the U.S. health care system.30 To be born black in the United States, according to critical race theorist Patricia Williams, writing in the 1980s, is to “embody” an otherness in relation to being born as the white self, and it is a threatening otherness that must be controlled or repressed. To this day, we have examples in the media all the time of how being especially a young black male in America is still a marker of dangerousness to be contained, from Florida to Ferguson, Missouri. For “blacks”—as Williams deliberately referred to a set of social actors—rights are a “magic wand of visibility and invisibility, of inclusion and exclusion, of power and no-power. The concept of rights, both positive and negative, is the marker of our citizenship, our participatoriness, our relation to others.”31
In the Spanish colonies, there were theological debates about whether just the black slaves brought from Africa or both they and the indigenous people of Latin America lacked souls, because the possession of a soul was thought to define “humanness.”32 Historically, a narrative of femininity in parts of Latin America is deeply tied to a vision of criolla women of European heritage as “clean and modern” as opposed to indigenous women who were thought to be dirty and animal-like.33
Women generally have historically been—and still often are—treated as less than fully human, as chattel or children or even on a par with animals.34 Women in many countries are still denied the right to inherit land and are required to obtain consent from men for certain medical procedures. And throughout the world, cultural norms and practices regularly define women not in terms of their humanity but in terms of their sexuality, which is to be managed and controlled. Women are the objects of both desire and misogyny, and in seemingly equal measure seem to need to be protected or repressed, rather than treated as subjects with rights, including to sexual pleasure.
One principal way in which women’s ethical and legal subjectivity is diminished is through laws and practices that reduce them to mere means for reproduction and childrearing. As Betty Friedan said, “There is no … full human dignity and personhood possible for women until we assert and demand the control of our own bodies, over our own reproductive processes…. The real sexual revolution is the emergence of women from passivity, from thingness, to full self-determination and dignity.”35 Among other courts, the Colombian Constitutional Court has explicitly used a “dignity” argument to strike down draconian abortion restrictions. In 2006, the court reasoned that to not leave any exceptions for the life and health of the mother, or for rape or incest, reduces the woman to being “a womb without conscience.”36 The Argentine Supreme Court was even clearer in striking down restrictions on abortion in the case of sexual assault: “From the notion of human dignity comes the principle that establishes [women] as an end in an of themselves and not merely a means or instrument of reproduction.”37
People with various disabilities have also been denied full human status by discriminatory laws as well as by social norms throughout history that dictate certain physical standards for humanness as well as define “normal” behaviors.38 Indeed, it is only in the last twenty to thirty years that the international human rights movement has begun to take seriously the violations of dignity faced by people with disabilities, including mental disabilities. Laws reducing “imbeciles” and “lunatics” to some less-than-human status, depriving them of control over basic decisions in their lives, including reproduction, were more the norm than the exception historically, and they continue to be in force in too many countries.
Historically, laws enshrined distinctions between citizens and others of lesser status based on property ownership as well—and across much of the world today, we still consign vast swaths of humanity to being less than fully human in practice, if not law, merely because they are poor. Stop at virtually any traffic light in Dar es Salaam or Freetown or Mumbai or Lima—or a hundred other cities across the globe—and there will be an immediate assault of beggars parading their misery in exchange for a handout. We, the well-off, who walk along or drive by in cars with the windows rolled up, tend to look right through the beggars, avoiding their eyes. However, the destitute and ill—trapped by their seemingly inexorable invisibility as human beings—often go to lengths to make themselves seem more pitiful and deserving of charity than the rest. Societies in which we tolerate these manifestations of tremendous inequality and extreme poverty structure this relationship between the well-off and the very poor, fostering systematic dehumanization that makes dignity impossible. Confronted endlessly with this visual barrage of deformities and desperation, the people in the cars or rushing by on the streets invariably stop seeing the extremely poor as fully human but rather as objects that inspire compassion at times and undoubtedly contempt and loathing at others.
And one step removed from the street—on the web, on our TV screens, and in our newspapers—the masses of people displaced by war or earthquakes, starving to death, or stricken with terrible diseases, which should have been preventable, are paraded before us; CNN, Al Jazeera, and the BBC are constantly feeding us some new atrocity or humanitarian crisis, as our ability to empathize and see the people on the screen as equal human beings grows ever more tenuous.
In human rights we used to believe that simply drawing attention to a horror would be enough to make people take action. Yet, the spectacles of misery all too often fail to focus our attention on the ways in which our social and economic arrangements systematically create the situations in which some people are treated as means rather than ends—with grave effects on their health, as well as on their dignity. As Susan Sontag writes, “The imaginary proximity to the suffering inflicted on others that is granted by [these] images suggests a link between the far away sufferers and the privileged viewer that is simply untrue, that is yet one more mystification of our real relations to power.”39
But in this inexorably interconnected world, we are not innocent spectators of suffering in our own countries or across the globe. For example, what if wages in a country are too low for laborers to exercise choice about their life plans while the wealthy live in palaces? And what if people in the United States or Europe are relying on the cheap labor provided in Guatemala to harvest sugar or in Bangladesh to make clothing—under conditions that make it impossible for them to live with dignity? Do we not owe those strangers the treatment that we would wish for ourselves, and shouldn’t we insist that our governments apply appropriate trade and labor regulations in the countries from which we import products? What level of concern for “the other” is feasible, or required by respect for human dignity, in our globalized world?40 My intention in these pages is to encourage readers not just to have a knee-jerk reaction of sympathy, which as Sontag notes, “proclaims our innocence as well as our impotence,”41 but to explore how a rights framework might make us rethink what we owe each other as full human beings, through the laws and institutional arrangements we devise at national and global levels.
Dignity, Health, and Human Rights
Dignity, health, and human rights are intimately connected. In a classic 1994 article, Jonathan Mann and colleagues described three dimensions of connections between health and human rights. The first dimension relates to the health impacts that result from human rights violations—especially, in their discussion, civil rights violations such as torture. The second dimension involves the impact of health policies, programs, and practices on human rights—again in their original conception, with a focus in particular on civil rights. The final dimension, and one that I discuss at length throughout this book, involves the recognition that health and human rights are integral dimensions of, and can be complementary approaches to advancing human dignity and well-being.42
Let’s start with the recognition that human rights abuses, such as torture, are not only violations of human dignity but also quite evidently bad for people’s health, as is clear from the Quijano case. As director of research and investigations for Physicians for Human Rights (PHR) in the 2000s, I supervised PHR’s investigation into the health effects of the so-called “enhanced interrogation techniques” that the George W. Bush administration was using on detainees in the “war on terror.” In 2006, the Bush administration was claiming that these techniques did not constitute torture because they did not meet the threshold of pain and suffering required under the UN Convention against Torture, which the United States had ratified