The point on human rights applied to perinatal health.
All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and must act towards one another in a spirit of brotherhood
This sentence opens the Universal Declaration of Human Rights, which was born on 10 December 1948 within the United Nations. (read the whole document here )
The premises of article 1 underline as a priority a value that today in our day risks being considered old, questionable and obsolete. A somewhat “loser” value, to put it like young people, a romantic thing of the late nineteenth century.
The spirit of brotherhood in our current society is not necessarily the prime mover of the daily actions of men and women: if this were the case, seventy-one years after this declaration, we should not work daily to promote the recognition and respect of human rights. , to remember its existence and to refresh the memory of the most distracted.
As often happens in the history of man, nature goes by leaps, to urgencies, it moves more in response to acute phenomena than with real and shared foresight. In 1948 it was certainly urgent to remedy systematic, clear and ignoble violations of human rights, reaffirming the values as universal and promoting their adoption by all member countries.
Looking back, it is clear that we have come a long way, it is clear that our grandparents and great-grandparents have allowed a substantial change and improvement in the general living conditions of all human beings. At least they have tried, achieving a global cultural change in a relatively short time, on many of the issues listed in the universal declaration.
It is equally clear, however, that given the precious and undeniable part of the work carried out so far, much still needs to be done to ensure that human rights are not just beautiful words written on paper and dusted off on the occasion of the dedicated days, but are acquired. culturally by all citizens.
Human rights as a universal heritage of girls and boys who enter the world and reap for years what we adults sow, for better or for worse. Starting from when they are in the womb, and then on and off, at the time of their birth, the first glance with the parents, entering their nuclear and extended family, the nursery and the kindergarten, up to the high school , at university or in the world of work.
Boys and girls grow up and undergo what we do, what we don’t do, what is respectful and what is not. And they learn from us.
From those who, according to article one, should be in the world moved by a spirit of brotherhood and reciprocity.
To do good good. To respect oneself and others at the same time, without putting one’s human rights before the human rights of others .
In particular, in the field of perinatal health and education , which are the two main areas of activity of CiaoLapo, the work on human rights is still incomplete, little recognized, in some cases deeply hindered, in our country and in numerous other countries with high, medium and low economic development.
Article 25.2 of the declaration of human rights mentions:
Motherhood and childhood are entitled to special care and assistance . All children, whether born in or out of wedlock, must enjoy the same social protection.
The “special care and assistance” are now confirmed by the main international realities that deal with health, health and rights; they are now also confirmed by the spontaneous movements of mothers who are present in many countries around the world.
Special treatments have their structural basis on these values: respect, clear and comprehensive information, the possibility of choosing, access to the best possible treatments that exist, without discrimination, of any kind. For example, having a psychiatric condition or having a difficult life should not be reasons for discrimination. Speaking a language other than that of the host country should not be grounds for discrimination. Nothing should, nothing will ever be a just cause for “discrimination” and violation of human rights. These listed are just a small example.
The principles of the declaration are clear.
They are public, we find them online in official documents, signed by international organizations, organizations, professionals, scientists, researchers and mothers.
We know that there is a normative line of behavior, based on firm principles in the declaration of human rights and official documents.
We also know that the health and social care system does not move automatically on the basis of international guidelines and reference documents.
Hospitals, Regions or Ministries do not always move with the primary objective of letter-by-letter compliance with official documents.
There is always something left behind, given the complexity of the theme “The human being and his rights” and its numerous theoretical and practical implications.
For example, there are always those who forget that free and equal is not only the name of a political party, but above all, literally, the definition that frames whoever I have in front of me: a man, a woman, by definition free, as I am free and equal to me in rights.
Free, equal and moreover, by definition, like a sister.
Only by recognizing the freedom and equality of those in front of me, with respect to me, can I fully respect human rights.
There are still those who are not fully aware of the role they play in society and the power conferred on them by the role.
When it comes to health and health determinants, it is undeniable that all health professionals (as well as teachers) have a role of great responsibility and great power .
Being a health worker myself, they occupy and occupy a prestigious role, because we have professional skills that can contribute to the well-being of others, making a difference for individuals, families and the community.
Our role in society is a role that takes on full meaning when it is carried out with respect for human rights. With all the limits on the intervention, on the solutions and on the choices that we would make, even for others, which entails recognizing the rights of others as such.
What is possible to achieve for the individual and for society, taking care of the other as a brother, respecting his freedom and his being equal to me, in rights, but also legitimately different in life choices and in life history, And the practical and not only theoretical promotion of the psychic, physical and bio-psycho-social well-being of our society .
We have skills that can make a difference in health promotion.
We have the power to help people improve their overall health.
We have the power to make a difference when it’s needed.
This power, given to us by the skills and role we play on the very sensitive issue of health promotion, can be best used, if we keep human rights in mind.
Using the power given by knowledge well means building respectful dialogues and bringing our knowledge constructively to the people who need it, building an opportunity for choice that is truly free (alas, the choices by bias, those for fear, those that are the result of cultural or political conditioning without valid scientific bases are not free and profound choices, they are often acted out, in protest, in defense, to escape from care relationships based on power and not on what best can be done in the single specific case. We will discuss this very important incident in detail later).
The power conferred by the title, the profession, the position in the institutions and places of care, by being “experts” in a field so incisive on the well-being of the individual and of the populations as that of the health or pedagogical profession can however also be used ” at worst “.
It happens every time we use power to replace the person we should help, to condition them, to reduce them into a situation of dependence or submission. When we use power to limit human rights.
There are many ways to exercise the power of us health professionals, and they are often derived from a reductive vision of medicine, the old paternalistic vision according to which the doctor and the healthcare professional decide and the patient, as such, nods (otherwise what patient is ?!?!, some might say).
If the patient does not nod, but is legitimately uncertain (for the simple reason that he is del his body we’re talking about, of the his psyche, of the health, or that of elderly parents or young children, for whom he is responsible), often the health worker, almost always the doctor, in a more or less good-natured way, persuades the patient to do what he must do “for the his good “.
The paternalistic medicine of the past was born in a historical moment of great disparity in the education of the population and of great suffering due to the limitations of the medicine of the past, in terms of technique, resources and number of deaths.
In 1948, when everything was still to be done, the paternalistic doctor was little compared to, for example, the shotgun marriage, the prohibition of divorce or the prohibition of abortion.
As if to say, there was no room, from a historical point of view, to analyze this issue and deepen it, there were other “urgent” human rights to be respected.
Medicine has had, and still has, extraordinary merits, which over the years have equated it to a mission and not strictly speaking to a profession, creating a semantic and also practical confusion about who the doctor is, what he does, what are his skills, his rights and duties in relation to the population he cares for.
Being a doctor today, with the enormity of knowledge and its fragmentation into a thousand subspecialties, with the reduction of health resources, the serious limitation given by the lack of colleagues and the high work stress has cut away, or in any case considerably reduced the ethical reflection and ethics on the role, power and meaning of this profession.
He mechanized a profession that by definition cannot be carried out like assembling an appliance on the assembly line.
A refrigerator has no human rights to enforce.
A patient yes.
A doctor, too.
We have forgotten that we are all part of the same category, we have divided ourselves beyond and on this side of a barricade promoted, often, by those who preceded us, by a handful of decision-makers more interested in themselves than in respect for human rights own and others; we have tolerated, as a category, increasingly alienating working conditions, where the space for dialogue and relationships is non-existent, even between colleagues on the same shift. Let alone between operators and patients.
It is unthinkable to dialogue with the patient, because it is seen by companies and decision-makers as a waste of time. As something that comes out of the paradigm: the doctor knows, the patient learns. The doctor diagnoses, the patient takes care. Aseptically. Without ties.
Yet, we know well, we see it every day in clinical practice, there are more and more “patients” who ask to resume the thread of the relationship with the caregivers, to be listened to, to be an active part of the treatment process. There are many who, when they do not receive adequate relational feedback from the operators, to be listened to come to protest in the way that is most appropriate today, that is, in the newspapers, in the media, or by taking the grueling and often unnecessary legal proceedings. .
It is now known that in the treatment centers, in the absence of a loved one, the legal procedures for protest are undertaken with much greater frequency than in places of treatment that are perhaps less excellent, but more respectful of human rights.
On the other hand we see that more and more healers are going in burnout , because they just would never have thought after 10, 12, 14 years of continuous study, of going to work on a human assembly line, by the piece, with more patients than hours of work in paychecks.
At least, I would never have believed that the beloved medicine in our country could become this thing here, where for example one grumbles, sometimes good-naturedly, sometimes not, the woman who dilates too slowly, because it makes us waste time and there are 3 more to follow at the same time.
Is it all lost?
We have to witness powerless on both sides of the fence to the incommunicability of health workers and “Patients”, to the lack of respect for fundamental rights passed off as the obvious consequence of a system that is screwed on itself and that has attempted to transform art. medicine on an assembly line, doing it so well that it drives operators and users crazy?
Patients lost patience.
For years they have developed an approach towards health care places that is an active user, with more or less adequate expectations, more or less elaborate and more or less achievable. It is up to us, the privileged interlocutors with the power of knowledge, to intercept these requests from time to time and understand if and what we can do to respond to these expectations. Learning, in some cases, to find a respectful way to say that some expectations, according to our point of view, are not achievable. However, maintaining the sacred and inviolable principle of respect for the thoughts of our interlocutor. Without giving in to the widespread temptation to ridicule him, belittle him, threaten him, remove him as punishment. Without violating his legitimate rights to be free and equal.
People today are more competent than the right to a relationship based on mutual trust and dialogue, which cleared the field of the paternalistic monologues our grandparents liked with second grade and death in the eye from today’s preventable diseases, such as diphtheria or the Spanish flu, which marked with death the disparity between those who knew and those who did not know, between who could be cured and who could not. Today, medicine has made it possible to prevent and properly treat most diseases. This progress, as has happened for human rights, has allowed enlightened doctors and operators and patients to work on the doctor-patient relationship in a more in-depth way, dictated more by rights than by the urgency to save populations from epidemics.
Being all better allows us to value the parties involved, and to put them around a decision-making table, in which everyone can express an opinion on the body but only the owner of the body can have the last word. By exercising your right, referred to in Article 1.
The axiom “The doctor said it = it is done as he said, because he knows what I have to do with my body” no longer works, or in any case it is no longer so obvious everywhere.
Today, women and men need caring and reciprocal relationships.
How can we think of a model of health and care that respects human rights, science and its achievements, who is treated and who cares?
A possible key, to facilitate this passage in the most linear way possible and without too many criticalities (read: without perpetrating battles between cured and healers, and without raising other sterile and counterproductive barricades, of which we do not feel any need) is the education of all the parties involved, based on human rights.
In this regard, article 26.2 of the document states:
Education must be directed to the full development of the human personality and to the strengthening of respect for human rights and fundamental freedoms. It must promote understanding, tolerance, friendship between all nations, racial and religious groups, and must promote the work of the United Nations for the maintenance of peace.
If we combine these two articles together and read them after having listened to or read the stories of pregnancy, childbirth and bereavement of many mothers and fathers, in Italy and in the world (for further information: read the report of the World Health Organization on death in pregnancy and read the words of the special rapporteur of the united nations on obstetric violence as a violation of human rights, here in Italian edited by OVOItalia), we have a clear guideline, “a lot of yield, little expense” as my grandmother would say.
Just drop the power acted for the worst, on either side of the fence.
It is enough to sit next to each other, cared for and cared for, and build an idea of health respectful of human rights with respect and method. Like brothers. As sisters.
Special thanks to the mothers of CiaoLapo and La Goccia Magica, a special thanks to the colleagues who believe in medicine and respect, to the health workers who bring respect every day in births, even in births with eyes closed and breathless, thanks to men, to males, who respect the complexity of pregnancy of childbirth and the puerperium on trust, recognizing its complexity without being able to live it on their skin and also for this reason respecting the bodies of women and children.
Thanks to the women who wrote, write and will write to give a dignified voice to the violence suffered.
Because another cure is possible. It is already here.
The old model, has to pack. It has done its time and its damage.