On 13 November 2019, the Health Information and Quality Authority (HIQA), in conjunction with Safeguarding Ireland, published Guidance on a human rights-based approach in health and social care services.¹ Its overall purpose is to ‘promote a human rights-based approach to care and support for adults in health and social care services’ (p. 4),¹ including those working in the addiction services. Taking a human rights-based approach to the delivery of care services is a requirement of public body staff and organisations under the Irish Human Rights and Equality Commission Act 2014, where Section 42 of the Act created a ‘public sector duty’ that requires public bodies to take proactive steps to promote equality, protect human rights, and fight discrimination in relation to their functions and powers.² However, practitioners experienced difficulties with translating the principles of human rights into their day-to-day practice and service delivery. HIQA’s guidance aims to bridge that gap.

Guidance structure

The guidance was developed based on a review of national and international best practice and through consultation with stakeholders. It provides an overview of what human rights are and how they apply to those working in health and social care services. The main body of the report is structured around a set of five principles, under each of which is the relevant human rights-related legislation, examples of how service providers can support and promote the principle in their work, and illustrations provided through the use of case studies. While service providers are the primary audience for the guidance, HIQA suggests that it should also be of value to service users by building their understanding of what to expect from any service grounded in a human rights-based approach.

FREDA principles

Based on their review of international best practice, the authors chose to structure the guidance around a set of principles associated with human rights. They use the FREDA principles, which they describe as ‘an internationally recognised framework through which human rights can be considered’ (p. 11).¹ The five principles as laid out in the guidance are: fairness, respect, equality, dignity, and autonomy (FREDA).

Fairness means ensuring that when a decision is made with a service user about their care and support that the person is at the centre of the decision-making process.

Respect is the objective, unbiased consideration and regard for the rights, values, beliefs, and property of other people. It applies to the person as well as to their value system.

Equality means people having equal opportunities and being treated no less favourably than other people on the grounds set out in legislation. In an Irish context, these grounds are: age; civil status; disability; family status; gender; membership of the Traveller community; race; colour or nationality; religion or sexual orientation.

Dignity means treating people with compassion and in a way that values them as human beings and supports their self-respect, even if their wishes are not known at the time.

Autonomy is the ability of a person to direct how they live on a day-to-day basis according to personal values, beliefs, and preferences. In a health and social care setting, autonomy involves the service user making informed decisions about their care, support, or treatment.

Conclusion

The HIQA guidance sets out to support organisations and staff by translating human rights theory into practice and therefore supporting them in complying with their public sector equality and human rights duty.² While the case studies and illustrations used in the guidance are not specifically in the area of addiction services, the principles should be transferable to any health and social care service.

1 Health Information and Quality Authority (HIQA) (2019) Guidance on a human rights-based approach in health and social care services. Dublin: HIQA. https://www.drugsandalcohol.ie/31418/

2 Section 42 of the Irish Human Rights and Equality Commission Act 2014 states: ‘(1) A public body shall, in the performance of its functions, have regard to the need to: (a) eliminate discrimination, (b) promote equality of opportunity and treatment of its staff and the persons to whom it provides services, and (c) protect the human rights of its members, staff and the persons to whom it provides services’. Irish Human Rights and Equality Commission Act 2014. Available online at:
http://www.irishstatutebook.ie/eli/2014/act/25/enacted/en/html