national   government  
fails   to   do   so.   Whether   under   the   responsibility   to   protect   or   not,   the   legitimacy   and  
legality   of   Security   Council–authorized   force   in   response   to   a   human   rights   crisis   is   now  
well  established,  although  the  decision  to  act  is  fraught  with  political  tension,  sometimes  
preventing  action,  as  with  efforts  to  protect  the  Syrian  population  in  2012.  
These  means  and  methods  of  implementation  are  summarized  in  Table  2.  
 
Table  2  

Means  of  Implementation   Examples  

A.  Promotion  

1.  Developing  awareness   Circulation  of  publications,  media  coverage,  human  rights  

education.  

2.  Standard-­‐setting  and  inter-­‐ Adoption   of   declarations   and   conventions   by   UN   Human  

pretation   Rights   Council,   regional   bodies;   general   comments   by  
treaty  bodies;  interpretation  by  tribunals.  

3.  Institution-­‐building   Judiciary  and  law  enforcement,  national  commissions  and  

ombudsman  offices.  

B.  Protection  

4.  Monitoring  compliance  with   Reporting   procedures,   fact-­‐finding   and   investigation,  

international  standards   special  procedures,  universal  periodic  review  (UPR).  

5.  Adjudication     Complaints   procedures   by   treaty   bodies,   judgments   by  

international  and  regional  tribunals.  

6.  Political  supervision   Resolutions   judging   state   policy   and   practice   by  

international   bodies;   “naming   and   shaming”   by   Human  
Rights   Council,   UN   General   Assembly;   demarches,   public  
and  private  statements  by  states  and  senior  officials.  

7.  Humanitarian  action   Assistance   to   refugees   and   internally   displaced   persons  

in   humanitarian   emergencies;   repatriation   and  
resettlement.  

8.  Coercive  action   UN   Security   Council   sanctions,   creation   of   criminal  

tribunals,   and   use   of   force   under   the   doctrine   of  
“responsibility   to   protect”   people   from   genocide,   war  
crimes,  ethnic  cleansing,  and  crimes  against  humanity.  
 

Conclusion
Every  country  in  the  world  has  accepted  the  human  rights  enunciated  in  the  UDHR  and  
in  UN  and  regional  treaties  that  they  have  ratified  and  incorporated  into  their  national  
legal   systems.   The   normative   content   of   human   rights   is   probably   the   most   complete  
catalogue   of   the   components   of   freedom   and   social   justice   and   thus   of   the   physical,  
mental,   and   social   determinants   of   health.   The   underlying   ethical   principles   of   human  
rights   overlap   with   those   of   bioethics.   The   methods   of   implementation   or   realization,  
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Marks         Human  Rights   10  

which   complement   those   used   by   bioethics,   range   from   dissemination   and   promotion   of  
ideas  to  enforcement  of  binding  obligations  and  their  effectiveness  varies  widely.    
 
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