Article
26 - Habilitation and rehabilitation
Background Documents | Article
26 Background
Seventh Session | Sixth Session | Fourth
Session | Third Session
Working Group | References
Compilation of proposed revisions and amendments made by the members of the Ad Hoc Committee to the draft text presented by the Working Group as a basis for negotiations by Member States and Observers in the Ad Hoc Committee
(updated after the completion of the first reading at the Fourth Session, 26 August 2004)
Article 21
Right to health [and rehabilitation — Mexico]1
(Access to healthcare and medical rehabilitation — EU) (Access to healthcare
— South Africa)
Right to health and medical and paramedical rehabilitation — Lebanon
States Parties recognize that (the promotion of health and the prevention of
disabilities is an immutable and essential responsibility of all health-care
systems and that — Philippines) all persons with disabilities have (full access
to and — Namibia) the right to the enjoyment of the highest attainable standard
of health (free — Yemen) [without discrimination on the basis of disability
— Costa Rica] (on an equal basis and considering human diversity — Costa Rica).
States Parties [shall — Japan] (and for that purpose — Japan) strive to ensure
no person with a disability is deprived of that right, and shall take all appropriate
(and effective — Australia) measures [to ensure access2
— Japan] (affordability, adequacy and continuity when needed — Lebanon) (to
create conditions which would assure to all persons with disabilities health
and rehabilitation services — Japan) for persons with disabilities to health
(health insurance — Uganda) (on an equal basis with others and without discrimination
— Thailand) [and (medical — EU, Canada, Lebanon) (and paramedical — Lebanon)
rehabilitation — Mexico] services. In particular, States Parties shall:
(a) [Provide — New Zealand] (Ensure — New Zealand) persons with disabilities
(have access to — New Zealand) [with — New Zealand] the same [range and standard
of — New Zealand] (all — Holy See) health (or healthcare — Holy See) [and (medical
— EU) rehabilitation– Mexico] services (and information related to the health
services — Guatemala) as provided [(to — Canada) other [citizens — Canada, New
Zealand] (persons and to the same standard — New Zealand) —Mexico] (to persons
without disabilities — Mexico), [including (rehabilitation as well as — South
Africa) sexual and reproductive health services — Holy See, Trinidad and Tobago];
[(b) [[Strive to provide — South Africa] (Achieve the progressive realization
of disability specific — South Africa) those (additional — New Zealand) health
[and (medical — EU) rehabilitation — Mexico] services needed (and requested
— Costa Rica) by persons with disabilities specifically because of their disabilities;
— Namibia] (Develop understanding of disability rights, respect for diversity,
non-discriminatory attitudes and realistic perception of the capacities of persons
with disabilities as users of health services for health professionals at all
levels, in line with the principles of this convention — Namibia)
(c) [[Endeavour — Uganda] (Ensure — Uganda) to provide these health [and (medical
— EU) rehabilitation — Mexico] services [as close as possible — New Zealand]
(in — New Zealand) to people’s own communities — Namibia];3
(including domiciliary attention and community-based rehabilitation — Costa
Rica) (Involve persons with disabilities and their representative organizations
in the development and monitoring of health policies and of a code of ethics
for public and private health care in promoting quality, transparency and respect
for human rights at national level — Namibia)
(c bis) Provide persons with disabilities with medical assistance including
the provision of medicines on a free basis in accordance with the minimum social
standards — Russian Federation)
[[[(d) [(Endeavour to — Australia) Ensure that health [and rehabilitation —
Mexico] services include the provision of [safe — South Africa] respite places,
to use on a voluntary basis, and counselling and support groups, including those
provided by persons with disabilities — Namibia]; — Jordan] (Ensure that respect
is afforded to persons with disabilities to give consent to or refuse medical
interventions of all kinds, in accordance with their evolving capacities — Namibia)
((d bis) Endeavour to support facilities that are in the ownership or managed
by persons with disabilities; — South Africa)
(e) [Provide programmes and services to prevent and protect against [secondary
— Morocco] disabilities, including among children (adults — Chile) and the elderly;4
— Namibia] (Ensure appropriate training and support of sufficient number of
rehabilitation — Namibia]
[[(f) [Encourage — Uganda] (Promote — Uganda) (biomedic, genetic and scientific
— Chile) research and the development, dissemination and application of new
knowledge and technologies that benefit persons with disabilities (involvement
of organizations and establishments whose interest is to support research and
spreading knowledge and awareness of preventive services — Bahrain);5
— New Zealand]
(g) [Encourage — Uganda] (Promote — Uganda) the development of [sufficient numbers
of — Costa Rica] health [and rehabilitation — Mexico] professionals, including
persons who have disabilities, covering all disciplines needed to meet the health
[and rehabilitation — Mexico] needs of persons with disabilities, and ensure
that they have adequate specialized (or continued — Morocco) training; — Canada]
— Jordan]
[(h) [Provide — Canada] (Promote the appropriate education and training of all
— Canada) [to all — Canada] health [and rehabilitation — South Africa, Mexico]
professionals [an appropriate education and training — Canada] to increase (their
knowledge and — Chile) their disability-sensitive awareness and respect for
the rights, dignity and needs of persons with disabilities, [in line with the
principles of this Convention;6 — Canada]
[(i) (Endeavour to — Australia) 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;
— Canada, —New Zealand]
[(j) Ensure that health [and rehabilitation — Mexico] services provided to persons
with disabilities, and the sharing of their personal health or rehabilitation
information,7 occur only after the person
concerned has given their free and informed consent (or with the application
of other relevant legal safeguards — Japan, Argentina) (or their guardian or
legal representative — Morocco) (in respect of each service offered — New Zealand)
(Ensure that free and informed consent is given only after the person concerned
has been told of the nature, consequence and risks of the health intervention
in the language understandable to the specific person with disabilities and/or
their immediate families and recognized guardians — Philippines),8
and that [health and rehabilitation professionals inform — Mexico] persons with
disabilities of their [relevant — Mexico] rights;9
— EU]
(Promoting quality public and private healthcare that respects the human rights
of persons with disabilities and ensuring that health and rehabilitation professionals
are aware of, and respect, the rights, dignity and needs of persons with disabilities
— EU)
[(k) [[Prevent — Costa Rica] (Impede — Costa Rica) unwanted medical and related
interventions (rehabilitation — Chile) and corrective surgeries from being imposed
on persons with disabilities (which are not authorized by them or their representatives.
— Chile) — China] (ensure that medical and related interventions are in the
best interests of persons with disabilities, and prevent unwanted medical and
related interventions unless exceptional circumstances in accordance with the
procedures established by law and with the application of appropriate legal
safeguards — China);10 — Jordan, New Zealand]
(Prevent medical, surgical and other related interventions from being imposed
on persons with disabilities without their free and informed consent. — New
Zealand)
[[(l) Protect the privacy of health and rehabilitation information of persons
with disabilities on an equal basis;11
— South Africa] — Australia, Mexico]
(Removing the barriers to access to health and rehabilitation services (as suggested
by the Asia/Pacific forum of National Human Rights institutions) — for example,
spousal consent being required, lack of convenient and affordable transport
and affordability of services (on an equitable basis);
Equal access to public health programmes e.g. programmes aimed at preventing
HIV/AIDS, ensuring provision of safe and potable water and sanitation and cervical
and breast screening for women;
Rationing of health services should not be on the basis of disability;
Access to other health-related services, such as dentistry, — New Zealand)
[(m) Promote the involvement of persons with disabilities and their organizations
in the formulation of health and (medical — EU) rehabilitation legislation and
policy as well as in the planning, delivery and evaluation of health and (medical
— EU) rehabilitation services.12 — EU]
— Namibia] — Canada] — Jordan, Argentina] — Namibia, Mexico, New Zealand] —
EU]
(Give priority to providing health services to persons with severe disabilities
— Bahrain)
(States should promote rehabilitation programmes based on the community. — Chile)
(Remove barriers to the equal access to health services by persons with disabilities;
Ensure public health programmes, and programmes concerned with the underlying
determinants of health, benefit persons with disabilities on an equal basis
with all others;
Prevent the discriminatory allocation of health resources on the basis of disability;
Prevent the provision of a different standard of treatment or the discriminatory
refusal to provide health services, including the refusal to treat or to provide
the food and fluids necessary to sustain life, on the basis of disability —
New Zealand)
(21 bis Right to Community Based Rehabilitation
1. States Parties recognize that all persons with disabilities have the right
to rehabilitation. States Parties shall ensure that no person with disabilities
is deprived of that right, and shall take all appropriate measures to ensure
full access for persons with disabilities to rehabilitation services. In particular,
States Parties shall:
(a) Endeavour to provide rehabilitation services within the community, based
on the principles of community based rehabilitation;
(b) Ensure that health and rehabilitation services include the provision of
safe respite places to use on a voluntary basis, counselling, and support groups
including peer support;
(c) Provide programmes and services to protect against and cope with secondary
disabilities including among 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 in consultation with persons with disabilities.
2. States Parties shall recognize community based rehabilitation as a rights-based
strategy to alleviate poverty and to address the direct and indirect socio-economic
costs of disability at the level of the individual, family and the society at
large
3. States Parties shall enhance rights, social and economic approach in the
development of community based rehabilitation services
(a) Mobilizing awareness and responsiveness towards equal rights among disabled
children and adults, authorities and the society at large;
(b) Removing attitudinal, financial and infrastructural barriers in society,
and promoting inclusive public and private services for all, particularly for
disabled children and adults;
(c) Consulting and strengthening representative organizations of disabled children,
adults as well as their families as primary stakeholders in the full development
of such strategies and services;
(d) Enabling disabled children and adults to reach their potential through the
development of community based rehabilitation strategies and services at all
levels, which are affecting attitude change at large and based upon priorities
of disabled children, adults and caregivers themselves to achieve their rights
(e) Providing early intervention-, advisory-, functional training- and respite
services to disabled persons, families and caregivers in the community aiming
at self-reliance and full participation.
4. States Parties shall equip and empower a national coordinating disability
body with the responsibility to manage community based rehabilitation at national
and international level, assuring cohesiveness across national legislation,
strategies and service provisions and in line with all other disability issues.
(a) The consultation of and best interests of disabled children and adults being
paramount;
(b) Access, affordability and quality of such services is assured at all governmental
levels for all children, adults and their families;
(c) Ensure community based rehabilitation is included in all community activities
at all levels — Namibia).
(21 bis Persons with disabilities have a right to a comprehensive psychosocial
rehabilitation in order to enable them to reach and sustain their optimum level
of functioning and self expression and to live an independent life of their
choice in their preferred community. Rehabilitation shall be understood as including
habilitation and rehabilitation. Toward this end States parties undertake:
1. To maintain and develop a comprehensive and integrated range of functional
rehabilitation services including occupational, vocational, housing, recreational,
educational, and associated assistive technology and management and a self-supportive
system, and to ensure that such rehabilitation is in alignment and continuity
with medical and paramedical rehabilitation.
2. Take steps to ensure that information with respect to rehabilitation services
and procedures are widely available and accessible to all persons with disabilities
and, when appropriate, to their families.
3. To ensure that access to such services will be open to all persons with disabilities
without discrimination of any kind, and particularly without regard to the kind
or severity of the disability.
4. To take steps to ensure that the specific rehabilitation needs of women,
girls, children, the elderly, and family members of persons with disabilities
are appropriately addressed in order to ensure respect for their dignity and
particular needs.
5. To base the design of rehabilitation programmes on the actual needs of the
person concerned, through a process of individualized comprehensive assessment
and intervention and, towards this end, to actively involve the person in the
design, organization, and periodic review of their programme.
6. To prohibit the imposition of any programme of rehabilitation against the
wishes of the person concerned.
7. To take steps to ensure that rehabilitation programmes are available locally
in the individual’s own community in order to ensure that the rehabilitation
process creates a meaningful and practical pathway into a life of full participation
and inclusion, in accordance with personal choice and opportunities.
8. To involve persons with disabilities and their representative organizations
in policy decision-making, the concrete rehabilitation process, and the evaluation
of rehabilitation outcomes.
9. To ensure that all personnel involved in rehabilitation are sensitized to
the rights and needs of persons with disabilities, and to ensure that their
objective is to make the full inclusion of people with disabilities possible.
— Israel)
(21 bis 1. States Parties recognize that rehabilitation is a prerequisite for
the equalization of opportunities and the full inclusion of persons with disabilities.
To that end, States Parties shall endeavour to ensure:
(a) Access to a continuum of rehabilitation services, including, inter alia,
physiotherapy, occupational therapy, speech language and communication therapy,
psychosocial counselling and therapies;
(b) These services are provided, to the extent possible, close to the communities
in which persons with disabilities live;
(c) The development of appropriate and specialized human resources and training
material to support the same;
(d) The production, usage and monitoring of good quality assistive devices at
affordable prices, and the promotion of research and development of the same
[removal of this clause from article 19 (e) and 20 (c)];
(e) Availability of programmes and services to prevent and protect against secondary
disabilities;
(f) Active involvement of persons with disabilities and their families in matters
of rehabilitation plans and policies; — India)
(21 bis Right to training and rehabilitation [Right to habilitation and rehabilitation
— Lebanon]
1. The States ensure to include reference to psychological, social, physical
and vocational rehabilitation in the chapeau of the article.
2. To include language on the need for consent of the person with disability
before any rehabilitation begins.
3. To include reference to the participation of persons with disabilities and
their representative organizations. — Yemen)
(21 bis Right to prevention
States Parties shall take all necessary measures particularly by offering programmes
and services that are aimed at preventing and fighting congenital or accidental
disabilities — Cameroon)
Footnotes
1. Some members of the Working Group considered that grouping “rehabilitation” with “health” was inappropriate, and that it would be better dealt with in a separate article, because “rehabilitation” includes more than “medical rehabilitation”, and should not be “medicalized”. Rehabilitation includes medical, physical, occupational, communication and psychosocial services as well as training in everyday skills and mobility. The term “rehabilitation” as used here includes those processes sometimes called “habilitation” (the gaining of skills that people have not previously had, rather than the regaining of skills lost). The Ad Hoc Committee may wish to include an explanation of this nature in draft article 3 on definitions. Rehabilitation for the purposes of work and education may be best covered in the relevant draft articles on work and education.
2. Some Working Group members suggested that
affordability, and access to health insurance by persons with disabilities without
discrimination on the basis of disability, should be addressed in the Convention.
3. There was general agreement in the Working
Group that, as far as possible, health care and rehabilitation services should
be decentralized, taking into account the degree of specialization. Some members
of the Working Group also suggested that community-based rehabilitation programmes
should be ensured, including the working in partnership with local communities
and families to continue rehabilitation.
4. There were conflicting views among members
of the Working Group on the issue of the prevention of disability. For some,
the Convention has to do with the rights of existing persons with disabilities,
and should mention only the minimization of the effects or progression of their
disability, and the prevention of further, secondary disabilities. Others felt
that the prevention of disability per se should be included.
5. Some members of the Working Group suggested
there should be a specific mention of the fields of (bio)medical, genetic and
scientific research, and its applications, and its use to advance the human
rights of persons with disabilities.
6. Part of the intent of this subparagraph
is to ensure that health and rehabilitation professionals providing services
to persons with disabilities understand the ongoing effect disabilities have
on a person’s life, as opposed to more immediate medical considerations.
7. Privacy issues have been also addressed
in draft article 14 on the right to privacy.
8. Free and informed consent has wider application
in this draft Convention than this paragraph alone. The Ad Hoc Committee may
wish to consider whether the following wording should be included in this subparagraph
or broadened to become a definition in draft article 3:
“Informed decisions can be made only with knowledge of the purpose and nature,
the consequences and the risks of the treatment and rehabilitation supplied
in plain language and other accessible formats.”
9. Some members of the Working Group considered
that the subparagraph should spell out the rights.
10. Some members of the Working Group also
considered that forced medical intervention and forced institutionalization
should be permitted in accordance with appropriate legal procedures and safeguards
(see also draft article 11).
11. Some members of the Working Group suggested
that this subparagraph was redundant and should be deleted.
12. The involvement of persons with disabilities
in formulating legislation and policy, as well as in the planning, delivery
and evaluation of services, has wider applicability than this draft article.
Some members of the Working Group suggested that it should be covered under
draft article 4 on general obligations.