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This piece introduces the special Public Health Reviews collection on human rights in patient care (HRPC). Work on HRPC dates back to 2007 and an Open Society Foundations initiative in collaboration with partners in Eastern Europe and Central Asia. We found that for marginalized groups, health care settings often were places of coercion, punishment, and/or violence rather than of treatment or care. At the same time, health care providers often did not know of their legal obligations and how to incorporate human rights norms in their work. They themselves faced a lack of independence, unsafe working conditions, and sanctions for providing evidence-based care. Laws existed that could potentially address violations, but they were rarely enforced, and most people did not know what they were. HRPC brings human rights principles to health care delivery and addresses the rights of both patients and health care providers. It seeks to translate laws and procedures protecting rights into practical terms, linking national, regional, and international frameworks. The special collection explores various aspects of HRPC, including state responsibility in private health facilities, reproductive health, palliative care, and intersections with public health. It further explores dimensions relevant to particular populations, including Roma, people who use drugs, and transgender persons.

We are excited to introduce this special Public Health Reviews collection on human rights in patient care (HRPC). Work on HRPC dates back to 2007 and an Open Society Foundations initiative in collaboration with partners in Eastern Europe and Central Asia. We found that for marginalized groups, health care settings often were places of coercion, punishment, and/or violence rather than of treatment or care. For example, a partner in Kyrgyzstan who formerly used drugs recounted a torturous shoulder operation without any anesthesia as doctors hammered nails into his bones. When the patient asked why he was made to suffer, the doctor responded, “Because you are a drug user. If I give you anesthesia, you will remember your drugs and tomorrow go buy more” [1]. The patient told us that since he stopped using drugs, he was no longer afraid of the police, but he was still afraid doctors. Examples of other encountered abuses included segregation of Roma women in separate maternity wards, disclosure of HIV status, and forced sterilization of women with disabilities. At the same time, health care providers often did not know of their legal obligations and how to incorporate human rights norms in their work. They themselves faced a lack of independence, unsafe working conditions, and sanctions for providing evidence-based care. While there was need for law reform, the biggest gap was in implementation. Laws existed that could potentially address violations, but they were rarely enforced, and most people did not know what they were.

In an effort to address the rights of both patients and health care providers and bring human rights principles to health care delivery, we coined the concept of “human rights in patient care.” Unlike “patients’ rights,” this concept is rooted in inherent human dignity rather than consumer transactions and allows for limitations, enabling an analysis of competing claims. It recognizes the interrelation between patient and provider rights and contexts of “dual loyalty,” where providers face simultaneous obligations to patients and another party, often the state. It is also complementary to bioethics, bringing a focus on systemic issues and the role of the state, procedures for accountability and enforcement, and a critical role for advocacy and community mobilization [2]. HRPC is not separate from the health and human rights approach, but rather probes and develops one particular aspect of it.

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