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AOHS Global Health

Lesson 5Human Rights, Ethics, and

Global HealthIn this lesson, students learn about the ethical principles that guide health care workers. Students begin by considering the concept of health as a human right, as expressed in the Universal Declaration of Human Rights. Students explore the connections between human rights and ethics and study the ethical principles of health care. They research and present their findings on real health initiatives, focusing on ethical principles. Students consider how ethical guidelines are implemented in the real world, specifically in the distribution of limited resources.

Advance Preparation In Class Period 1, you will need access to the YouTube video about the food crisis in North Korea:

http://www.youtube.com/watch?v=RYYKvpr1uTw . If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.

In Class Periods 2 and 4, students will need access to computers for Internet research, with one computer for every two to three students.

This lesson is expected to take 6 class periods.

Lesson FrameworkLearning ObjectivesEach student will:

Describe human rights guaranteed by the Universal Declaration of Human Rights Explain the relationship between health and basic human rights* Describe ethical guidelines for research and explain why they are necessary Evaluate how ethical considerations influence public health decisions Develop an ethical argument related to a global health dilemma

*This is one of the 16 key learning objectives assessed by the NAFTrack Certification end-of-course exam for this course.

Copyright © 2012–2016 NAF. All rights reserved.

http://www.keepvid.com/

http://www.youtube.com/watch?v=RYYKvpr1uTw

AOHS Global HealthLesson 5 Human Rights, Ethics, and Global Health

Academic StandardsThe relevant Common Core State Standards are too extensive to list here but are an important basis for this lesson. For details, please refer to the separate document “Correlations to the Common Core Standards” (available in the Course Planning Tools section of the course materials).

Define informed consent (National Health Science Standards 2015, Standard 5.24) Identify ethical issues and their implications related to healthcare (such as: organ donation, in vitro

fertilization, euthanasia, scope of practice, ethics committee) (National Health Science Standards 2015, Standard 6.12)

Discuss religious and cultural values as they impact healthcare (such as: ethnicity, race, religion, gender) (National Health Science Standards 2015, Standard 6.21)

Determine the academic subject matter, in addition to high school graduation requirements, necessary for pursuing a health science career (Common Career Technical Core 2012, HL 1)

AssessmentAssessment Product Means of Assessment

Research findings chart on human rights and health initiatives (Student Resource 5.7)

Assessment Criteria: Human Rights and Health Initiatives Research Findings Chart (Teacher Resource 5.2)

Prerequisites Knowledge of current significant communicable disease challenges to global health (malaria,

HIV/AIDS, etc.) Basic understanding of demographic transition and epidemiological transition

Instructional Materials Teacher Resources

Teacher Resource 5.1, Presentation 1 and Notes: Health Ethics and Human Rights (includes separate PowerPoint file)

Teacher Resource 5.2, Assessment Criteria: Human Rights and Health Initiatives Research Findings Chart

Teacher Resource 5.3, Presentation 2 and Notes: Distribution of Scarce Resources (includes separate PowerPoint file)

Teacher Resource 5.4, Answer Key: Distribution of Scarce Resources Scenarios Teacher Resource 5.5, Key Vocabulary: Human Rights, Ethics, and Global Health Teacher Resource 5.6, Bibliography: Human Rights, Ethics, and Global Health

Student Resources Student Resource 5.1, Scenarios: Human Rights Violations

Copyright © 2012–2016 NAF. All rights reserved. 2


Student Resource 5.2, Reference: Universal Declaration of Human Rights Student Resource 5.3, K-W-L Chart: Ethics and Human Rights Student Resource 5.4, Reading: Health Ethics and Human Rights Student Resource 5.5, Analysis: Ethical Guidelines in Refugee Camps Student Resource 5.6, Reading: Ethical Treatment of Participants in Research Studies Student Resource 5.7, Research Findings Chart: Human Rights and Health Initiatives Student Resource 5.8, Scenarios: Distribution of Scarce Resources Student Resource 5.9, Reading: Distribution of Scarce Resources

Equipment and Supplies LCD projector and computer for PowerPoint presentation and to show a video Computers with Internet access and word processing software (one for every two to three

students) Whiteboard, blackboard, or flip chart

Lesson StepsStep Min. Activity

CLASS PERIOD 1

1 20 Scenarios: Human Rights ViolationsStudents begin to understand the concepts of ethics and human rights by considering examples of human rights violations across the globe.

To begin, write the following questions on the board and ask students to spend a few minutes reflecting on them in their notebook:

What are rights? What rights do you have? What kinds of rights should every human have?

After students have a chance to write down their answers, invite volunteers to share their thoughts. Students may have a limited understanding of rights, and their ideas may stem from what they know about the US Bill of Rights or the Constitution. Point out that those are American documents. Does everybody in the whole world get those same rights? Should they? Why or why not?

Next, refer students to Student Resource 5.1, Scenarios: Human Rights Violations.



Step Min. Activity

Explain that these are short descriptions of real-world situations or events. Ask students to work in pairs or small groups, and assign each group one scenario. (There are five scenarios total, so more than one pair or group will be assigned each scenario.) Ask students to read their scenario and discuss in their group what the scenario has to do with human rights.

After a few minutes, ask groups to share what the scenario they read has to do with human rights. Guide students to recognize that these are all examples of what are called “human rights violations”—in other words, these are situations where people are not treated with the dignity and respect they deserve.

Refer students to Student Resource 5.2, Reference: Universal Declaration of Human Rights. Explain that after World War II, countries worked together to draft a Universal Declaration of Human Rights, which lists specific rights that every human being deserves to have. Tell students that the United Nations was responsible for drafting this declaration and that Eleanor Roosevelt, former first lady of the United States, was one of the leaders of the effort to develop this document. Point out that while this is meant to be a worldwide document, unfortunately not every country follows these guidelines.

Explain that each of the scenarios they read in Student Resource 5.1 describes a violation of one or more articles of the declaration, and point out the list of articles under each scenario. Ask students to work in their groups to discuss why their assigned scenario violates each of the articles. Then have groups share their ideas with the class. For groups that have the same scenario, you may wish to have different groups address different articles. As you discuss their ideas, continue to encourage students to think about why human rights matter and how governments and international bodies enforce (or don’t enforce) the guidelines of the Universal Declaration.

2 20 Analysis: Universal Declaration of Human RightsIn this activity, students begin to develop an understanding of what human rights are by considering examples of human rights violations across the globe. They compare these violations with the Universal Declaration of Human Rights and discuss why human rights are important, particularly in the field of global health.

Prior to class, prepare to project the video about the food crisis in North Korea at http://www.youtube.com/watch?v=RYYKvpr1uTw .

If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program. Or, if you cannot access this video, prepare to show another video that gives a human face to human rights violations.

Next, have students focus their attention on Article 25, which is the primary article concerning people’s right to health and medical care. Using an LCD projector, show the video “North Korean Children Bear Brunt of Food Crisis” (http://www.youtube.com/watch?v=RYYKvpr1uTw).

Lead a discussion to help students develop a more in-depth understanding of Article 25 by using questions like the following:

What are the key points of Article 25? How did the video show that North Korea is in violation of these points? Using North Korea as an example, why do you think that motherhood and






Step Min. Activity

childhood are emphasized in Article 25?

Explain that this lesson will focus on human rights and ethics in relation to global health, and that Article 25 guides much of the WHO’s and other organizations’ work in global health care. Instruct students to reference the Universal Declaration of Human Rights as an ethical guideline throughout this course.

If time allows, ask students to add information on countries they learned about in this activity to their regional reference maps.

3 10 K-W-L: Ethics and Human RightsAs preparation for viewing a presentation on ethics and human rights, students consider what they already know about these topics and what they would like to know more about.

Refer students to Student Resource 5.3, K-W-L Chart: Ethics and Human Rights. Review how to use a K-W-L chart as necessary. Then instruct students to complete the What I Know and What I Want to Know columns for both topics.

After students have written a few items on their chart, ask them to share their chart with a partner and to write down anything they learn from their partner. Then explain that they will complete the What I Learned column with the information they learn during the next class period.

CLASS PERIOD 2

4 30 Presentation: Health Ethics and Human RightsThis activity provides students with a more in-depth understanding of ethics and human rights and how the two are related. It also gets them thinking about ethical and human rights issues in global health. In addition, it develops students’ listening and note-taking skills.

To prepare notes to guide class discussion using Teacher Resource 5.1, Presentation 1 Notes: Health Ethics and Human Rights. Have Teacher Resource 5.1, Presentation 1: Health Ethics and Human Rights (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

Instruct students to get out their K-W-L chart and add to it as they view the presentation.

Present the slideshow. Use the notes you prepared previously and the questions on the slides to encourage class discussion.

This presentation is duplicated as Student Resource 5.4, Reading: Health Ethics and Human Rights. If an LCD projector is unavailable, students can read the presentation, answer the discussion questions in their notebook, and discuss their answers. This student resource is also useful for review.

After the presentation, divide the class into pairs or triads and have them compare their K-W-L charts for accuracy and completeness. Answer any questions. You may want to gauge student understanding by assessing Student Resource 5.3, K-W-L Chart: Ethics



Step Min. Activity

and Human Rights, on a credit/no-credit basis.

Explain that in the next activity, they will find out how the ethical guidelines they have learned about are applied in real life.

5 20 Analysis: Ethical Guidelines in Refugee CampsIn this activity, students think about how the ethical guidelines they just learned about are (or are not) applied in real life by analyzing photographs of the world’s largest refugee camp, located in Kenya.

Divide the class into pairs or triads and assign each group to a computer. Refer students to Student Resource 5.5, Analysis: Ethical Guidelines in Refugee Camps.

Assign each group one of the ethical guidelines listed on the resource (or allow students to choose). Keep in mind that some of the guidelines, such as beneficence and honesty, may be more difficult for this activity. Instruct students to begin by writing down what they already know about their guideline based on the lesson so far. Students may wish to refer back to Student Resource 5.4, Reading: Health Ethics and Human Rights, for guidance.

Ask students to imagine themselves as members of the UN High Commission for Refugees. Their job is to find evidence indicating whether or not the Dadaab camp is being run in an ethical way, focusing on their specific guideline.

Go through the instructions on the resource with the students, and answer questions.

Give students time to complete the resource, and then ask each group to share which photograph they chose. Use an LCD projector connected to your computer to project each chosen photograph while the group explains what they see in the photograph indicating that their guideline is or is not being observed.

Guide students to recognize that while some photographs may have made it very clear whether or not the guidelines were being followed, ethics are very complicated, and the UN High Commission would probably conduct several visits to a camp in order to evaluate its management. Also point out that ethics can be a personal topic, and different people may interpret the same ethical guideline in different ways. Tell students that in the next class period, they will continue to explore how different perspectives can be brought to the same ethical issue.

CLASS PERIOD 3

6 30 Reading: Ethical Health IssuesIn this activity, students learn more about how ethics are important in the practice of medicine.

Before class begins, read over Student Resource 5.6, Reading: Ethical Treatment of Participants in Research Studies, and familiarize yourself with the content.

Draw the two following charts on the board, and ask students to create these charts in their notebook:



Step Min. Activity

Characteristics of Ethical Research Study

Characteristics of Unethical Research Study

Ethical Aspects of AZT Trials

Unethical Aspects of AZT Trials

Instruct students to read Student Resource 5.6 and take notes on the first part of the reading in the first chart, and take notes on the AZT trials in the second chart. Tell them that as they read and take notes, they should decide if they think the AZT short course trials were ethical, in preparation for a debate in the next activity.

Ask students to talk briefly with a partner about their decision in preparation for the debate.

7 20 Vote with Your Feet Debate: Ethical Health IssuesStudents apply what they have learned about medical ethics to a real-life medical controversy by holding a debate. This activity also provides them with a chance to practice persuasive argument and impromptu speaking. This activity focuses on the following college and career skills:

Thinking critically and systemically to solve difficult problems Working effectively with a diversity of individuals and perspectives

To begin, post the following statement on the board:

The AZT short course trials were ethical.

Next, explain to the students that they are going to have a Vote with Your Feet debate. Ask students to stand up and move to the left side of the room if they agree with the statement on the board. If they disagree with the statement on the board, they should move to the right side of the room. If they are undecided, they should stay in their seats. Allow students to take their notes with them.

Once students have moved, explain that they are going to debate this topic. Their goal should be to convince their peers to stand on their side of the room. They can do this either by persuading the undecided people or by convincing people on the other side to change their views.

Set a time limit of six minutes for the debate. Call on a volunteer from the right side of the room to share one reason he or she chose that side. Remind students to keep the sharing brief, one minute tops, since they need to allow time for other people to speak. When that person stops talking, allow students to move to a different side if they wish. Then invite a volunteer from the other side to respond, and allow students to move after that speaker finishes. Repeat the process, allowing someone from the left side of the room to speak first and someone from the right to respond, allowing students to move after each speaker if they wish.

When the six minutes are over, note which side has the most students. That side wins the debate. When the debate is over, ask students:

How did what you know about the ethical principles of autonomy, beneficence, justice, dignity, and honesty come into play in this debate? Did they affect your



Step Min. Activity

opinion? Why or why not?

If time allows, invite a few students to share their thoughts.

CLASS PERIOD 4

8 50 Research: Current Initiatives to Promote Human Rights Related to HealthIn this activity, students explore programs currently in place to promote human rights and improve global health.

Before beginning this activity, review the list of global health initiatives provided in Student Resource 5.7, Research Findings Chart: Human Rights and Health Initiatives. Consider providing additional resources to students based on your own reading and research.

To start the activity, divide the class into pairs and refer students to Student Resource 5.7. Point out that there are many people working in governments or nongovernmental organizations (NGOs) to address human rights and health issues in countries all over the world, and explain that students are going to look at one specific initiative and report back to the class on it.

Assign each pair one of the initiatives listed on the resource (or let them choose), and ask students to read the instructions for the assignment. Next, have students look at the assessment criteria, and then read over the example with students and answer any questions they have about how the example meets the assessment criteria.

Instruct students to access the site for the initiative assigned to them and fill in their chart. Circulate while students are working and answer questions.

Near the end of the class period, tell pairs to take a few minutes to think about how they will present the information to their classmates in the next class period. Point out that they should plan to briefly explain where the initiative took place, what disease was treated, and how the health initiative worked. They should also share which ethical principles apply to the initiative.

If necessary, instruct students to finish up their chart for homework and come to the next class period ready to share their findings with the class. Remind students to make sure that their assignment meets the assessment criteria.

CLASS PERIOD 5

9 35 Class Discussion: Health InitiativesIn this activity, students share what they learned during their research on global health initiatives and discuss how global health priorities are established.

Have students regroup with their partners from the last class period, and give them one or two minutes to rehearse what they want to report to the class.

Call on pairs to present the initiative they reviewed. As time allows, encourage students to ask questions about each report.



Step Min. Activity

Collect the health initiative charts and assess them using Teacher Resource 5.2, Assessment Criteria: Human Rights and Health Initiatives Research Findings Chart. Then compile the charts in a binder or notebook so that there is a class list of health initiatives to refer to for future activities.

To conclude this activity, help students recognize that certain diseases or conditions, especially malaria and HIV/AIDS, get a lot of attention, whereas others do not. Invite students to talk about why they think some diseases get more attention than others. Point out that in many of the countries they reported on, resources are extremely limited, so the question of how to draw attention to a disease or condition is really important. Getting funding, supplies, or donations could mean the difference between life and death for some people. Let students know that they will next look more closely at how to allocate limited resources.

10 15 Homework: Distribution of Scarce ResourcesThe objective of this activity is to have students consider the ethics involved in distributing scarce resources.

Refer students to Student Resource 5.8, Scenarios: Distribution of Scarce Resources. Ask students to read over the scenarios on Student Resource 5.8 and decide whether these choices are ethical. Why or why not?

Tell them that they will be working with these scenarios in the next class period and will learn more about the ethics involved in distributing scarce resources. If they don’t finish reading the resource in class, tell students to complete it for homework.

CLASS PERIOD 6

11 50 Presentation: Distribution of Scarce ResourcesThis activity gives students a more in-depth understanding of the four principles of distributing scarce resources.

To prepare, make notes to guide class discussion using Teacher Resource 5.3, Presentation 2 Notes: Distribution of Scarce Resources. Have Teacher Resource 5.3, Presentation 2: Distribution of Scarce Resources (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

Ask several students to offer their opinions on the scenarios in Student Resource 5.8, Scenarios: Distribution of Scarce Resources. They should explain why they think the choices are or are not ethical.

Explain that there are general principles that global health professionals have developed. These principles help them determine who receives help first. Tell students to keep the scenarios they just read in mind as they view this presentation, and to note anything they learn that relates to ethical distribution of resources in a particular scenario on their resource. Advise them that you will be revisiting the scenarios when the presentation is over.

Present the slideshow. Use your preferred method for presenting this material. This presentation is also duplicated as Student Resource 5.9, Reading: Distribution of



Step Min. Activity

Scarce Resources, to use according to your preferences.

After the presentation, ask students to work with a neighbor and return to Student Resource 5.8 to reevaluate the scenarios. Write the following questions on the board for students to consider:

Are the resources being distributed ethically in each scenario? Which principle or principles for distributing resources are at work in each scenario?

As necessary, go through the slide presentation again while students reevaluate the scenarios. Answer any questions using Teacher Resource 5.4, Answer Key: Distribution of Scarce Resources Scenarios.

Point out that how to use limited resources is an extremely challenging decision but one that global health professionals are faced with on a regular basis.

You may want to gauge student understanding by assessing Student Resource 5.8 on a credit/no-credit basis.

ExtensionsContent Enrichment

Have students research the specific codes governing scientific research, such as the Nuremberg Code and the Declaration of Helsinki. Ask students to compare/contrast these codes with the ethical principles they learned in this lesson. How much do the codes overlap? What additional ethical principles apply to research (for example, having review boards monitor research, and avoiding plagiarism)?

Ask students to write personal responses to the clarification of the right to health by the United Nations High Commissioner for Refugees (UNHCR):o The right to health does not mean the right to be healthy, nor does it mean that poor

governments must put in place services for which they have no resources. But it does require governments and public authorities to put in place policies and action plans that will lead to available and accessible health care for all in the shortest time possible. To ensure that this happens is the challenge facing both the human rights community and public health professionals.

Student responses can answer such questions as: Whose responsibility is it to work toward providing a decent level of health care for all populations? What obstacles do you think the responsible parties face?

Ask students to write a persuasive ethical argument on which populations should receive a new malaria vaccine first. Explain to the class that in August 2014, researchers announced that they had made major strides in developing a malaria vaccine, and they anticipate that a vaccine will be available relatively soon. Tell students that often when a new vaccine is released, the supply is limited, and ethical decisions must be made about whom to give it to first. Ask students to say, based on what they already know about vulnerable populations, which populations they think should be the first to receive the malaria vaccine. Possible populations to receive the vaccine first: the US military; the pharmaceutical company that manufactures the vaccine; child health advocates; maternal health advocates; HIV advocates; health ambassadors from Africa; and medical providers.



Divide the class into groups and have each group research a controversial topic connected to health, such as the issue of generic drugs vs. intellectual property rights, or the distribution of donated organs. Ask each group to give a short presentation to the class on a controversial issue. Have students vote on an issue or issues they are interested in, and hold a debate (or a series of debates).

Ask students to watch one of the following brief documentaries on the Tuskegee syphilis experiment (https://www.youtube.com/watch?v=FFWiLKA-91s or https://www.youtube.com/watch? v=vCHU1-UKNQg), and then have them identify the human rights articles violated by the experiments. If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.

Have students read The Immortal Life of Henrietta Lacks by Rebecca Skloot. As students read, ask them to keep a list of ethical questions that the book raises. After they have completed reading, have them choose one of the questions to explore further in an essay.

STEM Integration Technology: Take virtual field trips to places that are connected to the people or places students

researched for their global health initiatives.

Additional Cross-Curricular Ideas English Language Arts: Have students take notes during the Vote with Your Feet debate and use

those notes to write a persuasive essay about the AZT short trials. Guide students to recognize that sometechniques for oral debate are the same as the techniques used in a persuasive essay, while other techniques work better in a public-speaking format than in a written format.

English Language Arts: Have students watch the movie Miss Evers’ Boys. Then ask them to write a review of the movie, focusing on whether the movie was effective in showing several sides of an ethical issue.

History/Social Studies: Have students research the historical context of the Universal Declaration of Human Rights. Why was this document created at this specific time in history? What events preceded it? What impact has it had on events since its creation? You may wish to broaden the activity to include a greater analysis of the existence of (and efficacy of) the United Nations as a whole, or compare the UN to the League of Nations.

History: Ask students to conduct research on the Geneva Convention, which established humanitarian principles for all nations to follow during armed conflict. Tell students to compare the Geneva Convention protocols with the Universal Declaration of Human Rights. How do they support each other? How are they the same or different? Ask students to write comparative essays exploring these questions.



https://www.youtube.com/watch?v=vCHU1-UKNQg

https://www.youtube.com/watch?v=vCHU1-UKNQg

https://www.youtube.com/watch?v=FFWiLKA-91s

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