CONTENT

TASK MEMBER

I. Nature of physician-patient relationship (1 member)

https://www.ncbi.nlm.nih.gov/pmc/art [email protected]
icles/PMC1071119/

II. Patient’s bill of rights (1 member)

Medical Law, Ethics, and Bioethics [email protected]
(Chapter 1 - PDF page 19 onwards
https://velezcollegecom.sharepoint.co
m/:b:/s/OT221ETHICS2023-2024/Ebj
0QMrbWIFAiM4k3Cll4qYBFlEXY0frUD
98Z5ADG4Gnyw?e=zucNlI)

III. Human rights (2 members)

https://velezcollegecom.sharepoint.co [email protected]
m/:b:/s/OT221ETHICS2023-2024/EeN [email protected]
2MiDBkTNJiRjOyaDoYH8BoLma6RCzIz
bKvp-kD7uySw?e=xTjYGa Chapter 6 pg.
66 onwards

IV. UN rights of a child (2 members)

https://www.ohchr.org/en/instrument Arianna Marie Reformina
s-mechanisms/instruments/convention [email protected]
-rights-child

V. Convention on the rights of persons (2 members)

with disabilities [email protected]
https://www.ohchr.org/en/instrument [email protected]
s-mechanisms/instruments/convention
-rights-persons-disabilities

DEADLINE
Content 09-26-2023 (Tuesday)

PPT 09-27-2023 (Wednesday)

Recording 09-28-2023 (Thursday)

P.S. report should be submitted on SEPTEMBER 29, 2023 (FRIDAY)

Main Reference: Bridgit

RIGHTS AND RESPONSIBILITIES
by Group 2

I. Nature of Physician-Patient Relationship

The doctor-patient relationship has been defined as “a consensual relationship in which the patient
knowingly seeks the physician’s assistance and in which the physician knowingly accepts the person
as a patient.”

Four elements that form the doctor-patient relationship

Trust. Bennett et al. found that, among patients with systemic lupus erythematosus, those who
trusted and “liked” their physician had higher levels of satisfaction. In another study, 13 patients’
perceptions of their physician’s trustworthiness were the drivers of patient satisfaction.

Knowledge. When doctors discovered patient concerns and addressed patient expectations, patient
satisfaction increased, just as it did when doctors allowed a patient to provide information.

Regard. Ratings of a physician’s friendliness, warmth, emotional support, and caring have been
associated with patient satisfaction.

Loyalty. Patients feel more satisfied when doctors offer continued support; continuity of care
improves patient satisfaction.

Factors affecting the doctor-patient relationship

1. Patient-Dependent Factors: Aspects of a patient's condition, choices, or characteristics that affect

their healthcare outcomes

2. Provider-Dependent Factors: Healthcare providers' actions, decisions, and competence that

impact the quality of care

3. Health System-Dependent Factors: Aspects of the healthcare system, such as accessibility and
coordination of care, affecting healthcare outcomes

4. Patient-Provider Mismatch: A disconnect or lack of compatibility between a patient and their

healthcare provider, potentially impacting the patient-provider relationship and outcomes.

The practice of medicine, and its embodiment in the clinical encounter between a patient and a
physician, is fundamentally a moral activity that arises from the imperative to care for patients and
to alleviate suffering. The relationship between a patient and a physician is based on trust, which
gives rise to physicians’ ethical responsibility to place patients’ welfare above the physician’s own
self-interest or obligations to others, to use sound medical judgment on patients’ behalf, and to
advocate for their patients’ welfare.
A patient-physician relationship exists when a physician serves a patient’s medical needs. Generally,
the relationship is entered into by mutual consent between physician and patient (or surrogate).

However, in certain circumstances a limited patient-physician relationship may be created without

the patient’s (or surrogate’s) explicit agreement. Such circumstances include:

(a) When a physician provides emergency care or provides care at the request of the patient’s
treating physician. In these circumstances, the patient’s (or surrogate’s) agreement to the
relationship is implicit.

(b) When a physician provides medically appropriate care for a prisoner under court order, in
keeping with ethics guidance on court-initiated treatment.

(c) When a physician examines a patient in the context of an independent medical examination, in
keeping with ethics guidance. In such situations, a limited patient-physician relationship exists.

TYPES OF DOCTOR-PATIENT RELATIONSHIP

Different forms of doctor-patient relationship arise from differences in the relative power and
control exercised by doctors and patients (Table 1). In reality, these different models perhaps do not
exist in pure form, but nevertheless, most consultations tend towards one type.

PATERNALISTIC RELATIONSHIP

A paternalistic (or guidance–cooperation) relationship, involving high physician

control and low patient control, where the doctor is dominant and acts as a ‘parent’
figure who decides what he or she believes to be in the patient’s best interest. This
form of relationship traditionally characterized medical consultations and, at some
stages of illness, patients derive considerable comfort from being able to rely on the
doctor in this way and being relieved of burdens of worry and decision making.
However, medical consultations are now increasingly characterized by greater
patient control and relationships based on mutuality.
MUTUALITY RELATIONSHIP

A relationship of mutuality is characterized by the active involvement of patients as

more equal partners in the consultation and has been described as a ‘meeting
between experts’, in which both parties participate as a joint venture and engage in
an exchange of ideas and sharing of belief systems. The doctor brings his or her
clinical skills and knowledge to the consultation in terms of diagnostic techniques,
knowledge of the causes of disease, prognosis, treatment options and preventive
strategies, and patients bring their own expertise in terms of their experiences and
explanations of their illness, and knowledge of their particular social circumstances,
attitudes to risk, values and preferences.

CONSUMERIST RELATIONSHIP

A consumerist relationship describes a situation in which power relationships are

reversed; with the patient taking the active role and the doctor adopting a fairly
passive role, acceding to the patient’s requests for a second opinion, referral to
hospital, a sick note, and so on.

DEFAULT RELATIONSHIP

A relationship of default can occur if patients continue to adopt a passive role even
when the doctor reduces some of his or her control, with the consultation therefore
lacking sufficient direction. This can arise if patients are not aware of alternatives to
a passive patient role or are timid in adopting a more participative relationship

Responsibilities

Providing information
The responsibility to provide, to the best of his/her knowledge, accurate and complete information
about past illness, hospitalizations, medications, and other matters relating to his/her health.

Respect and Consideration

The responsibility for being considerate of the rights of other patients and health care personnel
and for assisting in the control of noise, smoking, and the number of visitors. The patient is
responsible for being respectful of the property of other persons and of the facility.

Compliance with Medical Care

The responsibility for complying with the medical and nursing treatment plan, including follow-up
care, recommended by health care providers. This includes keeping appointments on time and
notifying the facility when appointments cannot be kept.
Medical Records
The responsibility for ensuring that medical records are promptly returned to the medical facility
for appropriate filing and maintenance when records are transported by the patients for the
purpose of medical appointments or consultation, etc.

MTF Rules and Regulations

Patients must follow general medical facility rules and policies affecting patient and visitor conduct.

Reporting of Patient Complaints

The responsibility for helping the MTF Commander provide the best possible care to all
beneficiaries. Patient's recommendations, questions, or complaints should be reported to the
Patient Contact Representative.

II. Patient’s Bill of Rights

The right to be respected

The patient has the right to considerate and respectful care at all times and under all circumstances
with recognition of his/her personal dignity, values and beliefs. The patient has the right to wear
his/her desired attire as long as it is appropriate and can wear religious or other symbolic items, as
long as they do not hinder or cause any issues during diagnosis procedures or
treatment . The practices of the patient’s family members are respected and accommodated by the
practitioner. The patient has the right to be free from any form of restraints and is not obliged to
participate in anything that is not medically related. The patient has the right to receive reasonable
responses to a question or request. A healthcare facility shall respond in a reasonable manner to the
request of a patient's healthcare provider for medical services.

The right to access medical record

The patient is entitled to a summary of his medical history and condition. He/she has the right to
view the contents of his medical records (except psychiatric notes and other incriminatory
information obtained outside or from third parties) including explanation of the contents by the
attending physician. At his expense and upon discharge of the pa He may obtain a copy of the
medical records from the health care institution whether or not he has fully paid his financial
obligation with the physician or institution concerned.

The right to receive a second opinion

He also has the right to seek a second opinion and subsequent opinions, if appropriate or adviced,
from another health care provider/practitioner.

The right to participate in your health care

The patient has the freedom to choose the health care provider to assist him/her as well as the
facility except if he/she is already under the care of a service facility or when public health and
safety demands. When the patient desires to cede this right, he/she has to put this into writing. The
patient has the right to discuss his condition with a consultant specialist, depending on the patient's
request and expense.

The right to privacy

The privacy of the patients must be assured at all stages of his/her treatment. The patient has the
right to be free from unnecessary public exposure, except in the following cases: a) when his
mental or physical condition is in controversy and the appropriate court, in its discretion, order him
to submit to a physical or mental examination by a physician; b) when the public health and safety
so demand; and c) when the patient waive this right in writing.

III. Human Rights

The Human Rights Act 1998

The act was enacted on October 2, 2000 in England, Wales, and Northern Island ( with an
earlier implementation in Scotland due to devolution. Its primary purpose is to incorporate rights
and freedoms outlined on Human Rights within the framework of UK legislation. Under the act,
there are three effects involved:
● The Human Rights Act 1998 requires public authorities and organizations with public
functions to acknowledge and uphold the rights outlined in the European Convention on
Human Rights. This ensures that these entities recognize and respect these fundamental
rights.
● It empowers citizens in the UK to bring legal actions in domestic courts to enforce their
human rights directly. This eliminates the need to go through the lengthy and costly process
of taking such cases to the European Court of Human Rights in Strasbourg.
● The Act mandates judges to declare legislation incompatible with the rights outlined in the
Schedule. An example of this was when the House of Lords declared incompatibility with
English law regarding transgender individuals' right to marry someone of the same gender.
Subsequently, the Gender Recognition Act 2004 and the Civil Partnership Act were passed to
address this issue, ensuring the protection of human rights for all individuals, including
those in same-sex relationships.

Who can be subject to legal action?

The Human Rights Act specifies that legal action under the Act can only be pursued by the
individual who has experienced a violation of their human rights. An individual is considered a
potential victim if they have a direct personal impact resulting from the decision or action they are
protesting, or if they are expected to be directly affected by it. The Act governs the interaction
between individuals and the government, with the goal of safeguarding individuals by ensuring
responsible exercise of power by the Government and public entities. Consequently, one cannot
bring a human rights lawsuit against one's neighbor. Nonetheless, public authorities can employ
existing laws to prevent one individual from infringing upon the rights of another. For instance, if a
woman is subjected to violence by her partner, she cannot directly sue him for violating her rights.
Instead, it is the responsibility of the police to safeguard her human rights by using other laws to
prosecute him for domestic violence. If they knowingly fail to provide adequate protection, it may
constitute a breach of her human rights. Furthermore, the Act does not generally extend to private
organizations, except in specific instances, such as when they provide services on behalf of a public
authority.

The Convention Rights

Article 2: Right to Life
“Everyone’s right to life shall be protected by law. No one shall be deprived of his life
intentionally save in the execution of a sentence of a court following his conviction of a
crime for which this penalty is provided by law. “

Article 2 of the European Convention on Human Rights (ECHR) protects the right to life. It states
that no one can intentionally be deprived of their life except as a lawful penalty for a crime. This
ensures that no one, not even the Government, can attempt to terminate your life. It obliges the
Government to enact protective laws and intervene when necessary to safeguard lives. Public
authorities must factor in your right to life when making decisions that could jeopardize your safety
or affect your life expectancy. If a family member dies in circumstances involving the state, you may
have the right to an investigation. The state is also mandated to investigate deaths deemed
suspicious or occurring in custody. Recent court decisions illustrate the interpretation of this right:

1. In one case, parents were unsuccessful in their attempt to ensure that their severely
handicapped prematurely born baby would be resuscitated if necessary. The judge ruled
that the hospital should provide palliative care to alleviate suffering but should not attempt
revival to avoid unnecessary pain.
2. In another case involved the withdrawal of life-sustaining medical treatment for a patient in
a persistent vegetative state. The court held that this action did not contravene Article 2.
3. Article 2 was also invoked in the case of Siamese twins' separation, where the Court of
Appeal ruled that separation, even though it would result in one twin's death, was
permissible.

Future cases may revolve around issues like disagreements between relatives and clinicians over
"not for resuscitation" orders or patients alleging that the denial of health services infringes on their
right to life.

Furthermore, the House of Lords ruled that Article 2 imposes an operational obligation on medical
authorities to take reasonable measures to prevent patients in mental hospitals, known to be at
immediate suicide risk, from harming themselves. Health authorities must fulfill various obligations,
including employing competent staff and adopting protective work systems. Failure to meet these
obligations can result in a breach of Article 2. If staff negligence occurs despite these measures,
health authorities may be held vicariously liable for violating Article 2 in failing to protect the
patient's life.

Article 3: Freedom from torture and inhuman or degrading treatment

“No one shall be subjected to torture or to inhuman or degrading treatment or punishment.”

Torture entails intentionally inflicting severe and cruel physical or mental pain or suffering on
another person, often for punitive, intimidating, or information-gathering purposes. Inhuman
treatment or punishment involves actions that result in intense physical or mental distress.
Degrading treatment refers to actions that are highly humiliating and lack dignity. These
principles are rooted in the inherent value of every human being and their right to be treated with
respect.

Article 3 of the European Convention on Human Rights covers various situations related to the
prohibition of torture, inhuman, and degrading treatment. While torture is not typically associated
with healthcare, instances of degrading and inhuman treatment can occur. For example, patients left
waiting on stretchers outside an emergency department may experience inhuman or degrading
treatment. Handcuffing a patient to a bed during childbirth could also be seen as a breach of Article
3. While some treatments in Occupational Therapy Departments may not always prioritize patient
dignity and comfort, they are seldom considered Article 3 breaches.

A case heard by the European Court of Human Rights found that severe corporal punishment by a
stepfather to discipline his stepson breached Article 3. The court ruled that ill-treatment must reach
a certain level of severity and considered various factors, including the nature of the treatment and
the victim's age and health. In this case, the court awarded compensation against the UK
Government.

Article 3 rights cover a wide range of situations. Failure to prosecute an assault due to the victim's
mental instability was deemed a breach of Article 3. However, a mandatory life sentence without
parole for a prisoner convicted of two murders was not considered inhuman or degrading
punishment.

In Northern Ireland, ensuring safe school access in an area of religious feuds was seen as a state
duty to prevent inhuman and degrading treatment, but it was not absolute, requiring reasonable
efforts.

Furthermore, the failure of the Home Secretary to investigate allegations of inhuman treatment at
an immigration detention center was deemed a breach of Article 3. Inmates at Winchester prison
were compensated after being denied drugs, as it was considered inhuman treatment to expect
them to undergo abrupt withdrawal.
Article 5: Right to Liberty and Security
“Everyone has the right to liberty and security of person. No - one shall be deprived of his
liberty save in the following cases and in accordance with a procedure prescribed by law.”

Article 5 prioritizes safeguarding individuals' liberty from unjustified confinement, rather than
emphasizing personal safety. An individual possesses the right to their personal liberty, meaning
that they should not be incarcerated or held in detention without valid justification.

Under the Human Rights Act, if you are apprehended, you are entitled to:

1. Be informed in a language you comprehend why you've been arrested and the charges
against you.
2. Receive a prompt appearance in court.
3. Seek bail, with specific conditions, as the court proceedings continue.
4. Have a trial conducted within a reasonable timeframe.
5. Challenge the lawfulness of your detention in court if you believe it is unjustified.
6. Receive compensation if you have been unlawfully detained.

Various situations are discussed, including:

● The lawful detention of individuals to prevent the spread of infectious diseases or
individuals with unsound minds, alcoholism, drug addiction, or vagrancy.

In the Bournewood case, the House of Lords ruled that individuals lacking the mental capacity to
consent to admission to a psychiatric hospital could be detained there in their best interests
without being detained under the Mental Health Act 1983. However, the European Court of Human
Rights found this action contrary to Article 5, leading to amendments to the Mental Capacity Act
2005 to establish safeguards against Article 5 violations.

In a 2000 case, the Court of Appeal determined that, in the absence of statutory provisions for
mentally incapacitated adults, the court had inherent power to address issues related to the daily
care of such individuals and issue declarations in their best interests.

Furthermore, the European Court of Human Rights found the UK in breach of Article 5.1 in relation
to non-national terrorist suspects. Their indefinite detention, without a view to deportation,
discriminated unjustifiably between nationals and non-nationals. The House of Lords held that
police crowd control measures used to prevent public order breaches, which involved confining
thousands of people within a police cordon for several hours, did not violate the right to liberty if
they were used in good faith, were proportionate, and enforced for a reasonable duration.

Article 6: Right to a Fair Trial

1. The right to a fair trial, as stated in Article 6, ensures that individuals have the right to a fair
and public hearing by an independent and impartial tribunal. Judgements are public, but
press and public can be excluded if it’s necessary for morals, public order, national security,
or protecting the interests of juveniles or parties’ private lives, or to the extent strictly
necessary in the opinion of the court in special circumstances where public would prejudice
the interests of justice.
2. Everyone charged with a criminal offense shall be presumed innocent until proven guilty
according to law

This right applies to civil rights and obligations as well, including disciplinary actions. The new
professional conduct and registration machinery for health professions consider these rights.
However, the High Court held that the governors ’ decision to permanently exclude a child from a
particular school did not engage the fair trial provisions protected by article 6 of the ECHR, as the
proceedings of the panel were not classified as criminal under domestic law.

Article 8: Respect for your private and family life, home and correspondence
1. Everyone has the right to respect for private and family life, his home and his
correspondence.
2. There shall be no interference by a public authority with the exercise of the right except
such as is in accordance with the law and is necessary in a democratic society in the interests of
national security, public safety or the economic well - being of the country, for the prevention of
disorder or crime, for the protection of health or morals, or for the protection of the rights and
freedoms of others.

This right will require better protection of patients' privacy in healthcare. Traditional practices like
the ward round may need to be reviewed. Many other actions may have to be taken in order to
ensure that this right of the patient is recognised and protected. Caldicott Guardians will ensure no
breach of Article 8. In other cases it was held that high security restrictions on child visits were valid
and not a breach of Article 8. The European Court of Human Rights ruled that a prisoner's right to
respect for his correspondence, as guaranteed by article 8 of the European Convention on Human
Rights, was violated when prison authorities monitored medical correspondence between a
convicted prisoner and his outside specialist doctor.

Article 8, which protects the right to privacy, must be understood in conjunction with Article 10,
which guarantees freedom of expression. Both rights are subject to limitations, and the courts must
strike a balance between them when determining if a breach has occurred.

In a notable case, the Court of Appeal overturned a High Court ruling in favor of model Naomi
Campbell, who sued a newspaper for violating her privacy and confidentiality. The Court of Appeal
justified the newspaper's report as being in the public interest, considering Campbell's active
pursuit of publicity. However, the House of Lords later overturned the Court of Appeal's decision
and ruled in favor of Campbell. They found that the publication of information about her drug
treatment, along with a covertly taken photograph outside the treatment center, violated her rights
under Article 8. This case highlights the complex nature of balancing privacy rights and freedom of
expression, and the importance of considering the specific circumstances in each situation.
The House of Lords examined the balance between Articles 8 and 10 in a case involving a defendant
in a rape trial who had been granted an anonymity order. Following the defendant's acquittal, the
BBC sought to have the anonymity order lifted. The House of Lords determined that the right to free
expression under Article 10 outweighed the need for anonymity in this case.

In a previous case, the House of Lords also ruled that the Article 10 right of expression by a
newspaper took precedence over the Article 8 rights of a child who was the sibling of a child
allegedly poisoned with salt by their mother.

Furthermore, Article 8 rights were linked to Article 14 by pensioners living abroad who were
excluded from index-linked updating. However, the European Court of Human Rights concluded that
they had not demonstrated a violation of the European Convention on Human Rights.

These cases demonstrate the complex task of balancing the rights to privacy and freedom of
expression under Articles 8 and 10, respectively.

Article 14: Protection from discrimination in respect of these rights and freedoms
“The enjoyment of the rights and freedoms set forth in this Convention shall be secured
without discrimination on any ground such as sex, race, color, language, religion, political or other
opinion, national or social origin, association with a national minority, property, birth or other
status.”

Discrimination is forbidden in the application of the European Convention's Articles under Article
14. It should be noted that the list of forms of discrimination in Article 14 is preceded by the words
"such as," and that other forms of discrimination could be added, including those based on a
person's disability, age, or sexual orientation, or on their travel status, AIDS or HIV status, or their
status as an asylum seeker.

Other significant articles :

Action
There are considerable advantages in each department carrying out an audit to ascertain the extent
to which the department is human rights compliant. Many changes may be required, but these may
be of a procedural kind rather than ones which require expenditure and building work.

Rights to healthcare and social care:

Enforcement of rights
These rights can be enforced by the individual patient in many ways through administrative and
judicial machinery. Administrative machinery includes:
● complaint through the set procedure
● inquiry by Secretary of State
● independent inquiry.

Judicial remedies
Judicial remedies refer to the legal actions or measurements that a court can take to provide relief
or resolution in a legal dispute. These remedies can include various forms of compensation,
injunctions, specific performance, or declaratory judgements, depending on the nature of the case
and the applicable laws.

Judicial remedies include:

● an action for negligence, when harm has occurred
● an action for trespass to the person, where treatment has been given without consent
● an action for breach of statutory duty, where it is alleged that a statutory authority has not
fulfilled its duties
● an action for judicial review of the functions of a statutory authority or other administrative
body.

The right to care and treatment:

Unenforceable rights
Unenforceable rights refer to rights or claims that cannot be effectively upheld or enforced through
legal means. They may lack legal backing or have limitations that prevent individuals from seeking
remedies or taking legal action to protect or assert those rights. It's clear that there is no absolute
right to receive treatment from the NHS. With limited resources and high demand, providers and
funders must prioritize. Courts only intervene if there's evidence of an unreasonable decision on
resource allocation. The Court of Appeal held that:

1. Whilst the precise allocation and weighting of priorities is a matter for the judgment of the
authority and not for the court, it is vital for an authority:
a. to assess accurately the nature and seriousness of each type of illness and
b. to determine the effectiveness of various forms of treatment for it and
c. to give proper effect to that assessment and that determination in the formulation
and individual application of its policy.

IV. UN Rights of a Child

Rights of the Child

Like any other person a child could bring an action against a public authority alleging
violation of his human rights as set out in the European Convention of Human Rights. Article 14
gives a right not to be discriminated against in the implementation of the rights set out in other
Articles, and whilst age is not specifically mentioned, this could be a reason for discrimination and
therefore unlawful under Article 14. In addition, a child can draw on the United Nations Convention
on the Rights of the Child. Whilst this has not been incorporated into UK law and is not therefore
directly enforceable in the UK, compliance by the signatories is monitored by the United Nations on
a biennial basis and the UK is warned about any failures of compliance. In addition, there are many
other charters which have been drawn up by charities and organizations caring for children and
these would have persuasive force in that they indicate good practice, while they do not in
themselves set down laws which can be enforced.

Children Act 1989

The Children Act 1989 set up a new framework for the protection and care of children and
established clear principles to guide decision making in relation to their care.

Principles of the Children Act 1989

(1) The welfare of the child is the paramount consideration in court proceedings.
(2) Wherever possible children should be brought up and cared for in their own families.
(3) Courts should ensure that delay is avoided, and may only make an order if to do so is
better than making no order at all.
(4) Children should be kept informed about what happens to them, and should participate
when decisions are made about their future.
(5) Parents continue to have parental responsibility for their children, even when their
children are no longer living with them. They should be kept informed about their
children and participate when decisions are made about their children’s future.
(6) Parents with children in need should be helped to bring up their children themselves.
(7) This help should be provided as a service to the child and his family, and should:
(a) be provided in partnership with parents;
(b) meet each child’s identified needs;
(c) be appropriate to the child’s race, culture, religion, and language;
(d) be open to effective independent representations and complaints procedures; and
(e) draw upon effective partnership between the local authority and other agencies
including voluntary agencies.

Its overriding principle is that: The child's welfare shall be the court's paramount
consideration.
The involvement of the child in the decision making is also a major principle and the
Principles of the Children Act 1989 sets out the considerations that the court should take into
account in making certain orders. Finally, in deciding whether or not to make an order, the court:
shall not make the order or any of the orders unless it considers that doing so would be better for the
child than making no order at all.
Whilst the considerations set out in the Circumstances to be taken into account by the court
under the Children Act 1989 –section 1(3) apply to specific decisions to be made under the Children
Act 1989, there is a good reason for the practitioner to follow these same considerations in the
general care of the child.
Circumstances to be taken into account by the court under the Children Act 1989 –section 1(3).
(a) the ascertainable wishes and feelings of the child concerned (considered in the light of
his age and understanding);
(b) his physical, emotional and educational needs;
(c) the likely effect on him of any change in his circumstances;
(d) his age, sex, background and any characteristics of his which the court considers
relevant;
(e) any harm which he has suffered or is at risk of suffering;
(f) how capable each of his parents, and any other person in relation to whom the court
considers the question to be relevant, is of meeting his needs;
(g) the range of powers available to the court under this Act in the proceedings in question.

Child Protection
The importance of a knowledge of child protection principles and practice by the OT cannot
be overstated. Where a practitioner is concerned that a child, or the sibling or child of one of her
patients, is being abused, whether physically, sexually or mentally, she should take immediate action
to ensure that this is drawn to the attention of the appropriate persons. For example, the
practitioner may notice bruising, signs suggesting cigarette burns or other scars. She may also see a
parent inflicting severe corporal punishment on a child and consider that action should be taken.
This means that she must be familiar with the provisions for child protection and who are the
persons to be contacted. It is not always easy to decide if action is necessary, and the practitioner
should see as her main priority the safety of the child. As the guidelines on inter-agency
co-operation state:

The difficulties of assessing the risk of harm to a child should not be underestimated. It is
imperative that everyone who deals with allegations and suspicions of abuse maintains an open
and inquiring mind. (Paragraph 1.13)

Should the practitioner be wrong in her fears, and it appears that there is no abuse, her
name could not be divulged to the parents. Nor, if her actions were reasonably taken in the best
interests of the child, would a parent have a right of action against her. Abuse may include an over
zealous dietary or religious regime. For example a 12-year-old girl was brought up on a strict vegan
diet and was admitted to hospital with a degenerative bone condition said to have left her with the
spine of an 80-year-old woman.

Procedure for the management of child abuse

There should be, in existence, an agreed procedure for the management of child
abuse cases in accordance with the national guidelines, and the practitioner should be
acquainted with this. The procedure should specifically refer to the role of the department if
child abuse is suspected. This would require any professional staff working in the
department who suspect that there is a possibility of ill - treatment, serious neglect, sexual
or emotional abuse of a child, to inform the senior practitioner in charge of the department
who should then contact a consultant pediatrician. If the pediatrician confirms the
possibility of abuse, then the pediatrician should inform the Social Services Department
immediately.

Green Paper Every Child Matters

In May 2003 the Department of Health launched a single source document for
safeguarding children, with the aim that all agencies would be working from the same
succinct set of advice. The publication was the result of one of the recommendations of the
Laming Inquiry which investigated the circumstances surrounding the death of Victoria
Climbié. The Inquiry made over 100 recommendations for future practice by health and
social services. A Green Paper Every Child Matters was published by the Department of
Health in September 2003. The Green Paper focused on four main areas:
● supporting parents and carers
● early intervention and effective protection
● accountability and integration – locally, regionally and nationally
● workforce reform.
The new single source booklet set out:
● What people should do if they have concerns about children.
● What will happen once they have informed someone about those concerns.
● What further contribution they may be asked or expected to make to the
process of assessment, planning and working with children, reviewing that
work and how they should share that information.
● Some basic information and background about the legislative framework
within which children’s welfare is promoted and safeguarded.

Inter-agency co-operation
There used to be in each local authority area a forum to ensure co-operation
between all the agencies involved in the protection of children at risk. This forum was
known as the Area Child Protection Committee (ACPC). On this forum there would be
representatives of the medical and nursing services. There were also advantages in having
representatives from professions allied to medicine. This representation would be at a
senior level and there would be a designated senior professional for child protection within
the hospital or community unit. Subsequently significant changes were made to Child
Protection Provisions as a result of the Green Paper Every Child Matters and the enactment
of the Children Act 2004. A Children’s Commissioner was appointed and each local authority
was required to appoint a Director of Children’s Services, covering education and child
welfare. Information is available from the website of the Department for Children, Schools
and Families and from the specific website set up by the Department of Health for child
protection.

Children Act 2004

The Children Act 2004 provides the legal underpinning for Every Child Matters and
its provisions and was followed by the publication Working together to safeguard Children.
Significant features of the Children Act 2004 include the new Local Safeguarding Children’s
Boards (which each local authority is required to set up under section 13), and the duty on
local authorities to appoint a director of children’s services and a lead member for children’s
services. The Local Safeguarding Children Boards, (LSCB) which came into being on 1 April
2006, are designed to ensure that the agencies work effectively together to protect children.
The old area child protection committees which they replace are in effect placed on a
statutory footing. The core membership includes local authorities, health boards, the police
and others. Guidance on the functioning of the LSCBs is obtainable on the Every Child
Matters website. The guidance is incorporated as chapter 3 of Working Together to
Safeguard Children which was published in 2006. The guidance describes the LSCB as “the
key statutory mechanism for agreeing how the relevant organizations in each local area
agree to co-operate to safeguard and promote the welfare of children in the locality and for
ensuring the effectiveness of what they do”.

Main Provisions of Children Act 2004.

Part 1 Children’s Commissioner
Part 2 Children’s services in England:
● Co-operation to improve well-being
● Arrangements to safeguard and promote welfare
● Information databases
● Local Safeguarding Children Boards: establishment, functions, procedure and funding;
● Children and young people’s plans
● Director of children’s services
● Lead member for children’s services
● Inspections of children’s services
Part 3 Children’s Services in Wales
Part 4 Advisory and support services for family proceedings

Carers and Disabled Children Act 2000

This Act gives a right to carers to be assessed and enables the local authority to provide
services to carers following such an assessment. Under the Act, vouchers can be issued by local
authorities for short - term breaks and direct payments to carers in lieu of services which they have
been assessed as needing. A person with parental responsibilities for a disabled child has the right
to an assessment, from a local authority under section 6, of his ability to provide care for the child.
The local authority must take that assessment into account in deciding what services to provide
under section 17 of the Children Act 1989. Vouchers and direct payments to disabled children and
to persons with parental responsibility for disabled children can be made under section 7 of the
Carers and Disabled Children Act. Regulations relating to the vouchers came into force on 29 May
2003.These state that the value of a voucher may be expressed in terms of money or the delivery of
a service for a period of time (time vouchers) but not both. Rules are laid down on the issue and
redemption of vouchers. In an early decision on the Act, a judge stated that on the facts of the case
an assessment should be carried out within 35 days.

Case: Assessment of Needs of a Child

J, a 7-year-old boy with autism and challenging behavior, sought judicial review of the local
authority’s refusal to carry out an assessment of his needs. He had been accepted as homeless and placed
in temporary accommodation together with his family. There was no indication of when the family
might be moved to permanent accommodation. J’s mother had difficulties in coping with his care. The
local authority took the view that an assessment should not be carried out as the family could be moved
to permanent accommodation, with the result that an assessment at the present time would be an
inappropriate use of its resources.
The judge allowed the application and said that the assessment should be carried
out within 35 days. J’s mother could not be expected to cope without support other than for
a short period. As there was no likely date for J’s move to permanent accommodation, there
was no basis for delaying the assessment required by section 6 of the Carers and Disabled
Children Act 2000.

Action by victim of child abuse

The European Court of Human Rights recently held that where the local authority
failed to protect children from sexual abuse by the stepfather, the local authority was in
violation of Article 3 and Article 13 and was held liable to pay damages. In another case, the
European Court of Human Rights held that there was no violation of Article 3 by the local
authority, but there was a failure to provide an appropriate means of obtaining a
determination of their allegations and therefore a breach of Article 13. The court has a
discretion to dispense with the time limits set by the Limitation Act 1980 and this discretion
can be used in determining the date of knowledge test under section 14 of the Limitation
Act 1980 in cases of sexual abuse. In another case against a local authority, this time by a
couple who adopted a violent child, the couple won their case that they should have been
notified by the LA of the boy’s serious and emotional behavioral difficulties. The court held
that the local authority could be held vicariously liable for negligence by its employees in
failing to fulfill their duty of care owed to those who might foreseeably be injured if the duty
was carelessly exercised

Discrimination in Education
Part IV of the Disability Discrimination Act 1995 covers discrimination in education and has been
amended by the Special Educational Needs and Disability Act 2001. Annual school reports are
required to include information as to:
● the arrangements for the admission of disabled pupils
● the steps taken to prevent disabled pupils from being treated less favorably than other
pupils
● the facilities provided to assist access to the school by disabled pupils (section 29(2)).

Under section 30 of the Disability Discrimination Act 1995, the conditions under which financial
support is given to further and higher education institutions:
● shall require the governing body to publish disability statements at such intervals as may be
prescribed, and
● may include conditions relating to the provision made, or to be made, by the institution with
respect to disabled persons.

There are two key duties involved in ensuring that schools do not discriminate against disabled
pupils:
● not to treat disabled pupils less favorably
● to take reasonable steps to avoid putting disabled pupils at a substantial disadvantage
This latter duty is known as the ‘ reasonable adjustments’ duty.

The Code of Practice states that the duties in the Disability Discrimination Act are designed to
dovetail with existing duties under the Special Educational Needs (SEN) framework. The main
purpose of the SEN duties is to make provision to meet the special educational needs of individual
children. A child has special educational needs if he or she has a learning difficulty which calls for
special educational provision (section 312 of the Education Act 1996). A child has a learning
difficulty if he or she:
● has a significantly greater difficulty in learning than the majority of children of the same age
or
● has a disability which prevents or hinders the child from making use of educational facilities
of a kind generally provided for children of the same age in schools within the area of the
LEA or
● is under five and falls within either of the two above definitions or would do so if SEN
provision was not made for the child.
Special education provision means:
● for a child of two or over, educational provision which is additional to, or otherwise different
from, the educational provision made generally for children of the child ’ s age in maintained
schools (other than special schools) in the area
● for a child under two, educational provision of any kind.

Special Educational Needs and Disability Act 2001

This Act makes significant changes to the rights of the disabled child within the context of
education. Schedules to the Special Educational Needs and Disability Act cover Amendments to
Statement of Special Educational Needs: the Procedure and Appeals; definitions of the responsible
bodies for schools and educational institutions; and amendments and modifications to the Disability
Discrimination Act 1995, the Disability Rights Commission Act 1999 and other legislation.
The occupational therapist may be involved in assessments and preparing reports for the Special
Educational Needs Tribunals. She should follow the principles of report writing set out in Chapter
13 and ensure that she is able to support her written report if called upon to be a witness at the
tribunal. The OT may be concerned as to whether the statement should include what the child
would need in an ideal world in contrast to what therapies could realistically be provided by the OT
service. If only the latter are included in the statement, then there would be no recognition of the
opportunities which additional resources could provide for the child. Resources are relevant to the
provision of appropriate services, but it may be helpful to identify the further services which would
be of value to the child. It may be that services which one OT department finds to be beyond its
resources, are provided as basic in another part of the country.

Consent by child: child/parent disputes

The child of 16 and 17
A child of 16 or 17 has a statutory right to give consent to treatment under section 8(1) of the
Family Law Reform Act 1969.

Section 8(3) covers two situations: the giving of consent by a parent on behalf of a child of 16 or 17
years and the giving of consent by a child below 16 years.

Overruling a young person’s refusal

The fact that a young person of 16 or 17 has a statutory right to give consent to treatment does not
mean that they cannot be compelled to have treatment or that their refusal cannot be overruled.
The Court of Appeal in the case of Re W70 upheld the decision of the High Court judge to order a
child of 16 years who was suffering from anorexia nervosa to undergo medical treatment against
her will. Clearly, overruling a child or young person ’ s refusal is an extremely significant step and
would only occur in very serious circumstances of a life - saving kind.

The child under 16

The parent has a right at common law to give consent on behalf of the child. In addition, as a result
of the House of Lords ruling in the Gillick case, 71 a child under 16 years who has sufficient
understanding and intelligence to be capable of making up his own mind could give a valid consent
to treatment. As a result of this case we have the term ‘ Gillick competent ’ which signifies a child
who has the maturity and competence to make a decision in the specific circumstances arising. (The
term ‘ Competent according to Lord Fraser ’ s guidelines ’ is occasionally used instead of ‘ Gillick
competent.
Even where the child and parents both agree that treatment should not be given, as in the case of a
Jehovah ’ s Witness family, the court can order treatment to proceed if it is considered to be in the
best interests of the child (case of Re E (1993)).

Giving information to children and young persons

Information giving is part of the duty of care and therefore in order that both the child/young
person or the parent can understand the implications of giving consent to treatment, they need to
be told the significant risks of substantial harm which could occur and also the existence of
alternative treatments or even of no treatments.

Disputes between parents

Those who have parental responsibilities are the married parents of the child, the unmarried
mother, or the father of the child who has not married the mother (or married her after the birth of
the child), but only where he has assumed the rights of a parent by ensuring that the necessary
papers were completed. Even when parents are divorced or separated, under the Children Act 1989
section 2(1), both parents retain parental responsibility for their children. Under section 2(7),
where more than one person has parental responsibility for a child, each of them may act alone and
without the other (or others) in meeting that responsibility. Even where one parent has a residence
order in his or her favor, the other still retains parental responsibilities and can exercise these to the
full. It also follows that one parent does not have the right of veto over the other ’ s actions. If,
however, there has been a specific order by the court relating to a decision affecting the care or
treatment of the child, then a single parent cannot change this or take any action which is
incompatible with this order unless the approval of the court is obtained. It therefore follows that if
there is a dispute between parents over treatment decisions in respect of the child, either can go to
court for a specific issue or prohibit steps order to be made.

Prohibited steps order

Where one parent wishes to prevent the other taking action which he or she does not consider is in
the interests of the child, he or she may seek a prohibited steps order. This can be ordered under
section 8 of the Children Act 1989 and means that no step which could be taken by a parent in
meeting his parental responsibility for a child, and which is of a kind specified in the order, shall be
taken without the consent of the court.
If the child is considered to be ‘ Gillick competent ’ and disagreed with actions which the parents
were intending, the child could seek the leave of the court to obtain a prohibited steps order. The
child would have to apply to the Family Court. The court must be satisfied that the child has
sufficient understanding to make the proposed application (section 10(8)).

Right to insist on treatment

Parents do not have the right to insist upon care or treatment which the doctors consider is not in
the best interests of the child. The court would not order the doctors to carry out treatment on a
child which the doctors considered was not in the best interests of the child.

Confidentiality of child information

The same principles apply in relation to maintaining the confidentiality of information provided by
the child patient, as apply to information provided by the adult patient . However, there may be
situations where the interests of the child require confidential information to be passed on to an
appropriate authority. If possible, the consent of the child should be obtained through disclosure.
However, where the child refuses consent, or where the child lacks the capacity to give consent, the
practitioner should notify the child of her view that the information should be passed on in the best
interests of the child. She should not make a commitment to the child that the confidential
information will never be passed on. She should also ensure that she takes advice before breaching
confidentiality. She should record the action she has taken and the reasons for it, and be prepared to
justify her actions if subsequently challenged.

Access of the child to health records

Access to child health records: by the child
The Data Protection Act 1998 applies to both computerized and manually held records and the
provisions of the Access to Health Records Act 1990 are repealed except in relation to the records of
dead people. The Data Protection Act 1998 does not make express provision for access by a child,
but such an application would come under section 7. Where the child has the capacity, he can apply
for access to his personal health data kept in both computerized form and held manually under the
Data Protection Act 1998. The Department of Health recommended under the provisions covering
the 1984 Data Protection Act 84 that a certificate should be signed in which a responsible adult
certifies that the child understands the nature of the application, and this procedure could be
followed in implementing provisions of access under the 1998 Act. No definition of the capability of
the child is given in the Act but it is submitted that the Gillick test of competence adapted to the
specific conditions of access to records would be applied. Access can be refused if serious harm to
the physical or mental health or condition of the patient or another person would be caused, or
where a third person (not being a health professional involved in the treatment) who has asked not
to be identified would be identified by the disclosure.

Access to child health records: by the parent

Under the Data Protection Act 1998, a parent or other relative could apply for access to data and the
data controller can comply with the request under section 7(4) if:
● The patient has consented to the disclosure of the information to the person making the
request, or
● it is reasonable in all the circumstances to comply with the request without the consent of
the other individual, or
● the information is contained in a health record and the other individual is a health
professional who has compiled or contributed to the health record or has been involved in
the care of the data subject in his capacity as a health professional.
Whether the records are held in computerized or manual form, the application for access can be
refused if serious harm would be caused to the physical or mental health or condition of the patient
or another person or would identify a third person (not being a health professional involved in the
care of the child) who did not wish to be identified.
The Data Protection (Subject Access Modification) (Health) Order 2000 85 prevents the disclosure
of information to a person other than the data subject if:
● the information was provided in the expectation that it would not be disclosed to the person
making the request, or
● obtained as a result of any examination or investigation to which the data subject consented
in the expectation that the information would not be so disclosed, or
● which the data subject has expressly indicated should not be so disclosed.

The 54 Articles of the Convention on the Rights of the Child

The United Nations Convention on the Rights of the Child (CRC) comprises 54 articles that establish a
comprehensive framework for safeguarding children's rights. These articles emphasize core principles such as
the best interests of the child, non-discrimination, and the right to survival, development, and participation.

The CRC recognizes children's inherent right to life, family, and identity. It addresses issues
like separation from parents, protection from abduction, and participation in decisions. It promotes
education, healthcare, and protection from exploitation, abuse, and involvement in armed conflict. It
also outlines governments' responsibilities to respect, protect, and fulfill children's rights, along
with reporting and awareness measures. In summary, the CRC sets forth a comprehensive
commitment to children's rights, emphasizing protection, participation, and non-discrimination in
under one minute.

V. Convention on the Rights of Persons with Disabilities

The International Classification of Functioning, Disability, and Health(ICF) can be used to
understand and measure the positive aspects of functioning such as body functions, activities,
participation, and environmental facilitation. Disability arises from the interaction of health
conditions with environmental and personal factors. There are 2 classifications of Disability, health
conditions and impairments. Health conditions are diseases, injuries, and disorders, while
impairments are specific decrements in body functions & structures often identified as
symptoms/signs of health conditions.
Disability is the interaction between parties, meaning that disability is not an attitude of a
person, rather the progress on improving social participation can be made by addressing the
barriers that hinder people with disabilities in their daily lives.
The Convention on the Rights of Persons with Disabilities is an international human rights
treaty adopted by the United Nations in 2006. It aims to promote and protect the rights and dignity
of persons with disabilities. The CRPD is based on the principles of equality, non-discrimination,
inclusion, and full participation for people with disabilities in all aspects of life.
Article 1: Purpose
The purpose of the present Convention is to promote, protect and ensure the full and equal
enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to
promote respect for their inherent dignity.
Article 2: Definitions
For the purposes of the present Convention:
"Communication"- includes languages, display of text, Braille, tactile communication, large print,
accessible multimedia as well as written, audio, plain-language, human-reader and augmentative
and alternative modes, means and formats of communication, including accessible information and
communication technology;
"Language" - includes spoken and signed languages and other forms of non-spoken languages;
"Discrimination on the basis of disability" - means any distinction, exclusion or restriction on the
basis of disability which has the purpose or effect of impairing or nullifying the recognition,
enjoyment or exercise, on an equal basis with others, of all human rights and fundamental freedoms
in the political, economic, social, cultural, civil or any other field. It includes all forms of
discrimination, including denial of reasonable accommodation;
"Reasonable accommodation"- means necessary and appropriate modification and adjustments not
imposing a disproportionate or undue burden, where needed in a particular case, to ensure to
persons with disabilities the enjoyment or exercise on an equal basis with others of all human rights
and fundamental freedoms;
"Universal design" - means the design of products, environments, programmes and services to be
usable by all people, to the greatest extent possible, without the need for adaptation or specialized
design. It shall not exclude assistive devices for particular groups of persons with disabilities where
this is needed.

Article 3: General Principles

The principles of the present convention are as follows:
a. Respect for inherent dignity, individual autonomy including freedom to make one’s own
choices, and independence of persons
b. Non-discrimination
c. Full and effective participation and inclusion in society
d. Respect for difference and acceptance of persons with disabilities as part of human diversity
and humanity
e. Equality of opportunity
f. Accessibility
g. Equality between men and women
h. Respect for the evolving capacities of children with disabilities and respect for the right of
children with disabilities to preserve their identities
Article 4: General Obligations
States Parties undertake to ensure and promote the full realization of all human rights and
fundamental freedoms for all persons with disabilities without discrimination of any kind on the
basis of disability.
Article 5: Equality and Non-discrimination
States Parties recognize that all persons are equal before and under the law and are entitled without
any discrimination to the equal protection and equal benefit of the law.
Article 6: Women with disabilities
States Parties recognize that women and girls with disabilities are subject to multiple
discrimination, and in this regard shall take measures to ensure the full and equal enjoyment by
them of all human rights and fundamental freedoms.
Article 7: Children with disabilities
State parties shall take all necessary measures to ensure the full enjoyment by children with
disabilities of all human rights and fundamental freedoms on an equal basis with other children.
Article 8: Awareness-raising
To raise awareness throughout society, including at the family level, regarding persons with
disabilities, and to foster respect for the rights and dignity of persons with disabilities.
Article 9: Accessibility
States Parties shall take appropriate measures to ensure to persons with disabilities access, on an
equal basis with others, to the physical environment, to transportation, to information and
communications, including information and communications technologies and systems, and to
other facilities and services open or provided to the public, both in urban and in rural areas.
Article 10: Right to life
States Parties reaffirm that every human being has the inherent right to life and shall take all
necessary measures to ensure its effective enjoyment by persons with disabilities on an equal basis
with others.
Article 11: Situations of risk and humanitarian emergencies
States Parties shall take, in accordance with their obligations under international law, including
international humanitarian law and international human rights law, all necessary measures to
ensure the protection and safety of persons with disabilities in situations of risk, including
situations of armed conflict, humanitarian emergencies and the occurrence of natural disasters.
Article 12: Equal recognition before the law
1. States Parties reaffirm that persons with disabilities have the right to recognition
everywhere as persons before the law.
2. States Parties shall recognize that persons with disabilities enjoy legal capacity on an equal
basis with others in all aspects of life.
3. States Parties shall take appropriate measures to provide access by persons with disabilities
to the support they may require in exercising their legal capacity.
4. States Parties shall ensure that all measures that relate to the exercise of legal capacity
provide for appropriate and effective safeguards to prevent abuse in accordance with
international human rights law. Such safeguards shall ensure that measures relating to the
exercise of legal capacity respect the rights, will and preferences of the person, are free of
conflict of interest and undue influence, are proportional and tailored to the person's
circumstances, apply for the shortest time possible and are subject to regular review by a
competent, independent and impartial authority or judicial body.
Article 17: Protecting the integrity of the person
Every person with disabilities has a right to respect for his or her physical and mental integrity on
an equal basis with others.
Article 22: Respect for privacy
States Parties shall protect the privacy of personal, health and rehabilitation information of persons
with disabilities on an equal basis with others.
Article 24: Education
States Parties shall enable persons with disabilities to learn life and social development skills to
facilitate their full and equal participation in education and as members of the community.
Article 25: Health
States Parties recognize that persons with disabilities have the right to the enjoyment of the highest
attainable standard of health without discrimination on the basis of disability.
Article 27: Work and employment
Promote employment opportunities and career advancement for persons with disabilities in the
labor market, as well as assistance in finding, obtaining, maintaining and returning to employment.
Article 29: Participation in political and public life
Protecting the right of persons with disabilities to vote by secret ballot in elections and public
referendums without intimidation.

Policies in the Philippines

● Batas Pambansa blg. 344/ Accessibility Law
- An act to enhance the mobility of disabled persons by requiring certain buildings,
institutions, establishments, and public utilities to install facilities and other devices.
- Focuses on access of the PWDs to buildings/institutions, and schools.; companies
and private institutions are required to comply with the accessibility law.

● Republic Act. no. 7277: Magna Carta for Disabled Persons and for Other Purposes
- An act providing for the rehabilitation, self-development, and self-reliance of
disabled people and their integration into the mainstream of society and for other
purposes.
- e.g., The 20% discount on medications, hotels, amusement parks, and 5% on
groceries. This also stipulates equal rights in terms of employment, incentives,
education, and political rights.
References

Dimond, B. C. (2010, September 7). Legal Aspects of Occupational Therapy. Wiley-Blackwell.

Lewis, M. A., Tamparo, C. D., & Tatro, B. M. (2012, February 7). Law, Ethics, & Bioethics for the Health
Professions. F.A. Davis.
Portmann, J. (2000, October 1). Physician-patient Relationship: Like Marriage, Without the
Romance. National Library of Medicine. Retrieved September 28, 2023, from
https://doi.org/10.1136/ewjm.173.4.279
United Nations. (1989). Convention on the Rights of the Child. Treaty Series, 1577, 3.
https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child
United Nations. (2006). Convention on the Rights of Persons with Disabilities. Treaty Series, 2515, 3.
https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-pers
ons-disabilities