On Health and Human Rights (Paul Farmer, Pathologies of Power”

“As the Haitians say,”Laws are made of paper; bayonets are made of steel.” Law alone is not up to the task of relieving such immense suffering. Louis Henkin has reminded us that international law is fundamentally a set of rules and norms designed to protect the interests of states, not their citizens. “Until recently,” he observed in 1989, “international law took no note of individual human beings.” And states, as we have seen, honor human rights law largely in the breach - sometimes intentionally and sometimes through sheer impotence. This chief irony of human rights work - that states will not or cannot obey the treaties they sign - can lead to despair or to cynicism, if all of one’s eggs are in the international-law basket.

Laws are not science; they are normative ideology and are thus tightly tied to power. Biomedicine and public health, though also vulnerable to being deformed by ideology, serve different imperatives, ask different questions. They do not ask whether an event or a process violates an existing rule; they ask whether that event or process has ill effects on a patient or a population. They ask whether such events can be prevented or remediated. A change of approach in that direction would have, I believe, a salutary effect on many human rights debates. And when medicine and public health are explicitly placed at the service of the poor, it provides even greater insurance against their perversion.” (p235-6, emphasis mine)