Equipping everyone to realise rights-based decision making  

Jane shares a new resource which explores good practice examples of rights-based decision-making.

We can create a culture where human rights are central to all decision making in our lives. 

In Scotland, we are, in many ways, in a good position with the presence of a strong policy and legal framework that supports human rights. The introduction of a new human rights framework, further integrating human rights and equalities related law, would ensure that current gaps are identified and addressed.  

However, these policy ambitions must be realised in practice. Human rights should be enjoyed as part of everyday life and be at the heart of decision-making. Take the right to health, one of our everyday rights which has an impact on our ability to enjoy other rights. Exploring healthcare settings offers an opportunity to identify examples of human rights-based approaches to decision-making in practice      

Last month, the Health and Human Rights Partnership, a collaboration between the ALLIANCE, Public Health Scotland and the University of Strathclyde published a suite of resources to help improve rights-based policy and practice. The resources are available on our website ‘New tools to help improve rights-based policy and practice’.  

As part of the development of these tools, I led the mapping exercise to explore real world examples of rights-based decision-making in healthcare settings. This mapping exercise delivers on one of the actions in Scotland’s second National Human Rights Action Plan (SNAP 2).  

“To help reduce inequalities and tackle discrimination, carry out a mapping exercise to identify good practice examples of rights-based decision-making in healthcare settings with people whose rights are most at risk. Use the findings and good practice examples to inform, improve and support the implementation of rights-based policy and practice across healthcare in Scotland” 

Taking a human rights-based approach ensures that dignity is at the centre of all decision-making. In healthcare, it’s about empowering people to understand and claim their rights and increasing accountability for those responsible for upholding rights. It also encourages people to seek remedy when they believe their rights have been infringed.  

We are now at a stage to move beyond exploring introductory approaches to fully embedding human rights. To help guide our research we used the PANEL Principles (Participation, Accountability, Non-Discrimination, Empowerment and Legality) as a framework to identify and understand real world examples. The partnership decided that all PANEL Principles would need to be evidenced for an example to be considered as fully aligned with a rights-based approach.  

As part of the scoping, I undertook desk-based research to review publicly available information including reports, journal articles, case studies and blogs. The focus was to gather examples related to people whose rights are most at risk with a focus on women, disabled people, people experiencing homelessness, and black and ethnic minority groups.  

Early on, I identified that the language and terminology used in healthcare can be challenging. Healthcare policy and practice places emphasis on ‘person centred care’ and ‘shared decision-making’ rather than explicitly using human rights language or explicitly taking a human rights-based approach. Anecdotally, it has been suggested there are other real world examples, but they have not been published or framed from the perspective of rights-based decision-making.  

I was able to identify a small number of examples which spotlight promising practice. These examples relate to: telemedical abortion care, Self-directed Support, near fatal overdose response, National Collaborative and examples from the Care Opinion website.  

The good practice examples I identified highlighted that there was stronger evidence for some of the PANEL Principles than others. I found it challenging to identify real world examples which aligned with all elements of the PANEL Principles. Examples identified highlighted the participation and empowerment principles, but with less emphasis on the accountability, empowerment, or legality principles. Accountability featured more prominently when rights were at risk rather than the positive promotion of rights.   

As part of the scoping, I also investigated existing rights-based decision-making tools. These are underpinned by the Human Rights Act and focus on the restriction of rights. In the absence of real-world examples, the partnership decided that a Rights-Based Decision-Making Flowchart, with accompanying guidance, should be created.  

Our flowchart has been designed to consider how policies or decisions can positively promote rights and not just limit them. It can be used alongside Equality and Human Rights Impact Assessments as part of a wider approach to Equality Mainstreaming. 

It has been encouraging to see the interest and feedback we have received on the flowchart. As part of our next steps, we will be looking to test the toolkit in a range of healthcare settings to understand how it can be used to inform policy and practice.  

Additionally, the report makes a series of recommendations for how to implement and embed rights-based decision making across Scotland’s healthcare settings. Recommendations include more research and engagement and better information provision, training and capability building in rights-based decision-making.      

To promote a positive culture of human rights, everyone needs to have an awareness, understanding and confidence in how to apply rights-based approaches to decision making.  

We will continue to share these findings and good practice examples from this research to inform, improve and support the implementation of rights-based policy and practice across healthcare in Scotland. Join us on the 21^st of October at our webinar ‘Improving rights-based policy and practice in health and social care’ to find out more and get involved.  

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