A/HRC/22/53. Tortur og anden grusom, umenneskelig eller nedværdigende behandling eller straf. Rapport fra FN den 1. februar 2013.

Rapporten fra FN‘s særlige rapportør, Juan E. Méndez fokuserer på visse former for misbrug i sundhedssektoren, der kan overskride grænsen for mishandling og dermed betegnes som tortur eller grusom, umenneskelig eller nedværdigende behandling eller straf.
Den identificerer de politikker, der fremmer denne praksis og eksisterende huller i beskyttelsen.

Ved at illustrere nogle af disse misbrug inden sundhedssektoren, kaster rapporten lys over ofte uopdagede former for misbrug, der opstår inden for rammerne af sundhedssektorens politikker og understreger, hvordan visse behandlinger kører på kant af forbuddet mod tortur og mishandling.
Den identificerer omfanget af staternes forpligtelser til at regulere, kontrollere og overvåge sundhedssektoren med henblik på at forebygge mishandling uanset begrundelsen.

Den særlige rapportør gennemgår en række af de rapporterede misbrug i sundhedssektoren og beskriver, hvordan reglerne mod tortur og mishandling skal anvendes i disse situationer. De beskrevne eksempler på tortur og mishandling i sundhedssektoren udgør sandsynligvis kun en lille del af dette globale problem.

Rapporten, der er på 23 sider, blev forelagt på den 22. ordinære samling i FN‘s Menneskerettighedsråd den 25. februar til 22. marts 2013.
Rapporten hos FN i pdf-format.

Herunder bringes uddrag af rapporten, som jeg har oversat til dansk.
Der tages forbehold over for eventuelle fejl i oversættelsen. Ved brug som dokumentation henvises til originalrapporten på engelsk.
I rapporten er der en del noter. Noterne til den oversatte tekst er medtaget, men ikke oversat til dansk. Der er kildehenvisning til de tekster, som noterne omhandler.

Den 6. februar 2012.
Tina Thranesen.

Uddrag af rapporten

C. Fortolkende og ledende principper

2. Afmagt og lære om “medicinsk nødvendighed”

31. Patienterne i sundhedssektoren er afhængige af sundhedspersonalet. Som den tidligere særlige rapportør erklærede: “Tortur, som er den alvorligste krænkelse af menneskers ret til personlig integritet og værdighed, forudsætter en situation med afmagt, hvorved offeret er underlagt en anden persons totale kontrol”. [14]
Berøvelse af retsevne, når en persons selvbestemmelse er fjernet og overdraget til andre, er en sådan omstændighed, ligesom frihedsberøvelse i fængsler eller andre steder – A/63/175, [pkt. 50].

32. Mandatet har erkendt, at indgribende og irreversible medicinske behandlinger, når de mangler et terapeutisk formål, kan være tortur eller mishandling, når de udføres eller administreres uden frit og informeret samtykke fra den pågældende person A/63/175, [pkt. 40], A/63/175, [pkt. 47]. Dette er især tilfældet, når indgribende og irreversible behandlinger uden samtykke udføres på patienter fra marginaliserede grupper såsom personer med handicap, på trods af krav om gode hensigter eller medicinsk nødvendighed. For eksempel har mandatet fastslået, at tvangsmæssige psykiatriske indgreb, når de begås af personer med psykosociale handicap, har en diskriminerende karakter, der opfylder både hensigt og formål som krævet i henhold til artikel 1 i konventionen mod tortur, uanset påstande om “gode hensigter” fra medicinsk personale A/63/175, pkt. 47, A/63/175, [pkt. 48]. I andre eksempler som medicinering eller ufrivillig sterilisation uden deres samtykke administration hævdes ofte at være en nødvendig behandling i den såkaldte bedste interesse for den pågældende person.

3. Stigmatiserede identiteter
36. I en rapport fra 2011 – A/HRC/19/41 – undersøgte FN‘s højkommissær for menneskerettigheder diskriminerende love og praksis og overgreb mod personer på grund af seksuel orientering og kønsidentitet
i sundhedssektoren. Hun bemærkede et mønster af menneskerettighedskrænkelser, som krævede svar. Med vedtagelsen i juni 2011 af [resolution] A/HRC/17/19 udtrykte Menneskerettighedsrådet formelt sin “dybe bekymring” om vold og diskrimination baseret på seksuel orientering og kønsidentitet.

37. Mange politikker og praksisser, der fører til misbrug i sundhedssektoren skyldes diskrimination rettet mod personer, der er marginaliserede. I en analyse af reproduktive rettighedskrænkelser spiller forskelsbehandling en fremtrædende rolle som en form for tortur eller mishandling, fordi køn og kønsfordomme almindeligvis ligger til grund for sådanne krænkelser. Mandatet har med henvisning til en ligestillingsorienteret definition af tortur anført, at elementet altid er opfyldt, når det kommer til kønsspecifik vold mod kvinder, idet vold i sagens natur er diskriminerende, og en af de mulige opregnede grunde i Konventionen om forskelsbehandling
– se rapporten A/HRC/7/3, [pkt. 68].

38. I forbindelse med prioriteringen af informeret samtykke som et afgørende element i en frivillig rådgivning, testning og behandling kontinuum, har den særlige rapportør om retten til sundhed observeret, at der især bør fokuseres på sårbare grupper. Princip 17 og 18 i Yogyakarta-principperne fremhæver for eksempel betydningen af at bevare informeret samtykke for seksuelle mindretal. Udbydere af sundhedsydelser skal være bevidste om og tilpasse sig de særlige behov hos lesbiske, bøsser, biseksuelle, transkønnede og interkønnede personer – A/64/272, [pkt. 46]. Udvalget for Økonomiske, Sociale og Kulturelle Rettigheder har tilkendegivet, at den internationale konvention om økonomiske, sociale og kulturelle rettigheder forbyder enhver forskelsbehandling i adgangen til sundhedspleje og de underliggende sundhedselementer, samt adgang til og betaling for ydelser på grund af seksuel orientering og kønsidentitet. [17]

IV. Stigende erkendelse af forskellige former for misbrug i sundhedssektoren

E. Marginaliserede grupper

4. Lesbiske, bøsser, biseksuelle, transkønnede og interkønnede personer

76. The Pan American Health Organization – PAHO – har konkluderet, at sundhedspersonales homofobiske handlinger er uacceptable og bør bandlyses og ophøre. [103] Der er et væld af tilfælde og vidnesbyrd fra personer, der nægtes medicinsk behandling, udsættes for verbale overgreb og offentlig ydmygelse, psykiatrisk evaluering, en række tvungne procedurer, såsom sterilisation, statskrævede analundersøgelser, retsforfølgning af mistænkte homoseksuelle aktiviteter, og jomfruelighedsundersøgelser foretaget af sundhedspersonale, [104] hormonbehandling og genital-normaliserende operationer under dække af såkaldte “genoprettende behandlingsformer”. [105] Disse procedurer er sjældent medicinsk nødvendige og kan [106] forårsage ardannelse, tab af seksuel lystfølelse, smerter, ufrivillig vandladning og livslang depression og er også blevet kritiseret for at være uvidenskabelig, potentielt skadelig og bidrage til stigmatisering – A/HRC/14/20, pkt. 23. Udvalget om afskaffelse af diskrimination mod kvinder udtrykte bekymring for, at lesbiske, biseksuelle, transkønnede og interkønnede kvinder var “ofre for misbrug og mishandling af sundhedspersonale” – A/HRC/19/41, [pkt. 56].

77. Børn, der er født med atypiske kønskarakterer, udsættes ofte for uoprettelig kønsskifte, ufrivillig sterilisering, ufrivillig normaliserende genitalkirurgi, udført uden deres eller deres forældres informerede samtykke “i et forsøg på at rette deres køn“, [107a + 107b] hvilket efterlader dem med permanent, irreversibel infertilitet og forårsager alvorlige psykiske lidelser.

78. I mange lande er transkønnede personer tvunget til at gennemgå ofte uønsket steriliseringskirurgi som en forudsætning for at få juridisk anerkendt deres foretrukne køn. I Europa kræver 29 stater sterilisering for at anerkende transkønnede personers juridiske køn. I 11 stater, hvor der ikke er nogen lovgivning, der regulerer juridisk anerkendelse af køn, er [108] praktiseres tvungen sterilisation stadig. Pr. 2008 kræver 20 stater i USA, at en transkønnet person gennemgår kønsskifteoperation, før de kan ændre deres juridiske køn. [109] I Canada er det kun provinsen Ontario, som ikke kræver kønsskifteoperation for at rette på kønsbetegnelsen på fødselsattester. [110] Nogle nationale domstole har konstateret, at ikke alene resulterer krav om kønsskifteoperation i permanent sterilitet, irreversible ændringer i kroppen og en indblanding i personers familie- og reproduktive liv, så udfør det også en alvorlig og uoprettelig indtrængen i en persons fysiske integritet. I 2012 afgjorde den svenske domstol, at kravet om tvungen sterilisation, var en indtrængen i en persons fysiske integritet, som ikke kan betragtes som frivillig. [111] I 2011 fastslog forfatningsdomstolen i Tyskland, at kravet om en kønsskifteoperation var en krænkelse af retten til fysisk integritet og selvidentificering. [112] I 2009 fastslog den østrigske administrative højesteret, at obligatorisk kønsskifte, som en betingelse for juridisk anerkendelse af kønsidentitet, var ulovlig. [113] I 2009 bemærkede Europarådets tidligere menneskerettighedskommissær, at kravet om sterilisering klart var i modstrid med respekten for den fysiske integritet. [114]

79. Mandatet har bemærket, at “medlemmer af seksuelle mindretal er uforholdsmæssigt udsat for tortur og andre former for mishandling, fordi de afviger fra socialt konstruerede kønsforventninger. Faktisk kan forskelsbehandling på grund af seksuel orientering eller kønsidentitet ofte bidrage til processen med umenneskeliggørelse af offeret, hvilket ofte er en nødvendig betingelse for, at tortur og mishandling kan finde sted. [115a + 115b] Det, at mænd, der mistænkes for homoseksuel adfærd, uden samtykke underkastes anal undersøgelse for at “bevise” deres homoseksualitet [116] er fordømt af Komiteen mod Tortur, den særlige rapportør om tortur og arbejdsgruppen om vilkårlig tilbageholdelse, som har fastslået, at praksis er i strid med forbuddet af tortur og mishandling – A/HRC/19/41, pkt. 37.

5. Personer med handicap
80. Personer med handicap er særligt berørt af tvungne medicinske indgreb og bliver fortsat udsat derfor uden samtykke – A/63/175, pkt. 40. I relation til børn med faktisk eller opfattet handicap skal sundhedssektoren vurdere med barnets øjne [117] og i barnets tarv som grundlag for beslutninger eller i samarbejde med forældre, værger, pædagoger eller offentlige autoriteter. [118a + 118b] Kvinder, der lever med handicap og i særdeleshed med diagnoser psykiatriske er i risiko for flere former for diskrimination og misbrug i sundhedssektoren. Tvangssterilisation af piger og kvinder med handicap er bredt dokumenteret. [119] Blandt andre lande giver lovgivningen i Spanien [120a + 120b] mulighed for sterilisering af mindreårige, der har alvorlige psykiske handicap. Det egyptiske parlament har undladt at medtage en bestemmelse om forbud mod brug af sterilisation som “behandling” for psykisk sygdom i sin patientbeskyttelseslov. I USA har 15 stater love, der undlader at beskytte kvinder med handicap mod ufrivillig sterilisation. [121]

V. Konklusioner og anbefalinger

B. Henstillinger

3. Lesbiske, bøsser, biseksuelle, transkønnede og interkønnede personer
88. Den særlige rapportør opfordrer alle stater til at ophæve enhver lov, der tillader indgribende og irreversible behandlinger, herunder tvungen genitalnormaliserende kirurgi, ufrivillig sterilisering, uetiske eksperimenter, medicinsk overvågning, “genoprettende behandlinger” eller “konverterings-behandlinger, når de er tvungne eller administreres uden frit og informeret samtykke fra den pågældende person. Han opfordrer også staterne til i alle sammenhænge at forbyde tvungen sterilisation og give særlig beskyttelse til personer, der tilhører marginaliserede grupper.

Rapporten i sin helhed i pdf-format.
Omtale af rapportens forfatter, Mr. Juan Méndez, Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment.

* * *
Noter
14. [Retur til 14]
A/63/175 – A/HRC/20/5
Thematic study on the issue of violence against women and girls and disability
United Nations, General Assembly, 30 March 2012.
Human Rights Council
Twentieth session
Report of the Office of the United Nations High Commissioner for Human Rights

A/63/175, pkt. 40 [Retur]
Implementation of the two paragraphs of article 12 requires five steps to be taken in order to effectively realize the right of the child to be heard whenever a matter affects a child or when the child is invited to give her or his views in a formal proceeding as well as in other settings.
These requirements have to be applied in a way which is appropriate for the given context.

A/63/175, pkt. 47 [Retur]
If the right of the child to be heard is breached with regard to judicial and administrative proceedings (art. 12, pkt. 2), the child must have access to appeals and complaints procedures which provide remedies for rights violations. Complaints procedures must provide reliable mechanisms to ensure that children are confident that using them will not expose them to risk of violence or punishment.

A/63/175, pkt. 48 [Retur]
The child’s right to be heard imposes the obligation on States parties to review or amend their legislation in order to introduce mechanisms providing children with access to appropriate information, adequate support, if necessary, feedback on the weight given to their views, and procedures for complaints, remedies or redress.

A/63/175, pkt. 50 [Retur]
The main issues which require that the child be heard are detailed below:
Det drejer sig om pkt. 51 – 56 vedrørende:
Skilsmisse og separation
Adskillelse fra forældre og andre omsorgspersoner
Anbringelse i pleje og kafalah i Islamisk lov. (Kafalah er arabisk og betyder gensidig eller fælles garanti).

(118b) A/63/175, pkt. 59 [Retur]
The practice of lobotomy and psychosurgery can serve as examples. The more intrusive and irreversible the treatment, the greater the obligation on States to ensure that health professionals provide care to persons with disabilities only on the basis of their free and informed consent. In the case of children, States must ensure that health professionals carry out such interventions only if they serve a therapeutic purpose, are in the best interests of the child, and are based on the free and informed consent of the parents (though parental consent must be disregarded if the treatment is not in the best interest of the child).23 Otherwise, the Special Rapporteur notes that such treatments may constitute torture, or cruel, inhuman or degrading treatment.

Rapporten i pdf-format.

17. [Retur til 17]
General comment No. 14 (2000)
The right to the highest attainable standard of health
E/C.12/2000/4.
11. august 2000.
United Nations, Committee on Economic, Social and Cultural Rights
Twenty-second session.

Pkt. 18. By virtue of article 2.2 and article 3, the Covenant proscribes any discrimination in access to health care and underlying determinants of health, as well as to means and entitlements for their procurement, on the grounds of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth, physical or mental disability, health status (including HIV/AIDS), sexual orientation and civil, political, social or other status, which has the intention or effect of nullifying or impairing the equal enjoyment or exercise of the right to health. The Committee stresses that many measures, such as most strategies and programmes designed to eliminate health-related discrimination, can be pursued with minimum resource implications through the adoption, modification or abrogation of legislation or the dissemination of information. The Committee recalls General Comment No. 3, paragraph 12, which states that even in times of severe resource constraints, the vulnerable members of society must be protected by the adoption of relatively low-cost targeted programmes.

Rapporten i pdf-format.

103. [Retur til 103]
“Cures” for an illness that does not exist
Pan American Health Organization – PAHO
2012
Side 3

To governments:
Homophobic ill-treatment on the part of health professionals or other members of health care teams violates human rights obligations established through universal and regional treaties. Such treatment is unacceptable and should not be tolerated.

Rapporten i pdf-format. [ 21. december 2023. Siden kan ikke vises. Tina Thranesen.]

104. [Retur]
In a Time of Torture: The Assault on Justice in Egypt’s Crackdown on Homosexual Conduct
Human Rights Watch – HRW – i 2004.
ISBN: 1564322963
Rapporten i pdf-format.

105 og 106. [Retur til 105] [Retur til 106]
“Therapies” to change sexual orientation lack medical justification and threaten health
Pan American Health Organization – PAHO – og World Health Organization – WHO
Washington den 17. maj 2012.
Rapporten i pdf-format.
Og indsendte informtioner til den særlige rapportør vedrørende tortur.

107a. [Retur]
A/HRC/19/41
FN rapport af 17. november 2011 om diskriminerende love og praksis vedrørende vold mod personer pga. deres seksuelle orientering og kønsidentitet
Omtale og dansk oversættelse af rapporten her i Vidensbanken.
United Nations, Human Rights Council Nineteenth session, 17 November 2011

A/HRC/19/41, pkt. 37. [Retur]
One issue highlighted by United Nations experts is the “medically worthless” practice of subjecting men suspected of homosexual conduct to non-consensual anal examinations to “prove” their homosexuality. Such examinations have been condemned by the Committee against Torture, the Special Rapporteur on torture and the Working Group on Arbitrary Detention, which has held that the practice contravenes the prohibition of torture and ill-treatment.

A/HRC/19/41, pkt. 56. [Retur]
In countries where no criminal sanctions exist, homophobic, sexist and transphobic practices and attitudes on the part of health-care institutions and personnel may nonetheless deter LGBT persons from seeking services, which in turn has a negative impact on efforts to tackle HIV/AIDS and other health concerns. Concerns of potential patients include breaches of confidentiality, further stigma and violent reprisals. The Committee on the Elimination of Discrimination against Women expressed concern about lesbian, bisexual, transgender and intersex women as “victims of abuses and mistreatment by health service providers”. Special procedures have also criticized the practice of so-called “reparative” therapy intended to “cure” individuals of their homosexual attraction, as being unscientific, potentially harmful and contributing to stigma.

A/HRC/19/41, pkt. 57. [Retur]
In many countries, transgender persons face particular difficulties in their access to health care. Gender reassignment therapy, where available, is often prohibitively expensive and State funding or insurance coverage is rarely available. Health-care professionals are often insensitive to the needs of transgender persons and lack necessary professional training. In addition, intersex children, who are born with atypical sex characteristics, are often subjected to discrimination and medically unnecessary surgery, performed without their informed consent, or that of their parents, in an attempt to fix their sex.

Rapporten på engelsk i pdf-format.

108. [Retur]
Discrimination on Grounds of Sexual Orientation and Gender Identity in Europe (2011)
Commissioner for Human Rights of the Council of Europe
Diskrimination på grund af seksuel orientering og kønsidentitet i Europa. 23. juni 2011.
Side 86 og 87.

Surgery leading to sterilisation as a requirement for legal gender recognition
Some countries require surgery leading to sterilisation before they legally recognise the new gender. It should be stressed that this requirement would also apply in the absence of a medical necessity or the applicant’s wish for such surgery. Surgery leading to sterilisation has been identifi ed as a requirement in 29 member states (Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Georgia, Greece, Iceland, Italy, Latvia, Malta, Moldova, Montenegro, the Netherlands, Norway, Poland, Romania, San Marino, Serbia, Slovakia, Sweden, Switzerland, Turkey and Ukraine). In two member states, Austria and Germany, the “sterilisation requirement” has been declared unconstitutional by their respective constitutional courts, but no new legislation has been proposed or adopted. In four member states – Hungary (administrative practice), Portugal, Spain and the United Kingdom (by law) – no requirements of sterilisation are enforced. In the
Russian Federation there is also nolegal basis for sterilisation , though some civil registry offices or courts have reportedly required sterilisation in order to recognise the new gender. In the remaining 11 member states there is either no legislation regulating legal gender recognition or the situation regarding the sterilisation requirement is unclear.

Rapporten i pdf-format.

109. [Retur]
Documenting gender
Dean Spade
Seattle University School of Law
Hastings Law Journal, vol. 59, No. 1 (2008)
Side 830 og 831.

Appendix 2: DMV Requirements for Gender Reclassification
(Summarized)
States requirements as to which types of evidence are needed to change the gender designation on their DMV ID are set out below.
State names with (*) indicate that the given piece of evidence is absolutely required, whereas state names without (*) indicate that such evidence is one in a set of possible submissions for fullfilling the evidentiary requirement. For a full description of each state’s requirements, see Appendix 1 and accompanying notes.
(Herefter er der angivet et skema med forholdene i de enkelte stater).

Social Science Research Network, hvorfra rapporten kan downloades.

110. [Retur]
Kønsbetegnelse i fødselsregistret kan ændres i Ontario i Canada fra 5. oktober 2012 uden krav om kønsskifteoperation
XY v. Ontario (Government and Consumer Services), 2012 HRTO 726 (CanLII) den 11. april 2012.
Dommen hos hos CanLII.

111. [Retur]
Krav om sterilisering ved kønsskifte strider mod Den Europæiske Menneskerettighedskonvention fastslog Kammarrätten i Sverige den 19. december 2012.
Mål nr 1968-12, Kammarrätten i Stockholm, Avdelning 03
Omtale af dommen her i Vidensbanken med pressemeddelelsen fra Kammarrätten oversat til dansk.
Dommen i pdf-format.

112. [Retur]
Federal Constitutional Court, 1 BvR 3295/07.
Leitsatz zum Beschluss des Ersten Senats vom 11. Januar 2011

Kort beskrevet, så gav den tyske forfatningsdomstol en 62 årig transkvinde ret til at indgå i et registreret partnerskab med en anden kvinde uden kønsskifteopertion.

Dommen i sin helhed på tysk hos Bundesverfassungsgericht.

113. [Retur]
Administrative High Court, No. 2008/17/0054, judgement of 27 February 2009.
Austrian Administrative High Court. Case VwGH 27.02.2009, 2008/17/0054.
Decided on 27 February 2009.
Dommen på tysk hos Bundeskanzleramt, Rechtsinformationssystem.

Case law: recognizing a right to legal change of gender without surgery.
The applicant was born male and, after hormone therapies and cosmetic measures, had been living as a woman.
The authorities refused the applicant a female name and corresponding documents, since she had not undergone gender reassignment surgery. Removal of genitals was a precondition for legal change of sex.
The applicant stated that every time she exhibited her documents (driver’s license, identification card, passport, birth certificate, etc.) she had to expose her transsexuality which, she argued, violated her right to privacy.

114. [Retur]
Thomas Hammarbergs rapport – Issue Paper – af 29. juli 2009 med 12 anbefalinger, som bør være gældende for alle transkønnede i Europa.
Human rights and gender identity, issue paper (2009)
Hele rapporten her i Vidensbanken.
Side 19.

It is disproportionate for the state to prescribe treatment in a “one size fits all” manner. The basic human rights concern here is to what extent such a strong interference by the state in the private lives of individuals can be justified and whether sterilisation or other medical interventions are required to classify someone as being of the one sex or the other.

Rapporten i sin helhed hos Council of Europe.
Rapporten i pdf-format.

115a. [Retur]
Question of torture and other cruel, inhuman or degrading treatment or punishment
United Nation, General Assembly, A/56/156, 3 July 2001

19. While no relevant statistics are available to the Special Rapporteur, it appears that members of sexual minorities are disproportionately subjected to torture and other forms of ill-treatment, because they fail to conform to socially constructed gender expectations.
Indeed, discrimination on grounds of sexual orientation or gender identity may often contribute to the process of the dehumanization of the victim, which is often a necessary condition for torture and ill-treatment to take place. The Special Rapporteur further notes that members of sexual minorities are a particularly vulnerable group with respect to torture in various contexts and that their status may also affect the consequences of their ill-treatment in terms of their access to complaint procedures or medical treatment in state hospitals, where they may fear further victimization, as well as in terms of legal consequences regarding the legal sanctions flowing from certain abuses. The Special Rapporteur would like to stress that, because of their economic and educational situation, allegedly often exacerbated or caused by discriminatory laws and attitudes, members of sexual minorities are deprived of the means to claim and ensure the enforcement of their rights, including their rights to legal representation and to obtain legal remedies, such as compensation.

Rapporten i pdf-format.

116. [Retur]
Working Group on Arbitrary Detention, opinion No. 25/2009 (2009)
16th session of the Human Rights Council
A/HRC/16/47/Add.1, Opinion No. 25/2009 (Egypt)
Communication addressed to the Government on 18 May 2009
Concerning: The source has specifically requested that the names of the 10 individuals concerned not be published; the Government was fully informed of their identities.

29. In the view of the Working Group, international human rights law, in principle, does not prevent States from enacting laws which provide for a procedure governing the granting and revocation of pardon following a criminal conviction and imposing legal conditions or restrictions. This can be both upon the Government itself and on the beneficiary of a pardoning act within the framework of separation of powers between the executive, legislative and judicial branches of Government.

Rapporten i pdf-format.

117. [Retur]
Committee on the Rights of the Child, general comment No. 12 (2009)
United Nation. Convention on the Rights of the Child. CRC/C/GC/12. 20 July 2009.
GENERAL COMMENT NO. 12 (2009)

21. The Committee emphasizes that article 12 imposes no age limit on the right of the child to express her or his views, and discourages States parties from introducing age limits either in law or in practice which would restrict the child’s right to be heard in all matters affecting her or him. In this respect, the Committee underlines the following:

First, in its recommendations following the day of general discussion on implementing child rights in early childhood in 2004, the Committee underlined that the concept of the child as rights holder is “… anchored in the child’s daily life from the earliest stage”.
Research shows that the child is able to form views from the youngest age, even when she or he may be unable to express them verbally. Consequently, full implementation of article 12 requires recognition of, and respect for, non-verbal forms of communication including play, body language, facial expressions, and drawing and painting, through which very young children demonstrate understanding, choices and preferences.
Second, it is not necessary that the child has comprehensive knowledge of all aspects of the matter affecting her or him, but that she or he has sufficient understanding to be capable of appropriately forming her or his own views on the matter.
Third, States parties are also under the obligation to ensure the implementation of this right for children experiencing difficulties in making their views heard. For instance, children with disabilities should be equipped with, and enabled to use, any mode of communication necessary to facilitate the expression of their views. Efforts must also be made to recognize the right to expression of views for minority, indigenous and migrant children and other children who do not speak the majority language.
Lastly, States parties must be aware of the potential negative consequences of an inconsiderate practice of this right, particularly in cases involving very young children, or in instances where the child has been a victim of a criminal offence, sexual abuse, violence, or other forms of mistreatment. States parties must undertake all necessary measures to ensure that the right to be heard is exercised ensuring full protection of the child.

Rapporten i pdf-format.

118a. [Retur]
A/HRC/20/5.
Thematic study on the issue of violence against women and girls and disability
United Nations, General Assembly, 30 March 2012.
Human Rights Council
Twentieth session
Report of the Office of the United Nations High Commissioner for Human Rights

53. Such policies and programmes should be developed in close partnerships with women and girls with disabilities and with disability organizations, including those providing services for survivors, and encompass:

Prohibiting by law forced sterilization of children and adults on the grounds of disability, ensuring adequate procedural safeguards to protect the right to free and prior informed consent;

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119. [Retur]
See Independent Expert for the Secretary-General?s Study on Violence against Children, World Report on Violence against Children (2009).
Published by the United Nations
Secretary-General’s Study on Violence against Children
ISBN-10 92-95057-51-1
ISBN-13 978-92-95057-51-7
Rapporten i pdf-format. [Den 7. december 2021. Ny url. Tina Thranesen]

120a. [Retur]
Against Her Will: Forced and Coerced Sterilization of Women Worldwide
Open Society Foundations
Fodnote 43, side 6.

United Nations Enable, Factsheet on Persons with Disabilities
June 14, 2011.
United Nations Enable Development and human rights for all
Factsheet on Persons with & Disabilities.
[Siden findes ikke mere. 12. oktober 2017. Tina Thranesen.]

Omtale af rapporten hos Open Society Foundations.
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A/64/272. [Retur]
United Nations, General Assembly, 10. august 2009.
Right of everyone to the enjoyment of the highest attainable standard of physical and mental health
Note by the Secretary General

Pkt. 46. Certain groups deserve special consideration regarding the protection of informed consent as a result of vulnerabilities stemming from economic, social andcultural circumstances. Principles 17 and 18 of the Yogyakarta Principles, forinstance, highlight the importance of safeguarding informed consent of sexual minorities. Health-care providers must be cognizant of and adapt to the specific needs of lesbian, gay, bisexual, transgender and intersex persons. Such elements of vulnerability significantly overlap and exacerbate inequalities; however, certain groups are addressed separately below for the purposes of this report.

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121. [Retur til 121]
Against Her Will: Forced and Coerced Sterilization of Women Worldwide
Open Society Foundations
Omtale af rapporten hos Open Society Foundations.
Rapporten hos Open Society Foundations i pdf-format..
Side 6.

In the United States, 15 states have laws that fail to protect women with disabilities from involuntary sterilization. 41.
41. See Amanda Robert, “New Law Prohibits Involuntary Sterilization,” Illinois Times, September 10, 2009. Fifteen U.S. states still had these laws on the books as of January 1, 2010.

Illinois Times
Thursday, September 10, 2009
New Law prohibits involuntary sterilization
By Amanda Robert
[…]
In the past few years, attitudes in Illinois have changed. In a 2008 landmark decision, the Illinois Appellate Court supported a 29-year-old woman who refused sterilization as a means of birth control. After Equip for Equality, lead counsel in the case, discovered that Illinois was one of only 16 states failing to protect adults with disabilities from involuntary sterilization, civil rights advocates joined forces to push a permanent statewide policy change.
In mid-August Gov. Pat Quinn signed legislation that bans the sterilization of adults with disabilities without court approval. The new law, which goes into effect on Jan. 1, 2010, amends the Illinois Probate Act, the statute that defines the duties of guardians of adults with disabilities. It now requires a guardian to file a court motion for any proposed sterilization and for the court to appoint a guardian and obtain a medical and psychological evaluation of the ward before consenting to the procedure.
[…]

The right to the highest attainable standard of health
11. august 2000.
General Comments

Article 12. Special topics of broad application
Non-discrimination and equal treatment
18. By virtue of article 2.2 and article 3, the Covenant proscribes any discrimination in access to health care and underlying determinants of health, as well as to means and entitlements for their procurement, on the grounds of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth, physical or mental disability, health status (including HIV/AIDS), sexual orientation and civil, political, social or other status, which has the intention or effect of nullifying or impairing the equal enjoyment or exercise of the right to health. The Committee stresses that many measures, such as most strategies and programmes designed to eliminate health-related discrimination, can be pursued with minimum resource implications through the adoption, modification or abrogation of legislation or the dissemination of information. The Committee recalls General Comment No. 3, paragraph 12, which states that even in times of severe resource constraints, the vulnerable members of society must be protected by the adoption of relatively low-cost targeted programmes.

Vedtagelsen i pdf-format hos Refworld.

115b. [Retur til 115b]
Civil and Political Rights, Including the Questions of Torture and Detention
Report of the Special Rapporteur, Sir Nigel Rodley, submitted pursuant to Commission on Human Rights resolution 2000/43.
United Nation, Economic and Social Council, E/CN.4/2001/66/Add.2.
Fifty-seventh session

199. Marli Barbosa and Rosana Lage Lígero, a same-sex couple, were allegedly arrested on 19 June 1996 in Jabotão dos Guararapes on suspicion of murder and were reportedly beaten with pieces of rubber at the 14th district police station in Piedade. According to the information received, they were also verbally abused for their sexual orientation and forced to perform oral sex. They were reportedly denied access to their lawyer. The police chief is said to have asked them for money, which they allegedly refused to pay. They reportedly remained at the police station for three days and then allegedly transferred secretly to the narcotics police station where they remained for five days. They were then allegedly returned to the Piedade police station and on the following day to a local prison, without having been sentenced. According to the information received, one month later they were taken back to the Piedade police station, where they were allegedly tortured again. They are said to have remained imprisoned for 11 months. It is believed that they suffered from discrimination due to their sexual orientation. It is alleged that the policemen involved received no punishment or reprimand. According to the information received, the case is being reviewed in the Supreme Court.

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Convention on the Rights of Persons with Disabilities

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. States Parties shall take all appropriate measures to ensure access for persons with disabilities to health services that are gender-sensitive, including health-related rehabilitation. In particular, States Parties shall:

Require health professionals to provide care of the same quality to persons with disabilities as to others, including on the basis of free and informed consent by, inter alia, raising awareness of the human rights, dignity, autonomy and needs of persons with disabilities through training and the promulgation of ethical standards for public and private health care;

Konventionen – artikel 25: Convention on the Rights of Persons with Disabilities – Article 25 hos United Nations Human Rights.

A/HRC/7/3 [Retur]
United Nation. General Assembly. Human Rights Council. Seventh session. 15. januar 2008.
Promotion and Protection of all Human Rights, Civil, Political, Economic, Social and CUultural Rights, including the right to Development
Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Manfred Nowak.

68. With regard to a gender-sensitive definition of torture, the Special Rapporteur referred to the elements contained in the definition of the Convention against Torture and stressed that the purpose element is always fulfilled when it comes to gender-specific violence against women, in that such violence is inherently discriminatory and one of the possible purposes enumerated in the Convention is discrimination. He also proposed to introduce an additional element, “powerlessness’ to underline that, whereas detention contexts are classic situations of powerlessness, it can also arise outside of detention or direct State control. Situations constituting of de facto deprivation of liberty may occur in different “private’ settings. There are also contexts, where fear can create a situation of total control: battered wives, victims of trafficking, as well as women prisoners who have been abused are likely to experience a permanent state of fear based on the unpredictable behaviour of the perpetrator. The Special Rapporteur considers that the concept of “acquiescence’, aside from the protection obligations, entails a duty for the State to prevent acts of torture in the private sphere and recalls that the concept of due diligence should be applied to examine whether States have lived up to their obligations.

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A/HRC/RES/17/19 [Retur]
Human rights, sexual orientation and gender identity
United Nations. General Assembly. 17. juli 2011.
Human Rights Council
Seventeenth session

Resolutionen, der blev foreslået af Sydafrika, anmoder FN‘s højkommissær for menneskerettigheder om at udarbejde en undersøgelse om vold og diskrimination på grund af seksuel orientering og kønsidentitet.

Resolutionen i dansk oversættelse her i Vidensbanken.
Resolutionen på engelsk i pdf-format.

A/HRC/14/20 [Retur]
The right of everyone to the enjoyment of the highest attainable standard of physical and mental health
Report of the Special Rapporteur, Anand Grover.
United Nations, General Assembly. 27. april 2010. Fourteenth session.

Pkt. 23. Stigmatization prevents legislative and policymaking institutions from adequately addressing health-related matters in communities that are especially vulnerable to the infringement of the enjoyment of the right to health. Where same-sex conduct is illegal, sexual orientation may be treated as a problem that needs to be corrected, ignored or used to legitimize violence directed towards these individuals. Attempts to “cure” those who engage in same-sex conduct are not only inappropriate, but have the potential to cause significant psychological distress and increase stigmatization of these vulnerable groups.

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120b. [Retur til 120b]
A/64/272
United Nations, General Assembly, 10 August 2009
Sixty-fourth session
Report of the Special Rapporteur:
Right of everyone to the enjoyment of the highest attainable standard of physical and mental health

F. Persons with disabilities
Pkt. 71. Forced sterilization of girls107 and women108 with disabilities has been documented internationally and is even being currently proposed in Rwanda.
Persons with disabilities, including children, continue to be exposed to non-consensual medical experimentation.

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CRPD/C/CHN/CO/1 and Corr.1
United Nations, CRPD/C/CHN/CO/1/Corr.1, Convention on the Rights of Persons with Disabilities, 11 October 2012
Committee on the Rights of Persons with Disabilities
Concluding observations on the initial report of China, adopted by the Committee at its eighth session (17-28 September 2012)

38. The Committee advises the State party to adopt measures to ensure that all health care and services provided to persons with disabilities, including all mental health care and services, is based on the free and informed consent of the individual concerned, and that laws permitting involuntary treatment and confinement, including upon the authorization of third party decision-makers such as family members or guardians, are repealed. It recommends that the State party develop a wide range of community-based services and supports that respond to needs expressed by persons with disabilities, and respect the person’s autonomy, choices, dignity and privacy, including peer support and other alternatives to the medical model of mental health.

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