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"The right to health imposes obligations not only on medical practitioners but on many others: teachers of medicine, medical administrators, on members of the many "professions supplementary to medicine"; manufacturers and dealers in pharmaceutical, medical equipment and supplies, manufacturers and dealers in food items, food supplements, cosmetics and other items relevant to health, the media and advertisers, and many others."

Justice Fernando made this observation while speaking on the topic 'ethics and negligence at the recently held medical symposium on "Medical negligence" in Colombo held jointly by the Sri Lanka Association for Advancement of Science (SLAAS) and the Sri Lanka Medical Association (SLMA).

Speaking further on this aspect of medicine at this well attended event by the medical and scientific professionals in the country Justice Fernando went on to say...

"The right to health has many implications for those in the health-care sector. A professional is one who has not only received a long period of systematic education and training, but who constantly improves and upgrades his knowledge and skill.

Can a professional totally ignore other systems of medicine besides his own? There are many systems of medicine which are much older than western medicine, from some of which western medicine has borrowed. If the medical profession is to fulfil its obligation to provide the highest attainable standard of health, should not its students and members have some access to other systems of medicine?

" Another ethical issue is the right to withhold treatment in the pursuit of "industrial action", whether termed strikes or sick-note campaigns or otherwise. Some may dispute the existence of a right to strike.

But accepting that there is a right to strike, nevertheless there will be situations in which the exercise of that right may seriously prejudice the right to health; which right is to prevail? Does the right to health impose restrictions on the right to strike? Should the right to strike be exercised only after alternative dispute-resolution processes have failed? If so, does the right to health cast an obligation on the State to provide an independent, impartial, competent and effective dispute-resolution procedure? These issues need to be studied and resolved in the interest of every citizen's right to health.

"Other issues relate to the patient's right to full information about diagnosis, treatment, side-effects, etc; the obligation for the State to provide adequate trained staff, equipment, supplies, etc; misleading advertisements which may affect health".

He said today most nations have accepted 'right to health' as a basic human right. "The right of everyone to the enjoyment of the highest attainable standard of physical and mental health," (Article 12 of the International Covenant on Economic Social and Cultural Rights, ICESCR, quoted below).

Accordingly, the legal, ethical and moral norms applicable to the medical profession (and the entire health-care sector) must be scrutinized afresh and developed in the light of that basic right.

This is a scene at one of the children’s clinics at the Lady Ridgeway Childrens Hospital in Colombo. These parents wait for hours to get their children seen by the specialists. There are occasions when they have to leave disappointed too. Most of them are not aware of their rights for proper health care.

Every basic human right embodied in that Covenant is fundamental, being "a peremptory norm of general international law from which no derogation is permissible", whether by treaties or agreements between nations, or by national constitutions or legislation (jus cogens). Confers Rights on individuals as well

That Covenant confers rights not only one State vis-a-vis other States, but on individuals as well-as against their own State, against other States, and even as against other institutions, entities and individuals - and on those others are imposed duties which are correlative to the rights of such individuals.

The right to the highest attainable standard of physical and mental health ("the right to health") thus imposes duties on the medical profession (and the entire healthcare sector) and makes existing duties more onerous than before.

A necessary consequence of the recognition by the ICESCR of more extensive rights and duties in regard to health is that the nature, scope and extent of the ethics of the medical profession (and of the entire health-care sector) has expanded. The rise in ethical standards results in duties of care, skill and diligence becoming more onerous.

Negligence must henceforth be considered in relation to those more onerous duties.

The question of liability for negligence arises in several different contexts, e.g. where there is a contractual relationship (as when a doctor treats a private patient for a fee), when there is no contractual relationship (as when a doctor in public service paid by the State treats a patient at a Government hospital) and when a doctor employed and paid by a private hospital treats a patient who pays the hospital for treatment, etc.

Whether the relationship is contractual or not, certain duties are imposed by statute (e.g. as to when a pregnancy may be terminated, as to obtaining consent to treatment). But most duties arise, directly or indirectly, from the ethical standards and practices of the medical profession.

In the law of delict, a person would be liable for "negligence" to a person to whom he owes a duty of care if he fails to exercise the care, skill and diligence which a reasonably prudent person would exercise in the known circumstances.

But in the case of alleged negligence by a doctor, the hypothetical "reasonably prudent person" is not a lay person but a person in the medical profession, and what is expected of such a person is the general level of care, skill and diligence possessed and exercised at that time by members of the medical profession. That standard of care, skill and diligence is determined by and large, by reference to the professional and ethical practices and standards of doctors.

To sum up, Article 12.1 entitled everyone to a higher - much higher - standard of health than previously recognised; consequently, the rights of people were enlarged, and the duties owed to them by those in the health-care sector became more onerous; those duties resulted in higher professional and ethical standards; correspondingly, the duties of care imposed by professional and ethical standards increased; and necessarily, the scope of "negligence" expanded.

According to research carried out in the University of Helsinki (Finland), a patient laughs four times during an average consultation with a doctor. (Journal of sociolinguistics, 2002,6, 207-35). Doctors rarely reciprocate, say the researchers who videotaped 250 consultations in order to count the number of instances of laughter, smiles and "smiling voices" involving the doctor or the patient or both.

The researchers highlight some of the subjects of conversation that triggered laughter in the patient - varicose veins, pain in the leg, yeast infections, finger injury and cholesterol testing. The report "Laughter in medical interaction" shows that in 70 per cent of cases of patients laughing, there was no response from the doctor. In 20 per cent of cases, the doctor did smile, but in only 10 per cent of cases did both laugh.

"The patients laugh more than the doctor. We see that the occurrence of laugher seldom leads to its reciprocation - laughing together. It is the patients who do most of the laughing in medical encounters," says the report.

The report says that laughter is seen as an invitation to "come closer" and that there can be problems where it is not reciprocated".

"Not laughing with someone could indicate such negative features as malalignment and social distance."

Having looked at the evidence, the researchers suggest two theories for the failure of doctors to laugh along with their patients. Firstly the doctor's role can be characterized by attributes such as professional cautiousness and neutrality.

Secondly the patients mostly used laughter for different kinds of delicate tasks. In these consultations there are more chances for delicate talks by the patient than the doctor describing one's drinking, eating habits undressing etc.

Your body breaks down the food that you eat into glucose, which it uses for energy. People with diabetes either don't have enough insulin, which helps your body break down the food you eat into glucose, or their insulin doesn't work right.

There are two types of diabetes, Type 1 and Type 2. Most people get Type 1 diabetes as a child or young adult, and there's nothing you can do to prevent it. Type 1 diabetes is insulin-dependent, which means that you need to keep track of your insulin levels, inject yourself with insulin each day and follow a special diet.

Type 2 diabetes usually develops in people older than 40 or people who are very overweight. You usually don't have to take insulin if you have Type 2. Type 2 is treated with exercise, weight loss, a strict diet and sometimes medicine.

* Have given birth to a baby who weighed more than 9 pounds. You should see your doctor if you have any of these problems - they can be signs of diabetes:

* You get a lot of yeast infections You can live a normal and full life with diabetes, as long as you get treated by a doctor. But, if you have diabetes and you don't see a doctor you may get very sick or even die.