国际人权法视域下的健康权保护研究

【作者】 孙晓云；

【导师】 邓瑞平；

【作者基本信息】 西南政法大学 ， 国际法学， 2008， 博士

【摘要】 20世纪末21世纪初,人权和健康几乎同时成为世界热点问题。以1999年世界贸易组织西雅图部长会议期间发生的大规模反全球化和反世界贸易组织的抗议活动为开端,从日内瓦、纽约到蒙特利尔、东京,凡涉及世界贸易与金融问题的国际会议都有大批反全球化的抗议者。由此,国际经济组织与人权,尤其是世界贸易组织与人权成为国际经济法领域的热点问题,其中,世界贸易组织对健康权和环境权的影响最为突出。同时,2001年南非宪法法院健康权判例“卫生部诉治疗行动计划组织”案引起全世界关注,极大地推动了国际人权法中第二代人权——经济、社会和文化权利运动的发展和研究。2003年全球非典暴发等系列公共卫生事件引发的全球健康危机进一步引起了公众对全球市场与公共健康的关注。在我国,继1993年宪法修改时明确规定国家发展社会主义市场经济后,2004年人权入宪,民生建设进一步成为当前社会的主旋律,在2007年党的十七大报告中“病有所医”是推进民生建设的重要构成,也是党对人民作出的庄严承诺。上述事件相继出现在国际国内舞台并非历史偶然,而是全球市场对健康权内在影响的必然外部反映。从健康权的最早起源看,是对19世纪工业大革命所引起的经济混乱的回应。健康权在21世纪成为国际社会的焦点也正是对全球市场负面影响的回应。南非非政府组织的行为成功地提供了解决健康问题的权利路径,而不是经济学家们惯用的全球经济范式以及政治家们眼中的国家安全问题或慈善事业;同时,南非宪法判例也从实践上给予否定健康权可诉性的人们以有力反击,证明了健康权司法保护的可能。因此,建立市场与国际人权法视域下的健康权之间的互动,研究全球市场影响下的健康权以及健康权为解决全球健康危机和国家医疗改革提供的权利路径具有时代意义。健康权的概念如何界定、世界贸易组织以及世界银行、世界卫生组织等联合国人权机构之外的世界性国际组织对健康权保护有何影响、现有区域人权保护机制如何实现健康权保护、健康权保护在不同国家的实践如何、健康权保护对我国当前的医疗卫生改革有何现实意义,这些问题的解答不仅关系到国际人权法领域中健康权保护的实现,也关系到我国医疗卫生改革的走向和人民健康权的享有,具有重要理论意义和实践价值。本文在综合运用国际政治经济学中的权力结构理论、实证分析、比较分析等方法的基础上,注重从文本主义到功能主义,从基本理论到解决各种现实问题,通过健康权保护基本范畴的分析建立健康权保护的理论根据,进而从世界、区域和国家三个层面对健康权保护进行系统分析和阐释,并立足于我国现实,提出构建我国健康权保护制度的具体构想。全文除引言和结束语外,包括五章:第一章:健康权保护的基本范畴。分析健康权的概念与结构形态、健康权保护的国际标准与历史演变,建立健康权保护的基本范畴。首先,通过健康观本体溯源和健康权在国际人权条约和案例中的释义,将健康权界定为享受有效和综合卫生制度的服务的权利,揭示出国际人权法视域中的健康权的实质是资源配置的要求、个人参与的强调以及法律责任的强化。其次,对健康权的结构形态进行深入分析,指出健康权保护存在最高可能——有限资源结构、立法权——司法权结构以及安全——生产——金融——知识权力结构三类内在结构性矛盾,进而利用索绪尔符号学理论中所指和能指的关系,指出健康权的外部形态具有多样性,表现为国际人权条约和宪法中的直接规定以及卫生等具体法律制度的间接规定。再次,分别以卫生服务和国家义务为中心,对健康权保护的两类国际标准进行分析,建立了健康权保护的分析框架。最后,从国际国内层面对健康权保护的历史演变进行分析,揭示出健康权在19世纪起源、之后在国际人权法中长期未受重视以及在21世纪进入发展阶段的表现和原因。第二章:健康权的世界保护。将国际政治经济学分析方法引入国际人权法研究,揭示出联合国人权机构之外的世界性国际组织对健康权保护的结构性影响及根本原因。与联合国人权机构囿于强制性监督法律的缺乏而无法对健康权提供有力的保护形成鲜明对照,晚近其他世界性国际组织,如世界贸易组织、世界银行和世界卫生组织对健康权保护的影响日渐突出。传统国际人权理论立基于自然法和社会契约理论,主要关注联合国人权条约和联合国人权机构,无法对世界性国际组织对健康权保护纷繁复杂的影响进行全面分析。本章将英国国际政治经济学中的权力结构理论作为分析工具,突破传统的国家与人权视角,将安全、生产、金融和知识四类权力结构作为研究基础,分别对世界贸易组织、世界银行、世界卫生组织等四类世界性国际组织影响健康权保护的大量国际文件和政策进行研究,分析了其结构性影响,揭示出国家与市场力量对健康权保护的深层影响。第三章:健康权的区域保护。主要对欧洲和美洲两个区域性人权保护机构提供的健康权保护以及大量案例进行分析研究,通过实证对健康权不具有可诉性的观点进行修正。由于联合国人权机构中长期存在第一代人权和第二代人权的两分法,健康权概念模糊和缺乏可诉性是以美国为主的某些学者反对确立健康权的主要原因。然而,两者都依赖司法实践的发展而发展。通过大量判例证明了健康权司法保护的可能性。首先,对《欧洲社会宪章》建立的健康权保护和《欧洲人权公约》建立的欧洲健康权保护进行分析和比较,指出健康权司法保护包括一体化和直接保护两类方法。对集体申诉机制中的健康权案例和《欧洲人权条约》第8条下与健康权有关的大量案例进行了深入分析,揭示出欧洲健康权保护正在趋于强化的结论。其次,对建立在《美洲国家宪章》基础上的健康权保护和以《美洲人权公约》为基础的美洲健康权保护进行分析。通过以美洲人权委员会为中心,对土著人健康权案件、囚犯健康权案和药品可及性案三类案例进行深入分析,揭示出美洲健康权保护逐案基础上的渐进趋势以及类型化特征。第四章:健康权的国家保护。主要对国际人权法视域中健康权保护的核心部分即国家保护进行分析。人权国际保护中国家作用的重要性已得到联合国经济、社会和文化权利委员会的充分肯定。以南非、加拿大和美国为代表,主要从健康权的立法和司法保护两方面,分别对健康权在三个国家的不同保护模式进行分析和比较。对立法保护的研究,主要从宪法和卫生制度两个方面进行了分析;对司法保护的研究,重点分析了南非宪法法院确立的优先权配置原则、成本效益原则和紧急医疗权原则,以及加拿大最高法院在健康权保护中的二元性。之后,对美国制宪前后对健康权的态度转变、20世纪的是非之争以及21世纪健康权保护的发展进行分析。从而指出确立健康权的宪法地位是实现国际人权法视域下健康权保护的必要手段,这既是全球市场对健康权具有侵蚀作用的印证,也为构建我国健康权保护制度提供了基础。第五章:我国健康权保护制度的构建。分析我国健康权保护的法律状况和现实意义,提出构建我国健康权保护制度的具体设想。首先,对我国健康权保护的法律现状进行分析,包括我国在国际社会中作出的国际承诺以及在宪法和卫生制度中的规定,指出卫生制度保护中的三个层次和两个缺陷以及存在的国家与市场之争。其次,分析了我国构建健康权保护制度的社会意义,认为在建设和谐社会和民生建设的时代背景下,构建我国健康权保护制度是建设和谐社会的需要,也是克服卫生领域中政府失灵和破解当前医疗体制改革难题的需要。最后,提出构建我国健康权保护制度的设想。认为我国健康权保护法律体系应由不同层次及不同部门的法律法规组成,主要包括国际人权法、宪法和基本法、卫生法、卫生法以外的法律法规和司法解释等,并对宪法具体条文进行了设计,对卫生制度的根本目标、基本原则、国家义务和卫生基本制度的构成以及卫生资源的筹集和分配原则等进行了全方位的制度构设。更多还原

【Abstract】 Between the end of the 20th century and the beginning of the 21st century, human rights and health, almost at the same time, are brought into the forefront of the world. With the outbreak of a large-scale anti-globalization and anti-WTO protest during the ministerial meeting of WTO in Seattle in1999 as a start, from Geneva, New York, Montreal to Tokyo, nearly all the international conferences concerning trade and financial issues would confront a large number of anti-globalization protesters. International economic organizations and human rights, in particular WTO and human rights, becomes a hot area of international economic law, which the impact of WTO on right to health and environmental is the most prominent.At the same time, Action Plan for the Ministry of Health v. organization in South African in 2001 has aroused worldwide attention and greatly accelerated the development of economic, social and cultural rights, the second generation of human rights. Meanwhile, SARS outbreak in 2003 and the following series of public health incidents triggered the global health crisis and caused the public’s further concern of the global market and public health. In China, after the 1993 constitution amendment, in which the status of the socialist market economy clearly defined, in 2004, respecting and protecting human rights becomes a part of the constitution. Nowadays the People’s Livelihood Building is the theme of the time and in the Party’s 17th Report, the Party made the solemn commitment Medical Care for All.The occurrence of those incidents in the international and domestic arena in history is not by accident, but the reflection of the effect of global market on right to health. Therefore, establish the interaction between the market and right to health, and carry out the current medical service reform by the new right approach has great significance.Issues such as how right to health is defined, what role WTO, the World Bank and WHO play in the protection of right to health, what mechanism the current regional human right organizations provide in the protection of right to health, how different countries protect right to health and what role the protection of right to health plays in Chinese medical reform, grow to be core issues in the realization of right to health in international human right law as well as in the direction of Chinese medical reform and the enjoyment of right to health. Study of these questions is of great theoretical and practical value.In this dissertation, the author, by taking comprehensive approaches, studies on the protection of right to health in the world, the region and the states. In view of the theory of right to health, on the basis of present social reality and legal situation in China, the author tries to provide legislative advice on construction of the system of right to health in China. This dissertation consists of five chapters, in total 150 thousand words approximately.Chapter one expounds on the basic issues of right to health. This chapter focuses on the definition, the structure and morphology, the international standards and the historical evolution of right to health. First, the defintion of right to health is defined as the enjoyment of service of an effective and comprehensive health system and then the nature of right to health is reavealed, which lies in the requirement of resources allocation, the stress of individual participation and the strengthening of legal responsibility. Then, the structure and morphology of right to health is analysized, three types of structures in right to health are exhibited, including the highest possible - limited resources structure, legislative - judicial power structures, as well as security - production - financial - knowledge power structure, and rich forms of right to health in different laws are displayed. Besides, two series of prevailing standards in the current international law are pointed out. The first series of standards is centered on medical service and the second on the state’s obligation. The last part of the chapter combs the historical evolution of right to health, from domestic and international level, dividing the evolution into three periods. In the 21st century, it steps into a quick development stage.Chapter two exhibits the structural effect of the world international organizations on protecting right to health, on the basis of the international political and economic theory. On power structure theory as an analysis tool, this chapter has broken through the traditional human right paradigm between state and human rights, makes use of four type of power, comprised of security, production, finance and knowledge, makes further study of the structural effect of WTO, the World Bank, WHO and other international organizations on right to health impact, and reveals the impact of the state and market forces on the protection of right to health.Chapter three deals with the protection of right to health in Europe and the Americas. By detailed analysis of a large number of cases, the dissertation proves the justifiability of right to health. It first deals with analysis and comparison between protections of right to health provided by European Social Charter and European Convention on Human Rights, pointing out that the judicial protection of right to health includes two methods, direct one and integration method. Carrying out in-depth analysis on cases in the collective complaint mechanism and cases under Article eight in European Human Rights Treaties, it concludes that the trend to protection of right to health has being strengthened in Europe. Then it analyzes protection of right to health under Charter of the Americas and American Convention on Human Rights and makes deep analysis of protection in Inter-Americas centered in the Inter-American Commission on Human Rights, which is considered as the engine of the Inter-American human rights system. It points out, given its comprehensive jurisdiction over social rights, the commission has developed a growing case-based jurisprudence on right to health. The cases dealed with by the commission include three types right to health of indigenous cases, right to prisoners’ health and access to medicines.Chapter four analyses protection of right to health in countries. It makes deep analysis and comparison in protection of right to health in different countries, mainly from the legislative and judicial protection. The legislative protection part is directed toward providing for health rights protection in constitutions and health systems, while the judicial protection part is focused on principles established by South African Constitutional Court, including the principle of the priority allocation, cost-effective principle and the principle of the right to emergent medical treatment and the contradiction in the Supreme Court of Canada. In addition, it deals with the attitude change towards right to health, the debate, as well as the tendency in 21 century in the United States. It then concludes that establishing the constitutional right to health is necessary to realize the protection of right to health in international human rights law.Chapter five is devoted to the suggestions to construct laws relating to protecting right to health in China. It analyses the current laws concerning right to health in China, including Chinese international commitment, regulation in the Constitution and the provisions in the health system and provides the social significance of constructing right to health protection system in China, which is necessary to build a harmonious society, overcome the failure of the Government in the field of health as well as to resolve the current problems of the medical reform. Finally it offers the detailed suggestions of legal construction of protecting right to health in China. The dissertation proposes not only the macro idea of legal system construction but also the microcosmic construction on detailed content.更多还原