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Article
26 - Habilitation and rehabilitation
Background Documents | Article
26 Background
Seventh Session | Sixth Session | Fourth
Session | Third Session
Working Group | References
Fourth Session
Governments
Sudan
Non-governmental organizations
Children's Rights Alliance for England
Working Meeting of NGOs for people with disabilities from Ukraine, Russia, Belarus & Moldova
Comments, proposals and amendments submitted electronically
Governments
PROPOSAL ON DRAFT ARTICLE 21
RIGHT TO HEALTH AND REHABILITATION:
- Add to article 21 a the phrase in bold so it would read as follows,:
Provide persons with disabilities with the same range and standard of health
and rehabilitation services as provided to other citizens, including sexual
and reproductive including all aspects of health services and when possible,
shall provide treatment to curable disabilities cases in their all different
stages failed by persons with disabilities due to poverty.
Non-governmental organizations
CHILDREN's RIGHTS ALLIANCE FOR ENGLAND
Article 21
Right to health and rehabilitation
States Parties recognize that all persons with disabilities have the right
to the enjoyment of the highest attainable standard of health without discrimination
on the basis of disability. States Parties shall strive to ensure no person
with a disability is deprived of that right, and shall take all appropriate
measures to ensure access for persons with disabilities to health and rehabilitation
services. In particular, States Parties shall:
(a) Provide persons with disabilities with the same range and standard of
health and rehabilitation services as provided other citizens, including
sexual and reproductive health services;
(b) Strive to provide those health and rehabilitation services needed by
persons with disabilities specifically because of their disabilities;
(c) Endeavour to provide these health and rehabilitation services as close
as possible to people’s own communities;
(d) Ensure that health and rehabilitation services include the provision
of safe respite places, to use on a voluntary basis, and counselling and
support groups, including those provided by persons with disabilities;
(e) Provide programmes and services to prevent and protect against secondary
disabilities, including among children and the elderly;
(f) Encourage research and the development, dissemination and application
of new knowledge and technologies that benefit persons with disabilities;
(g) Encourage the development of sufficient numbers of health and rehabilitation
professionals, including persons who have disabilities, covering all disciplines
needed to meet the health and rehabilitation needs of persons with disabilities,
and ensure that they have adequate specialized training;
(h) Provide to all health and rehabilitation professionals an appropriate
education and training to increase their disability-sensitive awareness
and respect for the rights, dignity and needs of persons with disabilities,
in line with the principles of this Convention;
(i) Ensure that a code of ethics for public and private health care, which
promotes quality care, openness and respect for the human rights, dignity
and autonomy of persons with disabilities, is put in place nationally, and
ensure that the services and conditions of public and private health care
and rehabilitation facilities and institutions are well monitored;
(j) Ensure that health and rehabilitation services provided to persons with
disabilities, and the sharing of their personal health or rehabilitation
information, occur only after the person concerned has given their free
and informed consent, taking into account the evolving capacities of the
child, and that health and rehabilitation professionals inform persons with
disabilities of their relevant rights;
(k) Prevent unwanted medical and related interventions and corrective surgeries
from being imposed on persons with disabilities;
(l) Protect the privacy of health and rehabilitation information of persons
with disabilities on an equal basis;
(m) Promote the involvement of persons with disabilities and their organizations
in the formulation of health and rehabilitation legislation and policy as
well as in the planning, delivery and evaluation of health and rehabilitation
services.
LANDMINE SURVIVORS NETWORK
Draft Article 21 - RIGHT TO THE HIGHEST ATTAINABLE STANDARD OF HEALTH
SYNTHESIS OF PROPOSALS
States Parties recognise that all persons with disabilities have the right
to the enjoyment of the highest attainable standard of health without discrimination
on the basis of disability. States Parties shall strive to ensure that no
person with a disability is deprived of that right, and shall take all appropriate
and effective measures to ensure access for persons with disabilities to
health and rehabilitation services. In particular, States Parties shall:
(a) ensure that persons with disabilities are provided with the same standard
of health care services, including sexual and reproductive health services,
within the same system as other members of society;
(b) ensure that preventive health care services, including HIV/AIDS programs,
are provided on an equal basis to all persons with disabilities;
(c) ensure that all medical and paramedical personnel are adequately trained
and equipped to give medical care to persons with disabilities and that
they have access to relevant treatment methods and technology;
(d) prevent unwanted medical, surgical and related interventions and ensure
respect for informed consent of all persons with disabilities;
(e) ensure that medical services respect the human rights of persons with
disabilities and that medical professionals are aware of, and respect the
rights, dignity and need of persons with disabilities; and
(f) promote involvement of persons with disabilities and their organizations
in the formulation of health legislation and policy as well as in the planning,
delivery and evaluation of health services.
COMMENTS
Draft Article 21 is quite different from the Working Group Draft Text as
States expressed overwhelming support for separate treatment of health and
rehabilitation during the Ad Hoc Committee meeting. The current Draft Article
21 is shorter than the previous draft, as it deals exclusively with health
care services and all reference to rehabilitation has been placed in the
Draft Article 21bis.
For the most part, the chapeau of Draft Article 21 was retained from the
Working Group Draft Text. It is in keeping with the previous international
documents’ provisions on health. (Cf. ICESCR, Article 12; CERD, Article
5; CEDAW, Article 12; CRC Article 24) The only addition to the chapeau was
the word “effective” as proposed by Australia during the Ad Hoc Committee
meeting. (Cf. CRC Reporting Guidelines)
Draft Article 21 (a) does not include reference to rehabilitation and reflects
changes proposed (South Africa) during the third session of the Ad Hoc Committee.
It reiterates the non-discrimination principle in attaining necessary health
care, which was expressed in the chapeau. (Cf. UNSR, Rule 2(3); Committee
on Economic, Social and Cultural Rights, General Comment No. 5; Committee
on the Elimination of All Forms of Discrimination Against Women, General
Recommendation No. 24)
Draft Article 21 (b) includes language proposed by New Zealand during the
third session of the Ad Hoc Committee, as well as proposals concerning prevention
of discriminatory allocation of health resources based on disability. It
should be noted that prevention in this draft Paragraph does not relate
to prevention of disability, but rather the focus is on prevention of, inter
alia, secondary disabilities, aggravating conditions, infectious diseases,
and so forth.
Draft Article 21(c) reflects Working Group Draft Text Articles 21(f), (g),
and (h), as well as UNSR, Rule 2(4). (Cf. CRC Implementation Guidelines)
The language in the Draft Article 21(d) is based on the Working Group Draft
Article 21 (j) and (k) and it emphasizes the importance of choice, necessary
for empowerment of people with disabilities to accept or refuse health care.
The language reflects proposal by New Zealand during the third session of
the Ad Hoc Committee. (Cf. Committee on Economic, Social and Cultural Rights,
General Comment No. 14; Committee on the Elimination of All Forms of Discrimination
Against Women, General Recommendation 24)
Draft Article 21 (e) reflects the proposals by Canada and the EU regarding
Working Group Draft paragraph (h) during the third session of the Ad Hoc
Committee. The original proposals included “promote” as the operative word,
but “ensure” is more appropriate given the importance of health care services
for people with disabilities.
Current Draft Article 21(f) addresses the involvement of people with disabilities
and their organizations in the formulation and implementation of health
legislation and policies. These important concepts find precedent in the
UNSR (Cf. UNSR 3(7) and 14(2); Committee on Economic, Social and Cultural
Rights, General Comment No. 14; WHO Declaration of Alma Ata (1978))
Draft Article 21bis - RIGHT TO REHABILITATION AND HABILITATION
SYNTHESIS OF PROPOSALS
States Parties recognise that all persons with disabilities have the right
to rehabilitation and habilitation. States Parties shall strive to ensure
no person with a disability is deprived of that right, and shall take all
appropriate measures to ensure access for persons with disabilities to rehabilitation
services. In particular, States Parties shall:
(a) ensure the provision of quality rehabilitation services and information
about such services, within the community, where possible and appropriate;
(b) ensure that health and rehabilitation services include the provision
of safe respite places, to use on a voluntary basis, counseling and support
groups, including peer support;
(c) provide programs and services to prevent and protect against secondary
disabilities, including amongst children and the elderly;
(d) encourage research and the development, dissemination and application
of new knowledge and technologies relating to rehabilitation that benefit
persons with disabilities;
(e) encourage the development of sufficient numbers of rehabilitation professionals,
including persons who have disabilities, covering all disciplines needed
to meet the health and rehabilitation needs of persons with disabilities,
and ensure they have adequate specialised training;
(f) provide the appropriate education and training of all rehabilitation
professionals to increase their disability-sensitive awareness and respect
for the rights, dignity and needs of persons with disabilities;
(g) ensure that rehabilitation services respect the human rights of persons
with disabilities and that rehabilitation professional are aware of, and
respect, the rights, dignity and need of persons with disabilities; and
(h) promote the involvement of persons with disabilities and their organizations
in the formulating of rehabilitation legislation and policy as well as in
the planning, delivery and evaluation of rehabilitation services.
COMMENTS
Draft Article 21bis responds to the overwhelming support of delegations
for the separation of health and rehabilitation into two separate articles
in the Convention. This is in keeping with prevailing international law
practice and consistent with the approach adopted in the UNSR and CRC which
reference rehabilitation as separate from health services.
The coverage of access to medical care and rehabilitation and habilitation
services in two separate articles reflects the understanding that health
care services and rehabilitation services are distinct and serve different
needs. Rehabilitation does not involve initial medical care and should not
be understood as a medical service. Rather, in keeping with the UNSR definition
(paragraph 23, Definitions), rehabilitation consists of a wide range of
services that seek to empower the individual, place the participant at the
center of his/her rehabilitation plan, and also engage people with disabilities
in the design and implementation of rehabilitation policies at all levels.
In keeping with recommendations by a number of organizations concerned with
implementing rehabilitation services, the term “habilitation” should likewise
be covered in a Convention article on rehabilitation.
Draft Article 21bis chapeau: The text provided is drawn from the Working
Group Draft Text. Rule 19 of the UNSR addresses the subject of personnel
training more broadly, though it requires specific mention in the rehabilitation
context.
Draft Article 21bis (a) combines both language as to the quality of rehabilitation
services and the preference that such services be provided within the community,
where possible. (Combining Working Group Draft Text Article 21(a) and (c)).
A number of delegations supported the provision of rehabilitation services
within the community. (Cf. UNSR, Rule 3(5))
Draft Article 21bis (b) is retained from the Working Group Draft Text, but
amended to explicitly reference “peer support.” (South Africa) The original
version referenced the need for “counseling and support groups, including
those provided by persons with disabilities.”
Peer support, reflecting the common practice of those with similar shared
experiences offering mutual support, is widely recognized for its success
as a component of rehabilitation and helps foster the active participation
of people with disabilities in their rehabilitation plan. The term “peer
support” has acquired meaning within the context of a wide variety of rehabilitation
services and is cross-disability in nature. This development is not fully
captured by the mere reference to “support groups, including those provided
by persons with disabilities.”
Draft Article 21bis (c) retains language from the Working Group Draft Text
Article 21, as applicable to rehabilitation services.
Draft Article 21bis (d) retains language from Working Group Draft Text Article
21bis (f), with minimal drafting changes. Coverage of research and application
of new knowledge and technologies to enhance access to quality and appropriate
rehabilitative services should receive separate mention in the draft, on
the basis of Working Group discussions.
Article 21bis (e) is retained from the Working Group Draft Text, but amended
to specify and make clear that the paragraph relates to knowledge and technologies
relating to rehabilitation services.
Article 21bis (f) draws from the Working Group Draft Text, but is amended
in line with proposals by Canada, emphasizing both training and education
for professionals that is disability-sensitive and respectful of rights.
Article 21bis (g) provides language drawn from the EU proposal and reflecting
the view of many delegations that Working Group Draft Text
Article 21, sub-paragraphs
(h)-(l), addressed a number of relating, and in some instances, overlapping
concepts. This creates redundancies and causes confusion. The EU proposal
reflects a much more consolidated and in fact stronger approach to ensuring
that the rights of people with disabilities are fully respected in the design,
implementation and evaluation of rehabilitative processes.
Article 21bis (h) retains language from Working Group Draft Article 21 and
corresponds to UNSR, Rule 3(7). It provides specific application to the
principle of participation, a guiding principle of the Convention.
WORKING MEETING OF NGOs FOR PERSONS WITH DISABILITY FROM UKRAINE, RUSSIA, BELARUS & MOLDOVA
Article 21
Right to health and rehabilitation
To add one more issue
(n) to provide to people with disabilities diagnosing and treatment according
to specialized methods in the cases when a person can not identify his/her
health problems, inform about own health problems and implement the doctor’s
prescription.