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Members of the United Nations Committee on the Rights of Persons with Disabilities
Palais des Nations
CH-1211 Geneva 10
Switzerland
 

Re: Upcoming review of Australia

Dear Committee members:

We write in advance of the United Nations Committee on the Rights of Persons with Disabilities’ review of Australia’s compliance with the Convention on the Rights of Persons with Disabilities (CRPD) to highlight areas of concern we hope will inform your consideration of the status and treatment of people with disabilities in Australia.

This submission is based on ongoing monitoring of the rights of persons with disabilities in Australia, analysis of current legal reform processes and input from local disabled persons’ organizations.

We would like to bring three key areas of concern to the Committee's attention:

1.                  Involuntary sterilization of women and girls with disabilities;

2.                  Use of guardianship as a form of substitute decision making; and

3.                  Abuses against people with psychosocial disabilities.

 

1. Involuntary Sterilization of Women and Girls with Disabilities (Articles 23 & 25)

Australian law allows the Family Court of Australia or a state or territory guardianship tribunalto authorize the involuntary sterilization of a child or adult with disability if the procedure is determined to be in the best interests of the person with disability.[1] Disabled persons organizations (DPOs) and human rights groups within Australia have raised concerns that the legal and regulatory frameworks underlying the system of court authorization have failed to adequately protect women and girls with disabilities from human rights abuses.[2] Some groups have questioned whether the “best interests” of the child is being judged according to human rights principles, or whether concerns about the competing interests of parents, caregivers, service providers and policy makers have greater influence in the decisions of courts.[3]  In a number of cases, for example, courts have cited evidence of the burden on parents in managing the menstruation of their daughters with disabilities as a consideration for authorizing sterilization, at times even before the onset of puberty.[4] Also of concern is the fact that in some cases, courts have declined to appoint a separate lawyer to represent the interests of the person with disability, and instead have relied upon medical experts to present a balanced view.[5]

The exact number of forced or coerced sterilizations performed in Australia on women and girls with disabilities is unknown,[6] however the government has previously conceded that the practice of involuntary sterilization of women and girls with disabilities continues in Australia.[7] The Community Affairs References Committee of the Australian Senate has held a recent inquiry into the sterilization of people with disabilities in Australia and received evidence at public hearings about the ongoing practice of forced or coerced sterilization of women and girls with disabilities.[8] The government has consistently taken the view that there are instances in which sterilization can and should be authorized.[9]

Although the government in its initial report to the Committee states that “stringent guidelines apply to court or tribunal decisions relating to sterilization",[10] the decisions cited above suggest that this is not in fact the case. The government’s description of the legislation governing court or tribunal approval indicate that the instances where court or tribunal authorization for sterilization must be sought are clear, but the framework to be applied in making the decision to authorize sterilization is less clear.

The United Nations Special Rapporteur on Torture has emphasized that forced sterilization of women with disabilities may constitute torture or cruel or inhuman treatment. Furthermore, the United Nations Special Rapporteur on Violence against Women has asserted that forced sterilization is a method of medical control of a woman’s fertility, and violates a woman’s physical integrity and security, constituting violence against women.

The Committee on the Elimination of Discrimination against Women has considered forced sterilization a violation of a woman’s right to informed consent, infringing on her right to human dignity and physical and mental integrity.[11] The Committee has clarified that except where there is a serious threat to life or health, the practice of sterilization of girls, regardless of whether they have a disability, and of adult women with disabilities in the absence of their fully informed and free consent, should be prohibited by law.[12]

In June 2011, the International Federation of Gynecology and Obstetrics (FIGO) issued new guidelines on female contraceptive sterilization and informed consent, stating unequivocally that “only women themselves can give ethically valid consent to their own sterilization. Family members including husbands, parents, legal guardians, medical practitioners and, for instance, government or other public officers, cannot consent on any woman‘s or girl‘s behalf.”[13]

Human Rights Watch asks the Committee to question Australia about the following:

-          How does the government keep data on the number of cases of involuntary sterilization?

-          What support services are offered to women and girls with disabilities and their families and caregivers to assist in making decisions about reproductive rights?

-          What guidelines and standards are in place to inform courts and tribunals about how to discern if a woman with disability has given her full and informed consent to sterilization?

-          In cases that come before a court or tribunal regarding involuntary sterilization, is it a requirement in all states that the person with disability has a separate legal representative to advocate for his or her interests?

-          What mechanisms are in place to ensure that women with disabilities are not forced to be sterilized against their expressed will?

 

2. Use of guardianship as a form of substitute decision making (Articles 12 & 19)

Australian law currently promotes guardianship as opposed to supported decision-making, and therefore limits the ability of people with psychosocial or intellectual disabilities to make their own decisions. In all Australian jurisdictions, guardians and administrators continue to be appointed for people deemed to lack capacity to make their own decisions.[14] In some states, in considering the appointment of certain types of guardians, the tribunal is not even required to consider whether the appointment of the guardian constitutes the least restrictive means.[15] Australia has made an interpretive declaration to the Convention indicating its understanding that the Convention allows for substituted decision-making arrangements which provide for decisions to be made on behalf of a person.[16]

In all Australian jurisdictions, if a suitable individual (such as a close family member or friend) cannot be identified to serve as a guardian for a person who is deemed to lack capacity, an independent statutory guardian is appointed.[17] Disability advocacy groups have highlighted the problems that frequently arise with the government bodies appointed to exercise guardianship functions, including the lack of individualized service; inconsistent service delivery and information to clients with disabilities which leads to high levels of stress and frustration; slow or no responses to requests from clients; an unwillingness to spend the time needed to understand the needs and changing circumstances of clients; and cynical and pejorative attitudes of some of the staff to their clients and to disability.[18]

The government’s initial report to the Committee indicates that guardianship and financial administration are only put in place where a person is unable to make “reasonable judgments” in respect of matters relating to his or her person, circumstances or estate.[19] However particularly with respect to financial matters, a judgment of what is “reasonable” is inherently subjective and risks taking away a person’s autonomy of decision-making based on a belief about what constitutes a correct decision. Guidelines on how a tribunal should determine what constitutes a “reasonable” judgment are either limited or completely lacking.

Article 12 of the CRPD creates an assumption that persons with disabilities can act in their own best interests and that, when needed, they should be given support to do so. The text of Article 12 does not foreclose the possibility of a support system in which a third party may advise or assist a person in making decisions and exercising rights, however it replaces the traditional model of substitute decision-making or guardianship with a model of supported decision-making. It is therefore essential that the regime for assisting in decision making is a support for the individual’s exercise of rights, and a process by which the will and the preferences of the person are fully respected.

Although the government’s initial report to the Committee suggests that legislation in various states strikes a balance between the right of a person with a disability to autonomy in decision-making and his or her right to support for decision-making,[20] guardianship and administration enshrine in legislation substitute decision-making, not supported decision-making, and are therefore inconsistent with the CRPD. Australia’s interpretive declaration to the CRPD is also inconsistent with Article 12 of the CRPD on this basis.

Human Rights Watch asks the Committee to question Australia about the following:

-          Is Australia considering withdrawal of its interpretive declaration to Article 12 of the CPRD?

-          What progress does Australia intend to make in reforming domestic legislation to move from substitute decision-making to supported decision-making?

-          What resources and support mechanisms are currently in place to assist people with disabilities in making decisions about their person, circumstances and estate? Are adequate resources allocated to ensure that people with disabilities receive the assistance that they require in this regard?

-          What mechanisms are in place to monitor the government bodies responsible for undertaking guardianship functions? Is adequate funding allocated to these bodies?

-          What training do the staff of bodies that exercise guardianship functions receive to ensure that they respond appropriately to the needs of persons with disabilities? What efforts are made by these bodies to provide supported decision-making services instead of substituted decision-making?

 

3. Abuses against persons with psychosocial disabilities (Articles 15, 16, 19 & 25)

People with psychosocial disabilities continue to face discrimination, abuse and lack of services in Australia. In 2012, a coroner’s report found that neglect, poor hygiene, poor nutrition and the over-prescription of anti-psychotic drugs contributed to the death of six residents with psychosocial disabilities living in a community-based boarding house in Sydney.[21] DPOs and NGOs have highlighted the lack of regulation of such community-based living arrangements, which allow abuse and neglect to go unnoticed and without adequate government oversight.[22]

A 2005 report by the Mental Health Council of Australia documented a fundamental issue of inadequate access to quality health services for persons with psychosocial disabilities. The report found that “any person seeking mental health care runs the serious risk that his or her basic needs will be ignored, trivialized or neglected”, and “the system as it currently operates may result in a failure to provide basic medical and psychological health care, inappropriate use of short term seclusion, confinement or over-reliance on sedating medications”.[23] Media reports suggest that the situation has not improved since 2005. Shackles and restraints are still used on patients with psychosocial disabilities at disturbingly high rates, sometimes because of a lack of beds in psychiatric wards in public hospitals.[24] Recent investigations by a South Australian Ombudsman highlight the case of a young man who was shackled for periods of four and 11 hours over four days in Adelaide, South Australia, and the South Australian Health Department is reviewing the shackling of a further eight patients in the hospital’s emergency department.[25]  Thirty percent of all mental health hospitalizations are involuntary,[26] and people with psychosocial disabilities continue to be discharged from hospitals or mental health treatment into homelessness, leaving them vulnerable and without support.[27]

All persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. The shortcomings in mental health care in Australia are of concern and should be addressed through the strengthening of community-based mental health services and alternatives for independent living in the community. However, where such community-based services exist, it is crucial that the government maintains regular oversight and monitoring to ensure that cases of abuse, neglect and violence are prevented. The UN Special Rapporteur on Torture, in his recent report on torture in healthcare settings, has raised concerns about forced medical interventions on people with psychosocial disabilities. The Special Rapporteur has also called for an absolute ban on restraints and seclusion, and has recognized that the use of restraint on people with psychosocial disabilities for even a short period of time may constitute torture and ill-treatment.[28]

Human Rights Watch urges the Committee to raise the following questions with Australia in its upcoming review:

-          What steps is the Australian government taking to address the inadequate access to healthcare for people with psychosocial disabilities, highlighted in the 2005 Report of the Mental Health Council of Australia?

-          What measures are being taken to prevent the use of restraints, shackles and seclusion on people with psychosocial disabilities in hospitals?

-          How does the government propose to manage the high level of involuntary hospitalizations of people with mental disabilities? What steps are being taken to replace involuntary hospitalization with community-based care that treats people with psychosocial disabilities on a voluntary basis?

-          How does the federal government monitor the resources provided by state governments to the treatment and health care of people with psychosocial disabilities?

-          What steps are being taken to prevent homelessness and neglect amongst people with psychosocial disabilities and to monitor community-based housing for people with disabilities? Has the government implemented new measures in light of the recent abuses revealed in boarding houses in Sydney?

* * *

 

We hope you will find the comments in this letter useful and would welcome an opportunity to discuss them further with you. Thank you for your attention to our concerns, and with best wishes for a productive session.  

                                   

Sincerely,

Shantha Rau Barriga
Senior Advocate/Researcher for Disability Rights  
Human Rights Watch

 



[1] Australian Human Rights Commission, Submission to Inquiry of the Senate Affairs References Committee on Involuntary or Coerced Sterilization of People with Disabilities (hereinafter “Submission to Senate Inquiry”) (November 2012), available at http://humanrights.gov.au/legal/submissions/2012/20121128_sterilisation.pdf at 10 (para 36).

[2] Id.; People with Disability Australia, Submission to the Senate Standing Committee on Community Affairs: Inquiry into the involuntary or coerced sterilization of people with disabilities in Australia (March 2013), available at https://senate.aph.gov.au/submissions/comittees/viewdocument.aspx?id=6efe508e-270b-4e8d-b85a-0711c74f618e  at 14-17; Queensland Centre for Intellectual and Developmental Disability et al, A Combined Response to the Inquiry into the Involuntary or Coerced Sterilization of People with Disabilities in Australia (2013), available at https://senate.aph.gov.au/submissions/comittees/viewdocument.aspx?id=d3e2932c-7e1f-44bb-9bf6-f310383d8d1e at 3-4; Intellectual Disability Rights Service Inc, The Involuntary or Coerced Sterlisation of People with Disabilities in Australia Senate Committee Inquiry: Submission (February 2013), available at https://senate.aph.gov.au/submissions/comittees/viewdocument.aspx?id=7d9....

[3] Australian Human Rights Commission, above n 1, 10.

[4] Re Angela [2010] FamCA 98 (16 February 2010), available at http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/cth/FamCA/2010/98.ht...("2010%20FamCA%2098"); In the Matter Of: Re Katie[1995] FamCA 130 (30 November 1995), available at http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/cth/FamCA/1995/130.h...(; Carolyn Frohmader, Moving Forward and Gaining Ground: The Sterilization of Women and Girls with Disabilities in Australia (2012), available at http://www.advocacyforinclusion.org/publications/Reports/moving_forward_and_gaining_ground_presentation_versionfinal.pdfat 4.

[5] Re Angela [2010] FamCA 98 (16 February 2010).

[6] Australian Human Rights Commission, Submission to Senate inquiry, above n 1, at 8.

[7] See Women with Disabilities Australia, Briefing Paper: Sterilization of Women and Girls with Disabilities in Australia: An update on the Issue in Australia, (December 2012)available at http://www.wwda.org.au/Sterilisation_of_Women_and_Girls_with_Disabilities_UpdateDec2012.pdf at 3.

[8] Community Affairs References Committee, Australian Senate, Inquiry into sterilization of people with disabilities, Transcript of Public Hearing December 11, 2012, available at: http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;db=COMMIT....

[9]2007 Report to the United Nations under the Convention on the Rights of the Child (CRC), available at http://www2.ohchr.org/english/bodies/crc/docs/CRC.C.AUS.4_en.pdf at 25-26.

[10] Implementation of the Convention on the Rights of Persons with Disabilities, Initial Report submitted by Australia, CRPD/C/AUS/1 at 24.

[11]Committee on the Elimination of Discrimination Against Women (CEDAW Committee) (1999), General recommendation No. 24: Article 12 of the Convention (women and health), A/54/38/Rev.1, chap. I; [para.22].

[12]CEDAW Committee (2010) Concluding observations of the Committee on the Elimination of Discrimination Against Women: Australia. CEDAW Forty-sixth session, 12 – 30 July 2010. CEDAW/C/AUS/CO/7. See http://www2.ohchr.org/english/bodies/cedaw/cedaws46.htm

[13] FIGO (International Federation of Gynecology and Obstetrics), Contraceptive Sterilization Guidelines, Principle 7. Available at:  http://www.figo.org/files/figo-corp/FIGO%20-%20Female%20contraceptive%20sterilization.pdf.

[14] Guardianship and Administration Act 2000 (Qld) s 12; Guardianship Act 1987 (NSW) ss 14, 25G; Adult Guardianship Act (NT) s 15(1); Guardianship and Administration Act 1993 (SA) s 29, 35(1); Guardianship and Administration Act 1995 (Tas) ss 21(1), 51(1); Guardianship and Administration Act 1986 (Vic) s 22(1)–(2); Guardianship and Administration Act 1990 (WA) ss 43(1), 64(1)–(2).

[15] See, e.g. Guardianship Act 1987 (NSW) s 25G.

[16] United Nations Treaty Collection, Status of the Convention on Rights of Persons with Disabilities, available at http://treaties.un.org/Pages/ViewDetails.aspx?mtdsg_no=IV-15&chapter=4&l....

[17] Department of Health and Aging, Guardianship and administrators, available at http://www.agedcareaustralia.gov.au/internet/agedcare/publishing.nsf/Con....

[18] Intellectual Disability Rights Service, Guardianship and administration laws across Australia (2012), available at http://www.idrs.org.au/_pdf/Guardianship_and_administration_laws_across_Australia_by_Ben_Fogarty.pdf at 6-7; Mental Health Legal Centre, Victorian Law Reform Commission – Guardianship Review: Submission in Response to the Information Paper (May 2010), available at http://www.communitylaw.org.au/mhlc/cb_pages/files/VLRC%20Submission%20to%20Gship%20Review_Info%20Paper_FINAL.pdf at 21.

[19] Initial Report submitted by Australia, above n 9, at 16.

[20] Id.

[21] ABC PM Program, Dickensian boarding house contributed to deaths, May 11, 2012, available at  http://www.abc.net.au/pm/content/2012/s3501075.htm.

[22] People with Disabilities, Six Deaths Too Many: Boarding House Reform Must Happen NOW, Press Release 16 March 2012, available at http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=4&cad... Public Interest Advocacy Centre, Appalling Boarding Houses Put Lives at Risk, available at http://www.piac.asn.au/news/2012/03/appalling-boarding-houses-put-lives-....

[23] Mental Health Council of Australia, Not for Service (2005), available at http://humanrights.gov.au/disability_rights/notforservice/report/exec.html.

[24] ABC News, Mental Health shortage having impact: doctors, February 28, 2013, available at http://www.abc.net.au/news/2013-02-28/mental-health-shortage-having-impact-doctors/4544318; The World Today, Restraint debate reignited over hospital mental health case, February 28, 2013, available at http://www.abc.net.au/worldtoday/content/2013/s3700275.htm.

[25] The Australian, Shackling mental health patients ‘a regrettable reality’, March 1, 2013, available at http://www.mhhub.com/archives/30812; The Australian, Treatment of mental health patient “inhumane”, March 21, 2013, available at http://www.theaustralian.com.au/national-affairs/state-politics/treatmen....

[26] Australian Government, A Contributing Life: the 2012 National Report Card on Mental Health and Suicide Prevention (2012), available at http://www.mentalhealthcommission.gov.au/media/39273/NMHC_ReportCard_Lo-res.pdf at 18.

[27] Id at 22.

[28] Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, 1 February 2013, available at  http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf at 14-15.

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