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Seventy years ago, the Universal Declaration of Human Rights (UDHR) was unanimously adopted by the General Assembly of the United Nations. A simple but far-reaching and transformative statement of the “inherent dignity and… inalienable rights of all members of the human family,” the UDHR is the foundation upon which the modern human rights movement has been built. In the seven decades since its adoption, the UDHR has inspired more than 80 international treaties and conventions, permeated countless domestic instruments, and been translated into more than 500 languages. A powerful instrument of social and political transformation, it has also played its complex part in a slow sea-change in medical ethics and helped recalibrate the relationship between doctor and patient.
The UDHR was primarily inspired by the atrocities of the second world war – after which a horrified medical profession learnt of the atrocities of Nazi physicians, many of whom were involved in conducting cruel experiments on involuntary human subjects. Twenty-three Nazi doctors were prosecuted for these crimes at Nuremberg between 1946-1947. During the trial, considerable attention was paid to the violation of the most basic requirement of consent. In its judgement the Court articulated a 10-point code for human experiments that has come to be known as the Nuremberg Code. Amongst other requirements, the Nuremberg Code demands ‘informed consent’ for any involvement of human subjects in research.
In the wake of the Nuremberg trial, doctors from around the world gathered at the first conference of the World Medical Association (WMA) to try to understand what had gone wrong: how had the healing profession become involved in these shocking crimes? At the conference, questions of medical ethics were central, and the WMA hammered out a contemporary restatement of the medical profession’s core moral code. This became known as the Declaration of Geneva, a contemporary formulation of the Hippocratic Oath. It began “At the time of being admitted as a member of the medical profession I solemnly pledge myself to consecrate my life to the service of humanity...”
A few months later, the UDHR was published and adopted, enshrining many of the principles of the Nuremberg code and the Declaration of Geneva. For example: respect for human dignity, freedom from torture, cruel, inhuman or degrading treatment, and a right to the standard of living adequate for health and wellbeing. Although the sources of cultural change are complex, in subsequent decades, prevailing discourse in (western) medical ethics placed increasing emphasis on patient autonomy and patient rights. Medical law and clinical guidelines have followed, leading to a reformulation of the doctor-patient relationship. Medical paternalism has slowly given way to a partnership approach: doctor and patient working together in the pursuit of sustainable health and well-being.
Today the UDHR (which has since been translated into the European Convention on Human Rights and adopted into UK law via the Human Rights Act 1998) continues to frame and clarify doctors’ obligations and, most importantly, enables doctors to better advocate for their patients. In addition, modern human rights law and discourse enables organisations like the BMA to demand better conditions and protections for doctors and patients in the United Kingdom and abroad, and to guard against state interference in medicine and medical ethics.