Source: https://www.hhrjournal.org/2013/10/effective-access-to-justice-against-state-and-non-state-actors-in-the-framework-convention-on-global-health-a-proposal/
Timestamp: 2019-04-18 11:38:38+00:00

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In order to remedy such pathological results in health rights litigation, an FCGH must articulate functional remedies for violations of the right to health by state or non-state actors. This paper analyzes one approach to ensuring the recognition of the rights defended in a future FCGH. Following the incremental development approach inspired by the architecture of other successful framework convention protocols, we propose the inclusion of access to health justice guidelines in an FCGH.8 This proposal is based on the amparo remedy, a figure already extant in the legislation of several Latin American countries. There are many advantages to broadly incorporated guidelines based on the amparo remedy, and Latin American countries that have incorporated it into law have already seen a great increase in the amount of litigation in defense of health rights. The proposed guidelines would serve as a basic agreement on broad principles on access to health justice. Then, at later stages, specific protocols would be developed for each of the basic principles originally set forth, including substantive and procedural legal norms and processes.9 Doing so would advance realistic access to justice for victims of health rights abuses, a clear priority for the FCGH, and begin to ensure that those responsible for the abuses answer for their actions, essential steps in framing global health rights within a contemporary paradigm designed to meet the challenges of the new millennium.
Our proposed guidelines are based on the writ of amparo, a brief and summary judicial action. Unlike the familiar habeas corpus, which protects physical liberty, amparo actions seek judicial protection as a shield for fundamental constitutional rights and liberties. Many jurisdictions already contemplate the amparo or equivalent remedies in their legal systems, but our proposal would have distinctive features. The following table outlines the different dimensions of the proposed guidelines.
While each feature of the guidelines deserves special attention, the issues of standing are the most salient. With regard to standing to sue, we propose that both individual and collective claims be admissible. As we will explain in the next section, the possibility of filing collective claims addresses the objection that under the current law of many jurisdictions, the least advantaged individuals lack effective access to justice. Our guidelines propose mechanisms for seeking the protection of the right to health of the least advantaged; institutional figures like the ombudsman or public defender are viable options through which the least advantaged may voice their claims. Regarding the defendant’s standing, we take into account that in jurisdictions such as Mexico, Germany, and many other potential signatories to an FCGH, the version of amparo—or legal equivalent— currently in force can only be filed against the state or state representatives.10 In light of that, we propose to expand passive standing so that actions may also be filed against non-state actors, such as transnational corporations, for actions or omissions that constitute actual or impending violations of the right to health.
In this section, we address the reason why FCGH guidelines on effective access to justice should include a collective remedy. We also consider why this would be a useful legal mechanism for advancing the right to health and health equity, and the ground that would be gained by allowing for claims against state and non-state actors.
Second, multiple violations of the right to health of several persons usually require that the judiciary resolve issues that deeply impact the social, economic, or political spheres of the state. For instance, successful health litigation may improve access to health services to particular litigants or groups, but that may not translate to improved access to health services for the general population.12 Such situations demand that the judiciary listen to all affected parties to ensure that wholly informed decisions are reached, for example, by ordering public hearings that enable robust debate with the parties. If reduced to the interest of a single claimant, a future decision that has strong repercussions may lack broader legitimacy because it fails to consider all affected parties.
Regarding situations where the state is the defendant, our guidelines propose that the collective remedy may be filed against both state and non-state actors. Recent case law, including a landmark 1998 right to health case in Argentina, Mariela Viceconte v. Ministry of Health and Social Welfare, illustrates the benefits of this possibility.33 Representing several community groups, the plaintiff sought to require the state to provide a vaccine against the Argentine hemorrhagic fever that threatened the lives of 3.5 million people. Most of the at-risk population did not have access to preventive medical services. The plaintiff´s argument invoked the state’s obligation to prevent, treat, and control endemic and epidemic diseases recognized in Article 12.2c of the International Covenant on Economic, Social and Cultural Rights (ICESCR). The Federal Administrative Court of Appeals ordered the government to designate funds for completing the vaccination campaign and ensuring the production of the vaccine. Remarkably, the Court also put a follow-up framework in place to oversee compliance with its ruling. Additionally, the Court established a deadline for the state to meet the requirements. The Court’s ruling was based on regional and international standards defined by international human rights instruments of constitutional rank in Argentina: the American Declaration on the Rights and Duties of Man, the Universal Declaration of Human Rights, and perhaps more importantly, Article 12 of ICESCR.
In situations where the collective right to health amparo is brought against non-state actors for violating fundamental rights, Venezuelan case law offers a paradigmatic example. In Defensora del Pueblo de la República Bolivariana de Venezuela et al. v. Galaxia Médica C.A., a group of women filed a collective amparo against a number of corporations and the state for marketing toxic breast implants as safe.35 In granting the case’s admissibility, the Supreme Tribunal invoked the “horizontal effect” of human rights duties, under which non-state actors—in this case corporations—are also bound to respect human rights, including the right to health. Additionally, the Supreme Tribunal established some of the procedural rules we suggest as guidelines to ensure effective access to justice. This includes opening channels for the participation of all affected parties and legal mechanisms to attract other possible individual claims that might be brought regarding the same cause.
From these Latin American right to health litigation experiences, we can conclude that collective procedures had a greater impact on the judiciary and the defendants because they communicated the needs, desires, and anxieties of a large group. Collective procedures transformed the complaints from isolated individual occurrences to broader societal issues. In this way, the collective writ of amparo strengthens community, equalizes the playing field in access to justice, and augments the force and effect—on both the judiciary and the defendant—of health litigation.
Some scholars criticize the central role that courts have played in protecting the right to health and the broad interpretations they have made. According to these critiques, such decisions ultimately benefit the more advantaged parties to the detriment of the disadvantaged victims of health rights violations. Several studies also demonstrate that judicial decisions on policies and budgets introduce judicial power into the sphere of executive power.36 Notwithstanding these issues, our proposed guidelines for collective remedies and participatory frameworks address these potential problems. The conceptual framework of guidelines advocates a different understanding of judicial review. From our standpoint, the judiciary´s role in the process would require its intervention to secure the participation of all possible affected parties and call for public hearings to promote open discussion about the proper solution to right to health conflicts.37 The court´s institutional objective would be to ensure that the health policies impacting society are the result of collective and inclusive debate. Sentence T-760/08 from Colombia is a good example of what we have in mind: the Constitutional Court of Colombia showed commitment to collective debate by holding public sessions exhorting the authorities to provide reports on the system of public health care coverage and its challenges, and information to those affected by the healthcare system’s failings. Colombian society was heard when the Court struck down structural aspects of Colombia´s public health system. In turn, in the Venezuelan case, the affected parties were gathered in public audiences to inform the Court about the claims under the suit. Additionally, the Supreme Tribunal urged the ombudsman to establish methods for all affected parties to participate in the public session online. All in all, these examples demonstrate the amparo’s usefulness as an effective remedy and its compatibility with participatory and robust notions of the role of courts. This disproves the objections that have been made about the illegitimacy of decisions affecting social policies or the dysfunction of state institutions.
We believe an FCGH should include guidelines on effective access to the judicial system in cases involving the right to health. The proposed guidelines would be the initial codification of normative parameters on access to justice. The proposed guidelines would prevent current pathological results in health rights litigation. We also argue for a robust conception of standing to sue. On the one hand, by allowing for collective claims, the guidelines offer mechanisms to promote the right to health of the most disadvantaged. On the other hand, the guidelines allow for the participation of juridical actors like the ombudsman for “institutionalizing” the health issues that are a priority for the most disadvantaged. In the absence of these procedures, as we have seen, individual claims cannot be channeled into a collective claim and the failures of the justice system become immediately apparent. In addition, the guidelines suggest that state parties to an FCGH should allow for simple, brief, and expedited claims not only against the state, but also against non-state actors. If an FCGH adopted these guidelines, it would set the stage for further, more detailed global agreements about how each country should internally design and tailor its procedural rules so that litigation can be as effective, efficient, and as socially beneficial as possible for everyone.
The authors would like to thank Marinka Yossiffon-Halpern, who meticulously edited this paper and challenged us on many points. Eric Friedman’s comments were also much appreciated. We are grateful to the two anonymous referees and to the editors of this special issue for their helpful comments.
Martín Hevia, SJD, is the Director of the LL.B. Program and an Assistant Professor at the Escuela de Derecho, Universidad Torcuato Di Tella in Buenos Aires, Argentina.
Carlos Herrera Vacaflor, JD, is a lawyer who graduated from the Escuela de Derecho, Universidad Torcuato Di Tella in Buenos Aires, Argentina.
Please address correspondence to the authors c/o Martín Hevia, Universidad Torcuato Di Tella School of Law, Avenida Figueroa Alcorta 7530 (C1428BCW) Buenos Aires, Argentina, email: mhevia@utdt.edu.
1. Joint Action and Learning Initiative for National and Global Responsibilities for Health, JALIHEART.COM. Available at http://www.jalihealth.org/; See also L. O. Gostin, “A framework convention on global health: Health for all, justice for all,” JAMA 307/19 (2012), pp. 2087-2092. Available at http://jama.jamanetwork.com/article.aspx?articleid=1157495; E. A. Friedman and L. O. Gostin, “Pillars for progress on the right to health: Harnessing the potential of human rights through a global convention on global health,” Health and Human Rights: An International Journal 14/1 (2012). Available at http://www.hhrjournal.org/index.php/hhr/article/view/483/751.
4. Minister of Health & Others v. Treatment Action Campaign & Others (July 5, 2002), CCT 8/02 (Constitutional Court of South Africa). Available at http://www.saflii.org/za/cases/ZACC/2002/15.html; State of Punjab & Others. v. Mohinder Singh Chawla (December 17, 1996), SC 1225/97 (Supreme Court of India). Available at http://indiankanoon.org/doc/1569214/; Cruz del Valle Bermúdez & Others. v. Ministerio de Sanidad y Asistencia Social (Supreme Court of Justice of Venezuela, Case No. 15.789, Decision No. 916, July 15, 1999). Available at: http://www.law.georgetown.edu/oneillinstitute/global-health-law/who-hhr/caselaw-detail.cfm?id=1292&b=1; Sandra Clemencia Perez Calderon & Others (Constitutional Court of Colombia, Case No. T-140800, Decision SU-225/98, May 20, 1998). Available at http://www.corteconstitucional.gov.co/relatoria/1998/SU225-98.htm.
5. See, for example, Article 4 of the 1857 Constitution of Mexico; Article 9 of the 1980 Constitution of Chile; Article 19 of the 1987 Constitution of Haiti; Article 20 of the 2012 Constitution of Hungary; Article 42 of the 1994 Constitution of Argentina; Article 83 of the Constitution of Venezuela; Article 18 of the Constitution of the Plurinational State of Bolivia; Article 43 of the Constitution of Spain; Article 64 of the 1976 Constitution of Portugal; Article 23(2) of the Constitution of Belgium. All available at http://www.constitution.org/cons/natlcons.htm.
6. Constitution of Colombia (1991), Art. 93. Available at http://confinder.richmond.edu/admin/docs/colombia_const2.pdf; Constitution of Argentina (1994), Art. 75(22). Available at http://www.senado.gov.ar/web/interes/constitucion/english.php; Constitution of Costa Rica (1949), Art. 105. Available at http://www.costaricalaw.com/legalnet/constitutional_law/constitenglish.html; Constitution of Switzerland (1999), Art. 121. Available at http://www.admin.ch/ch/e/rs/1/101.en.pdf; Constitution of the Republic of India (2007), Art. 52(c). Available at http://lawmin.nic.in/coi/coiason29july08.pdf, are some examples.
7. See, for example, L. M. Ferraz, “The right to health in the courts of Brazil: Worsening health inequities?” Health and Human Rights: An International Journal 11/2 (2009), p. 40. Available at http://www.hhrjournal.org/index.php/hhr/article/view/172/25. See also A.Yamin and S. Gloppen (eds.), Litigating health rights: Can courts bring more justice to health? (Cambridge, MA: Harvard University Press, 2011).
8. See, for example, WHO Framework Convention on Tobacco Control, World Health Assembly Res. 56.1 (2003). Available at http://whqlibdoc.who.int/publications/2003/9241591013.pdf.; Vienna Convention for the Protection of the Ozone Layer, UNEP Governing Council TIAS No. 11,097 (1987). Available at http://untreaty.un.org/cod/avl/ha/vcpol/vcpol.html; and the United Nations Framework Convention on Climate Change, FCCC/INFORMAL/84 (1992). Available at http://unfccc.int/2860.php.
10. See, for example, German Constitution (2009), Art. 93(1). Available at http://www.servat.unibe.ch/icl/gm00000_.html; Spanish Constitution (1978), Art. 41(2). Available at http://www.congreso.es/portal/page/portal/Congreso/Congreso/Hist_Normas/Norm/const_espa_texto_ingles_0.pdf; Constitution of Hungary (2011), Art. 64. Available at http://www.kormany.hu/download/4/c3/30000/THE%20FUNDAMENTAL%20LAW%20OF%20HUNGARY.pdf; Article 144 of the BVerfG do not prescribe effective legal remedies against non-state actors. Available at http://www.gesetze-im-internet.de/gg/BJNR000010949.html.
11. F. Verbic, Procesos colectivos (Buenos Aires: Ed. Astrea, 2007), pp. 34-36.
12. See, for example, Recurso Extraordinario (November 24, 2000) STF 271.286-8 D.J. (Federal Supreme Court of Brazil) or Caja Costarricense de Seguro Social (September 23, 1997) SC Res. 5934-97 (IV Constitutional Chamber of the Supreme Court).
13. Colombia´s executive decree 2591/1991, Art. 46. [unofficial translation]. See César Gaviria, Executive Order 2591: Acción de Tutela [Legal Protection Writ], November 19, 1991 (Colombia).
14. See Defensora del Pueblo de la República Bolivariana de Venezuela et al. v. Galaxia Médica C.A (June 6, 2012) TSJ Sentence No. 790 (Supreme Tribunal of Justice of Venezuela); Defensora del Pueblo v. Minister of Health et al. (access to medical treatment) (July 14, 2000) CCB N° 687-200-R (Constitutional Court of Bolivia).
15. L. M. Zanitelli, “Corporations and human rights: The debate between voluntarists and obligationists and the undermining effects of sanctions,” SUR International Journal on Human Rights 8/15 (2011), p. 36.
17. Para. 42 of CESCR General Comment 14 can also be understood in that light. See http://www1.umn.edu/humanrts/gencomm/escgencom14.htm).
On non-state actors and human rights violations, see S. Michalowski and J. P. Bohoslavsky, “Jus cogens, transitional justice and other trends of the debate on odious debts—A response to the World Bank discussion paper on odious debts,” Columbia Journal of Transnational Law 48/61 (2010); J. P. Bohoslavsky and V. Opgenhaffen, “The past and present of corporate complicity: Financing the Argentinean dictatorship,” Harvard Human Rights Journal 23 (2010), pp. 157-223.
18. Special Rapporteur´s Guidelines for Pharmaceutical Companies in Relation to Access to Medicines, available at http://www.who.int/medicines/areas/human_rights/A63_263.pdf.
19. The “Ruggie Principles,” UN Guidelining Principles on Business and Human Rights. See http://www.business-humanrights.org/SpecialRepPortal/Home/Protect-Respect-Remedy-Framework/GuidingPrinciples with summary at http://www.humanrights.gov/2012/12/03/un-guiding-principles-on-business-and-human-rights/.
20. Verbic, p. 52. See note 11.
21. Defensoría del Pueblo (Ombuds Office’s Office of Colombia), La tutela y el derecho a la salud. Periodo 2003-2005 (2007), pp. 77-79; Defensoría del Pueblo, La Tutela y el Derecho a la Salud. Periodo 2006-2008 (2009), p. 30 [hereinafter Defensora del Pueblo 2006-08].
22. Luz Mary Osorio Palacio & Others. v. SaludCoop & Others (July 31, 2008) CCC Judgment T-760/08 (Constitutional Court of Colombia, Second Panel of Review), sec. 3. Available at http://www.corteconstitucional.gov.co/relatoria/2008/T-760-08.htm. See also A.Yamin and O. Parra-Vera, “Judicial protection of the right to health in Colombia: From social demands to individual claims to public debates,” Hastings International and Comparative Law Review 33/432 (2010).
25. Verbic, p. 35. See note 11.
26. On judicial intervention in this sense, see, J. H. Ely, Democracy and distrust: A theory of judicial review (Cambridge, MA: Harvard University Press, 1980).
27. Constitution of Argentina (1994), supra note 5, Art. 43, para. 2. Available at: http://www.senado.gov.ar/web/interes/constitucion/english.php.
28. See, for example, C. Botero, La acción de tutela en el ordenamiento constitucional colombiano (Bogotá: Escuela Judicial Rodrigo Lara Bonilla, Consejo Superior de la Judicatura, 2006), pp. 85-88.
29. A. M. Morello and C. A. Vallefín, El amparo: Régimen procesal (La Plata: Librería Editora Platense, 2004), p. 286.
30. There is literature that makes the argument for including the Public Office (public defenders included) as an interested party that may file an amparo to advance the protection of the right to health. See, for example, Verbic, note 11, p. 76; O. L. Motta-Ferraz and D. W. Liang Wang, “Can public attorneys improve health equity through right to health litigation? A case study of the city of Sao Pablo” (unpublished manuscript). Available at www.raison-publique.fr/…/WangFerr.; the regulation of the tutela in Colombia explicitly allows the Ombuds Office to file a tutela writ indistinctively of what the affected party decides. See note 28, Botero, pp. 89-91.
31. Asociación Benghalensis v. Ministerio de Salud y Accion Social-Estado Nacional (National Supreme Court of Justice of Argentina, A. 186, XXXIV, June 1, 2000). Available at http://www.law.georgetown.edu/oneillinstitute/global-health-law/who-hhr/caselaw-detail.cfm?id=1464&b=1.
32. Idem, cited in A. M. Morello & C. A. Vallefin, supra footnote 29, p. 290. Case law of the Constitutional Court of Colombia also acknowledges civil society organizations and groups standing to sue. See, C.C.C., Judgment T-411/92, in Botero, supra footnote 28, p. 87.
33. Mariela Viceconte v. Ministry of Health and Social Welfare (June 2, 1998) FACA Exp. 31 777/96 (Federal Administrative Court of Appeals of Argentina, Fourth Chamber). See also, V. Abramovich, Argentina: The Right to Medicines’ in Litigating Economic, Social and Cultural Rights: Achievements, Challenges and Strategies (COHRE 2003).; V. Abramovich & L. Pautassi, “Judicial Activism in the Argentine Health System: Recent Trends,” Health and Human Rights: An International Journal 10/2 (2008), pp. 57-58.
34. Mariela Viceconte v. Ministry of Health and Social Welfare. See note 31.
35. Defensora del Pueblo de la República Bolivariana de Venezuela et al. v. Galaxia Médica C.A. See note 14.
36. O. L. Motta Ferraz, “Harming the poor through social rights litigation: Lessons from Brazil,” Texas Law Review 89/1643 (2011); C. Rodríguez-Garavito, “Beyond the courtroom: The impact of judicial activism on socioeconomic rights in Latin America,” Texas Law Review 89/1669 (2011).
37. R. Gargarella, “Dialogic justice in the enforcement of social rights,” in A.Yamin and S. Gloppen (eds.), Litigating the Right to Health: Can courts bring more justice to health systems? (Cambridge, MA: Harvard University Press, 2011).

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