The rights of the child, the sick and the older person

The document the notes summarise is a proclamation, not a statute. The 1959 text was adopted by the United Nations General Assembly as resolution 1386 (XIV) on 20 November 1959, and an Assembly resolution does not by itself create enforceable duties for a government. That is the normal status of a declaration: it states standards, it carries moral and political weight, and courts, professional bodies and ministries later use it as the measure of what a State has promised. Its ten principles run from equality — all children are equal and must be treated fairly without discrimination because of race, religion, country of origin or sex — through the opportunities and facilities, by law and by other means, for the child to develop physically, mentally, morally, spiritually and socially in a healthy and normal way and in conditions of freedom and dignity, to a name and a nationality from birth, social security and health care for the child and the mother, special care for a handicapped child, love and family security, free and compulsory elementary education, rescue in disasters, protection from cruelty, exploitation and neglect, and an upbringing in friendship and peace. The principles therefore bind the nurse in a different way from a penal code. They threaten no fine; they define the standard against which conduct, institutional policy and legislation are judged. This distinction resolves a beginner’s confusion when the same text is called a right and is not directly actionable in a courtroom. Three decades later the content hardened into a treaty. The Convention on the Rights of the Child, adopted by the General Assembly on 20 November 1989 and in force from 2 September 1990, converted the 1959 vocabulary into binding obligations for the States that ratified it. Its Article 3(1) makes the best interests of the child “a primary consideration” in all actions concerning children, while the 1959 declaration had said “the paramount consideration”. The wording difference is deliberate and it matters: a primary consideration must be weighed alongside others, whereas a paramount consideration outranks them. Article 12 adds a second change — the child who is capable of forming a view has the right to express it freely, and it must be given due weight according to age and maturity. Article 2 requires non-discrimination and Article 6 protects survival and development; these four are taught as the Convention’s general principles. Africa produced its own instrument, the African Charter on the Rights and Welfare of the Child, adopted by the Organisation of African Unity in 1990 and in force from 29 November 1999. One correction belongs here. The heading in the lecture notes, “The Declaration of Human Rights by the US, Monrovia 1979”, is a mistranslation of États africains. What the 16th Ordinary Session of the Conference of Heads of State and Government, held in Monrovia, Liberia, from 17 to 20 July 1979, did through Decision 155 was to launch the drafting of an African charter; the African Charter on Human and Peoples’ Rights of the Organisation of African Unity — today the African Union — was adopted at Nairobi in 1981 and entered into force on 21 October 1986. Read literally, the mistranslation would place the origin of an African instrument in the United States and lose the entire point of the text.

An exception to professional secrecy is not a licence; it is a rule with a trigger, a channel and a limit. The trigger is a fact that crosses a defined threshold — an immediate danger to the patient or to another person, a reasonable suspicion that a child is being abused, the notification of a contagious or epidemic disease, a demand made by a statute, or the recovery of payment for services. The channel is the authority the law names: the police, the prosecutor, the child-protection service or the public health authority, according to the situation. The limit is necessity: only the information required to remove the danger may be given, and no more. A report written to protect a child and then copied to the whole staff room has exceeded the exception and become the very disclosure the rule forbids. The threshold word is reasonable. Reasonable suspicion requires no proof, no confession and no diagnosis. In the child-protection case the notes describe the trigger precisely: a child with unexplained injuries who appears frightened of a parent or primary caregiver may be enough, and the professional then has a legal duty to report the suspicion to the authorities. Failure to report is itself an offence in many legal systems (a comparative claim attributed in the sources below, not a provision the notes state for Cameroon), which is why the duty is described as mandatory rather than optional, and why the nurse’s personal reluctance cannot suspend it; in Cameroon the enforceable duty rests on the code of ethics and on the law of offences by omission, since the notes name no failure-to-report article. The premarital examination shows the same logic in a gentler setting, and it is here that the notes must be corrected. They define premarital screening as testing couples who plan to marry for common genetic blood disorders, and then give the examples as “sickle cell anemia and thalassemia and sickle cell anemia” — a duplication. The standard content is the haemoglobinopathies, sickle-cell disease and thalassaemia, together with infectious-disease screening such as hepatitis B, hepatitis C and HIV. The legal mechanism is consent. If the professional has been consulted by only one of the two fiancés, that professional owes secrecy to the person who consulted him. If the couple consults together and agrees to communicate the findings before the marriage, there is no secret left between them, because the holders of the secret have waived it towards each other. The certificate follows an even simpler rule: it is requested by the interested party and must be given to that party; the doctor who draws it up is not bound to secrecy towards his own client, and disclosure of the certificate can only come from the patient himself. The statutory declarations complete the list: declarations of death and of contagious or epidemic diseases, and the denunciation of crimes such as poisoning, abuse, assault and injury to children, sequestration and criminal abortion.

The oath is a particular kind of promise, and its form explains its force. The notes define it as a solemn undertaking, often invoking a divine witness, made before an assembly of people and before God or “before his conscience”. Its object is future conduct, not a past fact. Because it is sworn, its violation is not merely a breach of an employer’s rule: the notes say it can have serious psychological and even legal repercussions. That is why the candidate is told to think carefully, to meditate and to evaluate himself before taking it, and to withdraw at once if he cannot keep it — the honest refusal to swear is treated as better than a false oath. The content of the nursing oath then falls into a small number of commitments worth separating. The first is personal integrity: the nurse promises a life that is exemplary, loyal and impeccable. The second is fidelity to the profession: he undertakes to fulfil the duties of his office faithfully and to observe the code of ethics and deontology that governs it, without violating any element of it. The third is abstention from harm: he will take part in no criminal or harmful practice, will do nothing that harms the persons entrusted to him, and will not deliberately administer a dangerous remedy. To these the notes add competence — the duty to update knowledge as science advances and to take part in research — and professional secrecy, described as the condition of the patient’s trust. There is also a clause of loyal collaboration with the other members of the health team for the good of the patient and the population. That principle reaches its practical conclusion in the clause on the welfare of those who are left without any discrimination. It names a population — the child, the older person, the patient who has nobody to speak for him, the one who cannot pay — and it turns their welfare into a professional duty that corresponds to a right held by the patient. Beyond the supplied notes, the text usually identified with this tradition is the Nightingale Pledge, written in 1893 by Lystra Gretter for the nursing school of Harper Hospital in Detroit; it is a later composition, not a text of Florence Nightingale herself, and the historical point matters because the pledge is often misattributed to her. The practical use of the clause is as a standard of judgement. Where a service promises care for all but quietly sorts patients by ability to pay, by social rank or by the willingness of relatives to complain, the promise is not decoration: it is the rule against which the sorting is measured, and it is why this section treats the rights of the weakest patients as a professional obligation rather than an act of kindness.