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Monday
Apr112016

Pregnancy, Drug Use, and Why Prison Is Not the Solution

@HuffPost

In New Hampshire, a bill to redefine opioid use or addiction in “custodial parents,” including pregnant women, as child abuse is making its way through the legislature, despite vocal objection from the state’s medical community. Much media treatment of this bill and similar bills in other states presumes women are not generally held criminally responsible for terminating—or losing—a pregnancy.

This illusion is increasingly hard to sustain.

In March 2015, Purvi Patel, a 33-year-old woman in Indiana, was sentenced to 20 years imprisonment for, prosecutors claim, inducing an abortion. Patel has maintained she had a miscarriage, and has never tested positive for any of the abortifacients the prosecution claims she took. In fact, the pathologist for the prosecution partially relied on the long discredited “lung test“ to determine if the recovered fetus had been born alive: a practice from the 17th century disproven as bad science over a century ago. Whether a miscarriage or an induced abortion, it is clear that Patel is in jail for not carrying a pregnancy to term.

Indeed, state legislators increasingly seek to hold women criminally responsible for not having healthy pregnancy outcomes. Since the beginning of this year, at least eight state legislatures have introduced bills to redefine legal personhood as starting at “fertilization” or “conception.” Though voters have generally rejected personhood measures when put to a vote—three times in Colorado alone—they keep resurfacing in new versions.

From a medical perspective, fetal personhood bills make no sense. “Conception“ is not a medical term and is interchangeably used to refer to the moment an ovum is fertilized and the moment a fertilized ovum implants in the uterine lining. “Fertilization“ is a medical term—referring to fusion of male and female gametes to form a zygote—but not all fertilized ova implant in the uterine lining (that is: not all result in a pregnancy), and the precise moment of both fertilization and implantation is hard to determine. As a result, the length of a pregnancy is usually calculated with reference to the pregnant woman’s last period—when she clearly was not pregnant yet—because that moment is an observable factor that can be defined.

There are also obvious logistical problems with fetal personhood bills. An estimated 10 to 20 percent of known pregnancies end in miscarriages, with the actual number likely much higher as many women miscarry before they know they are pregnant. In addition, the risk of miscarriage is higher for specific groups of women, such as older women, women with weight problems, women who have already miscarried, those who have contracted infections or who have immune response issues, and those who regularly use drugs, including alcohol and nicotine.

As a result, the implementation of fetal personhood laws would require unconstitutional discrimination and invasion of privacy. If a fertilized ovum has the same rights as a person after birth, each miscarriage (or failure to implant) would need to be scrutinized for intentional or reckless neglect. Detection would only be possible by registering all incidents of unprotected sex, and effective surveillance would require regular pregnancy testing, in particular of women at risk of miscarriage (think mandatory weekly pregnancy testing for women over 40 until they reach menopause). Of course, no one is advocating this.

Proponents of punitive pregnancy-related provisions have, however, successfully advocated for the growing surveillance of pregnant women from marginalized or stigmatized communities through social services, and in particular through medical providers. The organization National Advocates for Pregnant Women has documented the growing arsenal of state laws that treat drug use and addiction in pregnant women as a form of child abuse. Because health care providers in all states must report child abuse to the authorities, this reframing forces doctors and nurses to breach patient confidentiality for pregnant women who admit to struggling with drug use or addiction. The predictable result is a breakdown in the therapeutic relationship at best, and at worst, a reluctance to seek care at all for the women who arguably need it the most.

Many of these bills are pushed through without consulting the medical community, which is the case for the bill currently pending in New Hampshire. House hearings are under way, and both pediatricians and obstetric-gynecologists will testify to its predictably disastrous effects on the provision of addiction treatment and child welfare.

To be sure, both child abuse and drug addiction are serious matters, which require appropriate state support. Attempts to redefine drug use or addiction as child abuse in pregnant women, however, disregard the medical and psychological needs of both abused children and pregnant women. Advocates of such legislation are attempting to transform the fiction of fetal personhood into law by appropriating the problem of child abuse and punishing pregnant women in need of treatment for substance dependency or addiction.

A fetus is not a child and a women’s right to choose an elective abortion should not be circumvented by legislating punishment for women in need of treatment for substance use disorders. Legislators should listen to the medical community. Whether the conversation is about elective abortion, treatment for substance use disorder, or any other medical intervention, decisions about care are best made by the patient in private consultation with her doctor.

Monday
Jan112016

Protecting Syria's Civilians: Another Discarded New Year's Resolution?

@HuffPost

It's been just three weeks since the UN Security Council adopted its latest resolution on the conflict in Syria, re-authorizing cross-border delivery routes for humanitarian aid and promising -- once again -- to take "further measures" if the parties to the conflict do not comply with international humanitarian law.

In these three weeks, the Assad government has systematically ignored this warning. Instead, its forces have continued their relentless violation of international rules of war, among them the requirement to spare civilians, health personnel and medical facilities. 

On December 25, a suspected chemical weapons attack in Moadamiya drove civilians to the local hospital with symptoms consistent with exposure to toxic agents, including difficulty in breathing, bloody frothing at the mouth, muscular contractions and involuntary urination and defecation. Several patients have died as a result. Local documenters say the missile attack came from the Syrian government-controlled Al Mezzeh airbase. 

It's very likely that this suffering was caused by illegal chemical weapons, but it has not been possible to confirm which toxic agent was responsible, and how it was distributed. There's a reason for that. 

Chemical weapons attacks are notoriously difficult to substantiate. The debris they leave is hard to detect from satellite images. To positively identify a toxic agent, you need to analyze affected blood samples. But in Syria, and in particular in the Damascus suburb where the December attack occurred, the specialized medical equipment needed to conduct these tests is in severely short supply. 

What's more, it is exceedingly difficult to safely deliver blood samples from Moadamiya to health care facilities with the necessary infrastructure. Supplies to adequately preserve samples are virtually non-existent. With health care centers and personnel openly targeted -- at least 240 medical facilities have been attacked and 697 medical workers killed in the conflict, primarily by Assad government forces -- transporting blood samples has become very dangerous. The combination makes identifying toxic agents near impossible.

Further, government forces have recently turned their sights on border area hospitals in northern Syria that to some extent have served as referential hospitals. Physicians for Human Rights has received multiple reports that health facilities in 'Azaz and Hraytan, in the suburbs of Aleppo, were hit on December 25 and 26, further debilitating Syria's already fragile health infrastructure. 

How many war crimes does the Assad government need to commit for the UN Security Council to take more decisive action?

Some might say the December 2015 resolution did effect change. Last week, the Assad government agreed to allow humanitarian aid into Madaya, a rural area close to the Lebanese border where a six-month siege has caused countless deaths and unspeakable suffering. This aid is supposed to arrive today. Survivors, driven to starvation by their own government, report being reduced to eating leaves, insects, even their pets - and having to depend on a veterinarian and a carpenter for health care and surgery. 

However, the very fact that the Assad government is in a position to allow or deny humanitarian aid is because it is using besiegement as a weapon of war - in direct contravention of UN Security Council directives and the Geneva Conventions. In fact, the limited ceasefire agreement between Syrian government and opposition forces last year should, in principle, have brought humanitarian aid to Madaya months ago. Moreover, under international humanitarian law, organizations providing aid must have unfettered access to Madaya and the dozens of other besieged areas throughout Syria, with or without Assad's express permission. 

It has been nearly five years, 300,000 deaths, and four million refugees since the Security Council first called on the Syrian authorities to respect their obligations under international law. The three weeks since the latest Security Council resolution show the Assad government has no intention of doing so. 

Whatever solution Syrian peace talks may arrive at, world leaders must immediately focus on protecting civilians and improving conditions on the ground. Without concrete action to reduce the suffering of Syrian civilians, another UN Security Council resolution on this conflict will appear as empty as so many other New Year's resolutions.

Wednesday
Dec162015

A New Low: Stealing Family Heirlooms in Exchange for Protection

@HuffPost

The refugee crisis in Europe has shown the very real limits to the social coherence and solidarity that seemed to form the basis for the European Union until now. But even within the climate of hostility against asylum seekers in Europe, Denmark stands apart as one of the worst aggressors.

First, the Danish government took out advertisements in Lebanese newspapers stating that it had cut social benefits to refugees by almost 50 percent, and that family reunification would be out of the question for now.

Then, the government announced it would go back on its (measly) promise to resettle 1,000 refugees, and declared plans to further cut funding for refugee integration, criminally charge asylum seekers for asserting their protection needs, and increase criminal charges for begging.

Included in these proposals--many of which have been adopted--is a provision allowing authorities to confiscate asylum seekers' jewelry (exempting engagement and wedding rings and watches) to offset the cost of providing them shelter. This proposal appears to still be under discussion. 

From the international legal perspective, these measures place Denmark in breach of its obligations to shelter and provide for those in need. The 1951 Refugee Convention gives anyone who manifestly fears for his or her safety at home the right to seek protection elsewhere. It also prohibits safe countries, such as Denmark, from returning refugees to a place where they might be tortured, targeted for killing, or put through something even worse. Physicians for Human Rights has an intimate understanding of the situations the majority of refugees in Europe are fleeing in SyriaAfghanistan, and elsewhere. Without belaboring the point, let's just say these countries are far less than safe. 

Denmark's new provisions also appear to violate the rights to integrity, dignity, and personal property, all enshrined in the Danish Constitution -- though in a country where political leaders have protested the obligation to provide shelter even for the stateless, the existence of legal imperatives may not be much of a deterrent to this kind of callous policy-making.

In fact, the public debate in Denmark is more focused on how the country is being invaded by undeserving "migrants" looking for an easy life than about the security crises that are causing people to flee in the first place. Despite the fact that news media report daily on the conflicts and collapse of the rule of law in Afghanistan, Iraq, Libya, and Syria -- just to mention a few -- the thousands who flee are somehow still seen as resource-poor individuals trying to move their families to a place with better social benefits.

This conflation of migration and refugee flows is common. Most mainstream media, in Europe and around the world, continue to refer to the people flooding into Europe as "migrants," despite ample evidence to the contrary. In an October New York Times article about a four-year-old boy who had been abducted from a refugee camp, and subsequently found dead, the problem was summarized as one related to "migrant children." Yet, a child abducted from a refugee camp might reasonably be assumed to be, well, a refugee. 

And then there is the puzzling notion, propagated in online commentary and punditry, that refugees in Europe already have money and should not be entitled to social assistance in Europe. It is certainly true that compared to the millions who can't afford to leave, the hundreds of thousands of people who make it to Europe probably were the wealthier ones in their country of origin. But rather than proving refugees in Europe to be mercenary, this information does just the opposite: when the need to leave is shared by everyone, not just the poor, you know a country is unsafe.

Of course, Denmark is not alone in its active discouragement of asylum seekers. This summer, Hungary constructed a razor wire fence on its border with Serbia to deter refugees from passing through the country. Slovenia threatened to do the same, but settled on daily quotas for entry instead. However, in early November, Slovenian television reported that the government had purchased a border fence. And in November, the European Union agreed to pay Turkey €3 billion for assistance in returning refugees to Syria at the Turkey-Syrian border. 

To be sure, some European governments -- notably Germany and Sweden - have declared a willingness to welcome a larger number of refugees. This is laudable and should serve as inspiration for better policies everywhere. Instead, however, the initiatives and openness of these governments are being undermined by the institutionalized inhumanity displayed by their neighbors. Indeed, the toxicity with which many European governments are treating asylum seekers challenges the very idea the European Union was set up to protect: that everyone is better off when inequalities are less pronounced. 

This latest Danish bill which would to strip asylum seekers of the last thing that reminds them of the home they would prefer not to have left in the first place -- their grandmother's necklace, a friendship ring reminding them of happier times -- is not only illegal, it is inhumane. I have never been more ashamed to be Danish.

Editor's Note: This article has been updated to reflect the status of the proposed provision regarding confiscation of valuables.

Tuesday
Jun022015

New UN Report: Treat LGBTI Humans As Humans

@HuffPost

This week, the United Nations High Commissioner for Human Rights (OHCHR) issued its second report on the state of human rights for lesbian, gay, bisexual, transgender and intersex (LGBTI) people worldwide. 

Here's a hint: It's not pretty.

Intended originally to share good practices and ways to overcome violence and discrimination, this report in reality spells out the violence and discrimination that must be overcome. That's not a coincidence. Since OHCHR issued its first reporton this subject in 2011, many countries have certainly taken significant steps to advance the rights of everyone, regardless of their sexual orientation, gender identity and bodily diversity. But many others remain reluctant to do so. As the High Commissioner's report this week notes: "The overall picture remains one of continuing, pervasive, violent abuse, harassment and discrimination affecting LGBT and intersex persons in all regions."

There are many reasons why discrimination and abuse persist. The report addresses two of them head-on. 

First, it tackles the objection that LGBTI persons are not covered by international human rights protections. This may seem remarkably straightforward based on the premise that we are all human -- all of us -- therefore we all have rights, regardless of sexual orientation, gender identity and bodily diversity. 

However, human rights generate obligations for states -- to promote, protect and fulfill these basic rights. States, everywhere, are reluctant to recognize the rights of those they deem "other" or somehow less valuable: Whether it is denying felons the right to vote, excluding undocumented immigrants from schooling or criminalizing freedom of speech for political opponents. For bodily autonomy and privacy for LGBTI persons, the mechanism is the same. And some states simply want to exclude those they don't "like" from the benefits and protection that human rights standards entitle them to. 

In seeking to overcome this objection, the High Commissioner's new report details many of the specific obligations states have to address discrimination and violence against LGBTI persons: Protection against torture and abuse; refraining from criminally or otherwise punishing people because of their sexual orientation or gender identity, and ensuring everyone's right to freedom of speech and assembly.

Secondly, the report overcomes the general objection that there is just "nothing you can do" about stigma and prejudice. In its 20 recommendations to states, the report lays out the first crucial steps that should be taken to overcome violence and discrimination against LGBTI persons. The recommendations cover discrimination in housing, education, employment, and refugee policies; urges revision of blatantly discriminatory laws, and suggests ongoing sensitivity training for public officials in healthcare, education and justice systems. Same-sex relationships should be afforded the same protections as opposite-sex relationships, the report notes; everyone should have access to legal identity document reflecting their preferred gender, upon demand, and no intersex child should be subjected to medically unnecessary procedures.

These recommendations should serve as a blueprint for priority action to overcome the violence and discrimination that is detailed in the report. 

They may look extensive. 

But if you read carefully you will see that all the report asks for is for LGBTI humans to be treated as humans.

Wednesday
Dec102014

Protection from arbitrary killing should be a minimum standard not an aspiration

@ISHRGlobal

The right not to be arbitrarily killed ought to be the absolute floor for any understanding of human rights.

However, for many of our colleagues and the people they work with, basic safety and security seems more like an aspirational goal than a minimum standard. The offices of our partners are broken into. Private work meetings are cancelled by authorities. Our colleagues are arrested or harassed by police. A number are severely beaten, whether by public officers or by private individuals, often acting in groups.

And then there are those who are killed. The Transgender Murder Monitoring Project has tracked at least 226 reported murders of trans persons from November 2013 to November 2014 worldwide.  In New York City in the month of May 2014 alone, the Anti Violence Project reported 11 high-profile cases of anti-gay violence. Most likely, these are but the tip of the iceberg. Most cases of violence or murder directly against lesbian, gay, bisexual, trans, and intersex (LGBTI) persons are not reported to the police, or highlighted in the media. Justice for this violence is hardly ever forthcoming, even where the incidents are reported.

But perhaps more to the point, though we know for sure that LGBTI persons, as a group, are more exposed to violence than straight and/or cisgender counterparts—all other things being equal—it is not always possible to say whether a specific incidence of violence or harassment is motivated by the victim’s real or perceived sexual orientation or gender identity.

This is why it is paramount that governments pay specific attention to the violence directed at those identifying as or suspected of being LGBTI. For more than a decade, United Nations members states have pledged to do just in their biannual resolution on extrajudicial and arbitrary executions and killings. Since 2000, this resolution has included a reference to the need for states to pay specific attention to those killed because of real or perceived sexual orientation, and since 2012 also gender identity.

This resolution does not, of course, overcome the discrimination and abuse faced by LGBTI persons—and those suspected of being LGBTI—worldwide. However, the explicitly acknowledgement that violence against LGBTI persons is arbitrary, and that states must work to prosecute this violence where it happens, lends weight to the pushes for adequate legislation and policies to counter hate crimes everywhere.

Even more importantly, the resolution highlights those targeted because of real or perceived sexual orientation or gender identity as particularly vulnerable to arbitrary killings, implicitly acknowledging states’ failure to prevent this violence. Even if each individual murder motivated by homophobic or transphobic hatred were classified and prosecuted as a hate crime, this would still not, by itself, eliminate the societal prejudice that fuels these crimes.  The most important contribution the passage of this resolution could make is by implicitly calling out the need for cultural change.

The right not to be arbitrarily killed—or killed at all—for any reason whatsoever should not even be up for discussion. What we should be talking about is how to change the stereotypes that lead to abuse.