“The role and responsibility of Health Ministers in meeting the challenges of the changes in society and new technology at the beginning of the third millennium”

Oslo, Norway, 12-13 June 2003

13 June 2003

The Oslo Declaration on Health, Dignity and Human Rights

• Changes in society and technological innovations are dominant features at the beginning of this millennium. These developments provide new possibilities and create potential risks at the same time. The Council of Europe, with its human rights vocation, has the obligation to defend human rights and dignity. This protection can only be achieved through strong social cohesion, equal rights to health care and an ethical and human rights framework, within which health care is delivered.

• We, the European Health Ministers, gathered in Oslo, on 12-13 June 2003:

• recognise that providing appropriate and good quality care is a responsibility of every government in general and particularly Health Ministers; this goes beyond the mere delivery of health services and encompasses the respect of the dignity of the individual, which acquires particular importance in our modern multicultural societies;

• agree that health care services should function within a human rights framework as promoted by the Council of Europe, keeping in mind that vulnerability is not necessarily the lot of certain social groups and restricted to certain age groups, but can hit anybody at any time;

• agree to give high priority to identifying the needs of all those individuals and groups who are socially excluded and mobilise the necessary human and financial resources for an appropriate response to their health needs;

• are fully aware of the increasing importance for health issues and health implications to become an integral part of policies and decisions in all sectors of government, due to the constant need to respond to new health problems resulting from social and environmental policies; Ministries responsible for Health must play a leading role in providing evidence on health consequences of policies in other areas;

• are fully aware that solidarity can no longer be limited to one’s own population; it has to be extended to other countries facing similar challenges;

• agree to increase efficiency and safety in health care through alliances, bilateral or multilateral with other countries, including the public and private sectors, in order to facilitate sharing experiences, knowledge and technology and for carrying out research jointly;

• commit ourselves to work together to bridge the knowledge gap and to provide a more equal distribution of health technologies, taking into account that the member States undergo to a large extent, but at a different pace, the same changes in society, and should respond politically according to national priorities and possibilities;

• agree to monitor the advances in information technology and in relevant research for the purpose of appropriate handling of patients’ information, with full respect of safety, privacy and confidentiality and to assess their contribution to patients’ empowerment;

• agree to work towards a proper balance between preventive and curative care, with a marked insistence on the development of healthy lifestyles, to stimulate responsibility of individuals towards their own health, and ensure citizen participation in the decision making process concerning health care;

We, the European Health Ministers, call upon the Council of Europe and the European Health Committee (CDSP) in particular:

to pursue and intensify, in a coordinated fashion, its work on the social, ethical and human rights dimension of health in the delivery and availability of evidence-based health care and related services, and make proposals on possible partnerships aimed at reducing inequalities within and between countries;

draw up conceptual frameworks for various aspects of the health agenda, their organisation and functioning, including social, ethical and legal aspects.

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In pursuing these aims we recognise the following challenges and agree to take into consideration the following policy guidelines:

Challenge 1 – Managing the impact of the changing societies on health, dignity and human rights

The changing environment

Challenges and problems in health care are not confined within national borders. The outbreak of SARS (Severe Acute Respiratory Syndrome) is only the most recent example that health challenges need a global response.

Modern technology has cut through time and space, with inevitable effects on the market economy. Availability to all who need these products of modern technology is of paramount importance in democratic societies respectful of human rights.

The Council of Europe, with now 45 member States together with the enlargement of the European Union, is contributing to new possibilities for providing health care and social coverage between states.

Options for an effective response

• develop alliances, bilaterally or multilaterally with other countries, including the public and private sectors, to facilitate sharing achievements, knowledge and technology and for carrying out research jointly;

• develop health systems which:

• guarantee sustainability for future generations;
• ensure high common standards of quality in health care and health care goods;
• are effective in combating the old and new epidemics;
• ensure solidarity, not only within national territories, but also between states.

• develop flexible health policies which take into account a mobile demographic pattern and a health environment with divergent needs and expectations, ensuring better social cohesion by:

• respecting the cultural values and beliefs of the various components of society with regard to health and health care;
• establishing a fair balance of financial and human resources between the various categories of the population to ensure that older persons get the necessary care.

Dignity and vulnerability in a changing society

Few social phenomena in recent decades have undergone profound changes as in health care. Health care is concerned with life and well-being, and both are a priority with individuals and populations. No government can ignore it or the environment in which it is delivered.

It is precisely this environment, which has changed dramatically and increasingly during the last few decades.

Old customs, traditions and ways of living have given way to new ones. During the last few decades Europe has undergone a veritable social revolution in both thinking and behaviour. Demand for health care has changed in number and nature. This change is due to several factors:

• technical and technological achievements in both information and medicine, which has sharpened popular awareness and increased patient expectations;
• major social evolutions: strong individualism, new family structures, new lifestyles, new notions of equity and right to health care;
• political developments, particularly in those countries where the health services were refashioned to suit the market economy;
• demographic changes with ageing populations and multicultural societies.

These developments have highlighted awareness of the vulnerability of each and every individual, not only at specific periods of life (infancy, old age), but through a whole lifetime. They also highlighted the vulnerability of whole groups in society, where social and economical marginalisation adversely affects their health status.

In this new and constantly changing environment, populations, governments, scientists and politicians have been led to question the why and how of the demand, the expectation and the delivery of health care. Are governments fulfilling their duty in responding to health needs – both preventive and curative of all sectors of the population? Are individuals behaving responsibly? Are technological innovations being used correctly? These questions raise serious ethical questions, affecting basic human rights and the dignity of the individual.

Options for an effective response

• give high priority to identifying the needs of all those individuals and groups who are socially excluded and therefore vulnerable with regard to their health, and mobilise the necessary human and financial resources for an appropriate response;

• Ensure:

• a proper balance between preventive and curative care, with a marked insistence on the development of healthy lifestyles. For this purpose measures should be taken to develop individual responsibility towards one’s own health, and ensure citizen participation in the decision making process concerning health care;
• the appropriate training of health personnel to adapt to the social, cultural changes across society and technological developments.

2. Challenge 2 – Managing the impact of new technology on health, dignity and human rights

Responsible and equitable introduction of new technologies

Innovations, in information technology and medicine, arrive at a higher pace than ever before, but also at a higher cost. This may lead to a widening of the information gap between and within member States, as well as differences in access to medical technologies.

Information means knowledge. We have today a new generation of emancipated patients, empowered by knowledge and a wish to have a voice in medical decision making. The old patronising attitude of the health professional is giving way to a new partnership. The Internet may become a vehicle for democratising health systems.

Medical technology can equally be costly and available only to those that can afford it. This could lead to a weakening of groups that are already vulnerable.

Care has to be taken not to be blinded by technological innovations, and to be aware of the potential adverse effects of commercialisation of technological innovations and research. Not all technological innovations pass the test of cost/efficiency, or quality criteria.

Options for an effective response

• make information technology widely accessible, including to those who are weak and have fewer resources, avoiding a knowledge gap between and within societies;
• take measures to avoid that technological innovations are driven solely by commercial interests; therefore governments should finance developments towards knowledge gain which leads to health gain, for the benefit of all, not only those who can afford it;
• secure equity in access to new medical technology;
• share technological knowledge and information between member States.

Ethical and human rights challenges of technological innovations

In the past technology helped to master the outside environment; now it can determine the course of the natural evolution of human beings. After the era of technological development in health care, we have now reached the age of the human genome – frightening for many, a door towards a brave new world for others. The application of genetics will have an impact on the organisation of health care. The implications of the introduction of genetic screening and testing for the availability, the organisation and the financing of health services have to be examined by member States.

Societies have to decide about the limits of implementing of the technically possible. Misuse of information technology can violate the right to privacy and confidentiality. Development of human cloning and uncontrolled embryo-based research can be a threat to human rights and dignity.

An abuse of predictive medicine may lead towards creating groups of un-insurable and un-employable citizens.

New options of intervening in the natural course of life as well as possibilities opened by research raise serious ethical issues concerning life and death.

The human rights and dignity of the terminally ill and the dying have to be protected. Persons near the end of life desire to be treated as valued individuals. Palliative care intends to help people with advanced disease to enjoy the best possible quality of life until the end. Palliative care affirms dying as a normal process.

Options for an effective response

• intensify the exchange of views and information on the ethical dimension of medical and information technology with a view to adopting common approaches;
• develop palliative care to make it more readily available to all who need it and cooperate between countries to address the difference in the availability and quality of palliative care throughout Europe.