Every action taken by a health professional, with and for children, can be based on respect for their rights.
The Convention on the Rights of the Child (CRC) defines the prerequisites for children’s right to health.
The CRC creates a shift in the role of the health professional from simply responding to children's needs to a more rights focused approach, where children are recognised as rights holders and their rights are taken into account.
Understanding the CRC and the rights involved
Because children's rights are indivisible and interrelated, a number of rights should be taken into consideration for children to attain the highest standards of health. The CRC acknowledges the different rights and defines the obligations of individuals, parents, communities and governments to fulfil children’s rights.
A rights-based approach to children's rights to health requires that children's rights to be listened to and taken seriously (article 12), their right to access information (article 17) and their right to privacy and respect for confidentiality (article 16) are given special attention.
Children's rights to the highest attainable standard of health care
Article 24 and article 6 are the two key articles of the CRC that deal explicitly with healthcare.
Article 6 guarantees the child's fundamental right to life. It is one of the guiding principles of the CRC.
Article 24 builds on and develops the right to life and survival and development to the maximum extent possible that is set out in article 6.
All children, without discrimination on the basis of colour, race, sex, language, religion, social background, disability or other, should have access to "facilities for the treatment of illness and rehabilitation of health" and to the "highest attainable standard of health care".
The holistic nature of the CRC stresses the obvious connection between realising the children's rights to health and other rights recognised in the CRC.
For example, in order to provide the child with the best possible healthcare (article 6), to better understand the child's health situation, to make him or her more confident about the treatment and to encourage him or her to take more responsibility for their own health, doctors should listen to the child's opinion and concerns (article 12).
They should make the child feel involved in the process and give him or her the ability to contribute effectively to their own health care.
But for that to happen, the child should have access to the necessary information that will help him or her understand their situation and the process of the treatment (article 17).
Article 24 specifically requires action to abolish traditional practices "prejudicial to the health of children".
Read the report on harmful practices based on tradition, culture, religion and superstition by the International NGO Council on Violence against Children.
The right to be heard
Article 12 gives children the right to be heard on all matters that affect them and these views need to be given due weight.
This includes the child's right to give consent to treatment, to be involved in his or her treatment and to be able to give his or her opinion about the treatment.
Respect for the views of the child needs to be built into healthcare and into the design of health services.
Involving children in their healthcare will help them relieve any possible anxieties about their condition and associated treatment. Knowing that no action will be taken without their knowledge and consent will help them feel more confident and will encourage them to cooperate in treatment.
The right to privacy and respect for confidentiality
Article 16 provides for the right of every child to privacy and respect for the confidentiality to be protected by law.
The CRC provides that "no child shall be subjected to arbitrary or unlawful interference with his or her privacy … or correspondence".
With respect to health care, this includes the right of the child to confidentiality in seeking medical advice, to access medical records and control who else can access those records. The right to confidential advice and counselling can extend to the right to withhold medical information from everyone except the medical professional involved, including parents, a requirement recognised by the Committee on the Rights of the Child’s General Comment 12 on the child’s right to be heard. This has obvious applications for children experiencing violence or abuse at home, but also in seeking reproductive health education or services.
Doctors sometimes have to comply with laws that impose parental consent but there is often scope for a professional judgement. Also, health professionals are in a good position to advocate for legal reform as they may have a lot of examples on why confidentiality is of particular importance for children. For example, children are likely to avoid seeking medical help if they fear that they will need their parents' or guardian's consent.
The issue of confidentiality is separate to that of decisions over the child’s care. Where a child lacks the capacity to make a determination about his or her care, it may frequently become necessary for medical professionals to discuss a child’s care with parents or carers, but this does not override the child’s right to confidential advice and counselling.
Access to information
Article 17 includes a general obligation on governments that children have access to information and material from diverse sources, especially those aimed at promoting well-being and physical and mental health.
Article 24(2)(e) requires that states take appropriate measures to ensure that children are informed about their health and various specific health issues.
Children should receive appropriate information in order to be able to give their informed consent to treatment and medication. The prescription of drugs is often an important component of health care. But over the past ten years, lawsuits and investigations have cropped up around the world that raise concerns about not only testing drugs on children, but administering untested or unnecessary drugs on children.
Children have the right to receive education on sexual and reproductive health. Sexual and reproductive health education is one of the most important ways to help children avert risks, improve their reproductive health and make informed decisions regarding their sexual and reproductive health. It is very important that health facilities provide information on sexual and reproductive health.
This applies equally to LGBT children, and limiting access to information on these issues can have a profoundly negative effect on children’s physical and mental health. With regards to sexual health, it is important that LGBT children understand the risks of sexual activity and the measures that can be taken to limit those risks. The dangers of sexually transmitted infections and the relative merits of various forms of contraception is important here, as is discussion over the emotional implications and dimensions of sexual relationships.
Protection from all forms of violence and abuse
Article 19 requires that the child is protected from "all forms of physical and mental violence" while in the care of parents or others.
Health services must develop codes of practice and ensure that staff do not abuse or hurt children in any way. Health professionals also have an obligation to take action to protect children when they suspect that they have been abused or hurt by their parents or guardians. Article 19 is closely linked to the right to life and to survival and development guaranteed under article 6, and asserts children's rights to respect for their dignity and physical and personal integrity.
Health staff’s role in identifying, reporting, referring and treating cases of violence and abuse is crucial. Here again, the right to confidentiality and privacy is often a key to protect children from further harm and to build a relation based on trust with the child.
Other rights that should be taken into consideration
- Equal access for all children (article 2),
- The right to services designed for their best interest and convenience (article 3),
- The right to education is not denied (article 28),
- The right to play (article 31),
- Protecting children from arbitrary detention and cruel and inhuman treatment or punishment (article 37).
For example, children who spend a long time in the hospital should still have access to education.
Health facilities should be available and accessible to children with disabilities.
Also, health professionals can and should play a key role in fighting harmful practices based on tradition. They should provide children and their parents with the necessary information on the harm that certain practices can cause and take all possible measures to make sure that they are not practised.
Conflict between parents and children’s rights
Sometimes children’s rights are put aside to "safeguard" parents’ rights.
"In reality, the conflict is often between different rights of the child. For example, where the child refuses the necessary treatment that the parent or guardian wishes him or her to receive, the real conflict is not between the parent and the child, but rather about the child's right to respect for their physical integrity and to have their views taken seriously, and their right to the best possible health." - A Course for Health Professionals, Children's Rights and Child Health
Parental rights and responsibilities cannot be exercised in contravention of children’s rights; they exist primarily in order to protect and promote their children's rights.
Dialogue between parents/guardians and children is important and the approach to resolving matters must be through reference to how best to promote the rights of the child (article 12; right to be heard and taken seriously).
Child friendly health facilities
It is important that health professionals ask themselves how child friendly health services are.
For example, children often find themselves waiting long hours to see a doctor.
Many things can be considered here:
- Is the waiting area safe?
- Are there any age-appropriate toys, magazines?
- Is it comfortable?
Other things to consider:
- The language of the information provided - is it the language spoken by the main community? What about languages spoken by other groups?
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How much information in general is given to children about:
- the person responsible for the treatment;
- the treatment itself; as well as
- the possibility to express any concern.
Children should feel comfortable about expressing their concerns inside health facilities. They should be provided with an environment free from violence and in which they can share with health staff any situation of violence and/or abuse they have been through.
Advocating for children's rights
Health professionals have a big responsibility in achieving children's right to the best possible healthcare.
On top of their responsibility to provide children with the medical care they need, they can seek to find out the causes of the child's condition; even when the cause is not medical.
For example, the child’s situation can be caused by violence administered by parents, guardians or school teachers, and in such cases appropriate measures should be taken. Those measures depend on the child's situation, the services available in each country and the child's opinion; decisions should be taken on a case-by-case basis. Here, respecting children's rights to confidentiality (article 16), their right to be heard (article 12) and their right to access information (article 17) is very important.
Discriminatory policies and laws and harmful practices based on tradition, amongst others, can stand in the way of children's rights to the best possible healthcare.
Health professionals can play a big role as advocates for children’s rights.
They can work closely with child rights lawyers to identify harmful policies/laws and promote change.
They can also advocate for changing harmful and/or discriminatory practices. When it comes to harmful practices based on tradition that are based on religious beliefs, doctors and other health staff might be in a good position to convince influential religious leaders.
They are also in a good position to highlight how the government is failing to comply with its obligations to ensure that all children have access to the best possible healthcare. They can also gather evidence from children on their experience with the healthcare system.
What should NGOs do?
NGOs’ role in advocating for better healthcare for children is very important.
They should raise awareness among health staff about children's rights and familiarise them with the CRC as well as their role in achieving rights for children.
Above all, NGOs should make sure that all children's rights are respected inside clinics and hospitals. They should remind health professionals that children are rights holders and not just simply beneficiaries of aid.
Like all children's rights matters, different actors should be involved and should work together. NGOs have the knowledge that health practitioners need in terms of children's rights, while health practitioners are in direct contact with children every day. They should work together in order to fully understand what children need and how the system can be improved.
NGOs should also, in partnership with health professionals, work closely with the authorities to develop better laws and policies that respect all children's rights and provide children with a safe, supportive and inclusive healthcare system.
References:
CRED-PRO, Child Rights Curriculum for Health Professionals.
Useful guides:
Training Manual on Human Rights for Health Workers developed by the International Federation of Health and Human Rights Organisations (IFHHRO).
Health and Human Rights Resource Guide, How is children's health a human rights issue?