Human rights are entitlements that belong to every human being from birth until death. The state is obliged to guarantee human rights and adopt the measures necessary for their protection. The importance of respecting human rights and freedoms in social work should be not only self-evident but also a duty.
The state exercises its competencies through administrative authorities, while in the name of the authority specific employees act, who are entrusted with carrying out state administration. All state bodies are required to implement human-rights principles and protect citizens' fundamental rights and freedoms. Every state employee is obliged to comply with the Constitution of the Slovak Republic, laws, and legally binding international treaties and conventions, to refrain from anything that could endanger their impartiality. It is necessary to ensure that every state employee is also familiar with human rights, while their duty is to ensure that these rights are never violated. Knowledge of human rights has exceptional significance in social work, and this is equally true in social assessment activity.
Social assessment activity is an area in which social workers make decisions about the needs of people with severe disabilities. The social worker should be guided by the principles of Christian humanism, should act in accordance with the social worker’s ethical code, defend the human rights and freedoms of socially weaker individuals, and act fairly, in line with moral and ethical principles.
In view of the current relevance of this issue—the reform of social assessment activity—we point to certain principles that should form part of social assessment activity, focusing especially on the area of human rights. Fair assessment has a substantial impact on the quality of life of the assessed person; therefore this activity requires a qualified expert in assessment practice.
Human rights in social work and in assessment practice
The social work profession is closely connected with human rights because it recognizes basic values such as social justice, respect, human dignity, and self-determination. The significance of human rights in social work is indisputable. Through them, every individual can live fully and with human dignity.
From a philosophical perspective, the work of a social worker can be characterized as a love of wisdom and the search for truth. In work with a client, the social worker encounters not only another person, his or her problems and their solutions, but also themselves. They represent society and should strive to be a moral authority. They represent a mediator between the client and society; however, the most important element in social work is to recognize in oneself, and also in the client, a person worthy of respect, dignity, and trust. One’s attitude toward oneself determines one’s attitude toward another person, as well as toward society and humanity as a whole (Glasová, 2008).
Respecting fundamental rights and freedoms is the foundation of a modern democratic and constitutional state. Respect for and guarantee of human rights is a duty of the state. The individual has the right to require the state to respect and protect their rights.
The Universal Declaration of Human Rights of 1948 is one of the most important sources of economic, social, and cultural rights. In Article 22 it recognizes the right to social security, and in Article 25 the right to an adequate standard of living. Article 7 recognizes equality before the law and the right of everyone to protection from any discrimination.
The European Social Charter protects economic, social, and cultural rights; Article 12 regulates the right to social security. The Charter is linked to the European Convention on Human Rights, which primarily protects civil and political rights. The economic, social, and cultural rights set out in international and regional human-rights documents are legally binding. Contracting parties, that is, states, have a legal obligation to respect, protect, and realize these rights (Hetteš, 2015).
The Charter of Fundamental Rights of the European Union in Article 34 recognizes and respects the right to social security and the right to social assistance. Article 20 of the Charter regulates equality before the law, and Article 21 prohibits any discrimination for various reasons, including disability.
Basic rights and freedoms are also regulated in the second chapter of the Constitution of the Slovak Republic. According to Article 12(1) of the Constitution of the Slovak Republic, "People are free and equal in dignity and in rights. Basic human rights and freedoms are inalienable, nontransferable, nonprescriptible, and nonrevocable." The principle of equal treatment is regulated in Article 12(2), where it is stated that rights and freedoms are guaranteed to all without regard to various grounds. Although disability is not explicitly regulated there, from the phrase "other status" one can infer that this term also includes disability.
The Convention on the Rights of Persons with Disabilities was adopted by the UN General Assembly in 2006. In 2010, this Convention was ratified by the Slovak Republic and therefore became a legally binding document that has priority over our laws. The purpose of the Convention on the Rights of Persons with Disabilities under Article 1 is “to promote, protect, and ensure the full and equal enjoyment of all rights and fundamental freedoms by all persons with disabilities and to promote respect for their inherent dignity.”
Article 5 regulates equality and non-discrimination, stating that all persons are equal before the law and before the law. In Article 5(2), it states that any discrimination based on disability is prohibited and effective legal protection from discrimination for any reason is guaranteed.
The prohibition of discrimination is also regulated in Act No. 365/2004 Coll. on equal treatment in certain areas and protection against discrimination, and on amending and supplementing certain laws (the Anti-Discrimination Act). This law directly establishes discriminatory grounds, regulates various concepts such as direct discrimination, indirect discrimination, and others.
According to §2a(2), direct discrimination is an act or omission in which a person is treated less favorably than another person is, has been, or could be treated in a comparable situation. Indirect discrimination is regulated in paragraph 3, according to which indirect discrimination is an outwardly neutral regulation, decision, or instruction that disadvantages, or may disadvantage, a person compared to another person. The principle of equal treatment does not only mean a prohibition of discrimination, but also that it is necessary to ensure that discrimination never occurs, that is, to implement preventive measures to prevent discrimination. Under the anti-discrimination law, everyone also has the right to protection from discrimination and the right to pursue legal protection in court.
Among the basic principles of approaching a person with a disability are respect for the client’s autonomy, their uniqueness, acceptance, humanity, doing good, nonjudgmental attitude, non-harm, and fair treatment.
The issue of human rights in Act No. 448/2008 Coll. on social services is found in Appendix No. 2 of the law, where the conditions for the quality of social services provided are regulated. In addition, the entire Social Services Act is based on human-rights obligations.
Human-rights obligations are also included in different international documents and national programmes, such as the National Priorities for the Development of Social Services 2021–2030. At the local government level, we can mention documents such as the concept for the development of social services prepared by higher territorial units and community plans at the municipal and village level. These obligations consist of ensuring that people with disabilities can lead a free, independent life and that their full inclusion in society is ensured.
The Slovak Republic has committed itself to a human-rights-based approach and must ensure conditions for a free, independent life, especially for people with severe disabilities who are dependent on the help of others.
Independent living is regulated in Article 19 of the Convention on the Rights of Persons with Disabilities. This article requires state parties to recognize equal rights for all persons with disabilities to live in the community on an equal basis with others. It regulates the rights of persons with disabilities and their full inclusion and participation in society.
In Act No. 447/2008 Coll. on financial compensation benefits for severe disability, independent living is manifested mainly through the personal assistance allowance, which is the basic tool for ensuring independent living. Personal assistance is a human right.
Every human being has the right to participate in society, to be an equal partner, to decide about one’s own life, to engage in various activities according to one’s own choice. No one may be restricted in where, how, or with whom they want to live, as all human beings are equal in dignity and rights. It is also necessary to ensure their access to services and to necessary assistive aids and to avoid their segregation and isolation in society.
Support for social inclusion
The most important international document regulating integration into society is the Convention on the Rights of Persons with Disabilities, which in Article 3, among its general principles, lists respect for inherent dignity, independence, non-discrimination, and full and effective participation and inclusion in society, among others. Then in Article 19 of the Convention, independent living and inclusion in society are regulated, which recognizes the equal right of all persons with disabilities to live in the community on an equal basis with others.
In addition to international documents, protection of the rights of persons with disabilities and their integration is also regulated within the European Union. The Charter of Fundamental Rights of the European Union, adopted on 7 December 2000 and amended on 12 December 2007, did not originally have the status of a primary source of Union law, until the Lisbon Treaty brought this change. The Charter of Fundamental Rights of the European Union is therefore also among the primary sources of European law, where Article 26 regulates integration of persons with disabilities as follows: “the Union recognizes and respects the right of persons with disabilities to use measures designed to ensure their independence, social integration, integration into employment, and participation in social and cultural life.”
Integration of persons with disabilities is also regulated in various documents at national level. One such document is the National Programme for the Development of Living Conditions for Persons with Disabilities for 2021–2030 and many others. However, it should be pointed out that integration of people with severe disabilities into society will not be possible until the state ensures suitable conditions and access to services, until all barriers—both physical and psychological—are removed in society and in people, and until people with severe disabilities have the same chance of integrating into society on an equal basis as others. It is precisely here that compensation for the social consequences of disability plays an important role; through these measures, persons with severe disabilities can become equal partners. A modern democratic society is only a society that accepts all human rights, including the right to integration, where all people have equal access to services and where there are no differences.
In the past, both generally and in assessment practice, a medical approach predominated that viewed people mainly as patients, and viewed disability as an illness to be treated. In the medical model, terms such as illness, diagnosis, patient, treatment, care, and incapacity dominated. The medical model of social work represents the orientation of social workers toward health in the context of social work. In medical-oriented social work, in the past, the social worker worked with a client-patient and his or her environment, and was understood as part of the treatment process. The social worker considered themselves as the person allowed to find answers to problems arising from social-system dysfunction. In the classical (medical) model, in addition to the term social case used to refer to an individual or family, we also encountered the term patient. The medical model emphasized the importance of three basic elements of social work—treatment, prevention, helping—but it was oriented mainly toward two components: treatment and helping. The term medical social work is now replaced by the term biomedical discourse in social work. Health is seen as the desirable state of integration of psychosocial factors affecting the individual. The biomedical discourse emphasizes that, unlike the classical medical approach, contemporary social work can be characterized as social work in the service of health (Levická, 2016).
The social model focuses primarily on the person and only then on the disability. The words most often used in the social model are ability, need, rights, difference, and capacity.
The bio-psycho-social model was developed by the World Health Organization and provides a holistic view of different aspects of health. It is a combination of the previous two models. The modern approach to disability views people as being disabled primarily by society, rather than by their own bodies.
A modern approach in social work is based on a humanistic perspective and should be an equal partnership relationship. This also applies to social assessment activity, where we work primarily with a person with a particular disadvantage. Every human being deserves respect and recognition; the state is obliged to fulfill commitments it has undertaken in various international documents. A person with severe disability, dependent on another person’s help and who seeks integration into society, also needs state support, for example in the form of compensation benefits or by providing the necessary social services.
The philosophy of independent living brings a different approach to meeting the needs of persons with disabilities. It is based on the assumption that a basic need of every human being is the desire for an independent and meaningful life. Independent living leads to the achievement of equality.
Just as people without disabilities, people with severe disabilities also want to live with dignity. They want their own family and home, they need people around them to whom they belong, they need love and security, recognition, and peace. Yet to meet basic life needs they need more than people without disabilities—they need the help of another person, and in some cases, additional aids that allow them to live similarly to other people.
Integration into society, up to inclusion, is a basic human right of every person. In assessment one should proceed from a holistic understanding that views the person as a whole bio-psycho-socio-spiritual being with individual needs. It is important to guarantee everyone the right to preserve human dignity and equal opportunities. Only through the gradual removal of all barriers—both physical and psychological—can we achieve full participation in society.
Social assessment activity
Social assessment activity is the activity whose goal is to support the social inclusion of persons with disabilities, and it involves assessing the individual circumstances of a person with severe disability, the family environment, and the broader environment influencing their inclusion into society.
The term social assessment activity is explicitly used only in the legislation on social services and financial compensation for severe disability, for persons who, because of severe disability, long-term adverse health condition, or older age, are dependent on personal help from another person (Repková, 2022).
In social services, we speak of providing help to address adverse health status due to severe disability, long-term adverse health status, or retirement age. Regarding compensation for severe disability, it concerns disability that a person has as a result of severe disability, including the provision of monetary allowances to compensate, issuance of a severe-disability person card, and a parking permit.
Under § 48 of Act No. 448/2008 Coll. on social services, assessment activity means medical and social assessment activity. Through assessment activity, dependence of a person with severe disability or adverse health status on a social service in an institution for persons who are dependent on the help of another person and on home care service is determined.
Under § 10 of Act No. 447/2008 Coll. on financial compensation for severe disability, assessment activity is both medical assessment activity and social assessment activity. Severe disability for the purposes of this law is a disability with a functional impairment rate of at least 50%.
Attempts to reform assessment activity have been a topic in the professional public sphere for several years. In 2022, concrete activities in this area began, mainly focusing on unifying social assessment activity. Under § 46 of Act No. 219/2014 Coll. on social work and conditions for exercising certain professional activities in social affairs and family matters, and on amending and supplementing certain laws, social workers had to meet by 31 December 2023 the requirement of a specific qualification for professional competence for specialized professional activities as set out in Government Decree No. 5/2016 Coll., according to which social assessment activity is a specialized professional activity. The amendment Act No. 116/2023 Coll. changed this, in that fulfillment of the professional competence requirement is considered met for up to four years from the date of performance of specialized professional activity, and for social workers already performing this work, this period expires on 31 December 2027. Under § 5(2) of the Social Work Act, the specific qualification for carrying out social assessment activity is the completion of an accredited specialized educational program in social assessment activity.
The goal of social assessment reform is to create an effective and unified assessment system, where assessments under the Social Services Act and the Act on compensation allowances will be carried out by labour, social affairs, and family offices. The assessment is to be comprehensive, digitization of assessment activity is to be introduced, and assessment is to be more efficient due to better financing of assessment physicians, while the requirement of professional qualifications for medical assessment activity was removed (Repková, 2022).
With regard to digitalization of assessment activity and the use of the e-health system and public registries in assessments, it will be necessary to amend several laws, including, for example, Act No. 576/2004 Coll. on health care, services associated with the provision of health care. Because of shortages of assessment physicians and a growing number of clients, the law removed the need for qualification requirements for medical assessment activity. The question arises whether removing this requirement alone will be enough to ensure assessment quality, as in previous practice the issue of assessment physicians was often a subject of debate and it was argued that an appeal against a medical assessment cannot be filed and there is no oversight of assessment physicians, while personal accountability lies with competent actors. For this reason, this area can become ineffective and easily subject to abuse. Persons with severe disabilities belong to groups the law is meant to protect, but when an incorrect assessment results in non-compliance with their health status or when an unlawful assessment is issued, conditions for defense are extremely difficult. Appeals and subsequent enforcement of legal entitlements often end up in court disputes, which are costly and lengthy because such proceedings can last several years, while support must be provided promptly given the situation and need for support. Various documents, whether national or international, guarantee the right to full inclusion in society and non-discrimination, yet these persons nevertheless have weak protection when unequal treatment occurs.
A crucial issue is assessment by the assessment physician, because at present most assessment outcomes are based solely on the medical report. It must be stressed that such assessment is insufficient, as the law still provides a combined assessment consisting of medical/health and social assessment activity, and only their results together should form a comprehensive assessment of dependence on a social service. It is important that the result reflects the actual state of affairs, which forms the basis for every decision. A decision is lawful if it meets all procedural requirements, and it is crucial that the principle of material truth be observed. If a decision is issued where this principle is not observed, such a decision is unlawful and grounds for remittal for renewed proceedings.
Fedorová (2019) also underlines the importance of evidentiary proceedings, noting that evidence in severe disability matters cannot be reduced simply to an assessment of a participant’s health condition by the assessment physician. She also cites the judgment of the Supreme Court of the Slovak Republic, case No. 1Sžso 6/2015 of 28 June 2016, where it is clearly stated that labour, social, and family offices must resolve whether the basis for preparing a comprehensive assessment was complete, objective, and convincingly reasoned; if not, the comprehensive assessment must be supplemented and contradictions resolved. A medical assessment does not represent and cannot represent the only basis for a decision under Act No. 447/2008 Coll.
Regarding medical assessment activity, one may also refer to the judgment of the Supreme Court of the Slovak Republic, case No. 1Sžso/32/2013 of 15 April 2014, which also points out that “although Act No. 447/2008 Coll. allows medical assessment activity, mainly for the purpose of evaluating and assessing health status, its changes, and disorders requiring disability in an individual, this does not authorize, under Article 152(4) of the Constitution for the defendant, to refrain from, or even to forgo, a detailed analysis of established conclusions in its decision, including explaining why it did not consider the plaintiff’s objections, or why the conclusions contained in the comprehensive assessment satisfy the criterion of reliably established facts in the sense of the cooperative search for material truth in administrative proceedings (§ 3(2) and 4 of the Administrative Procedure Code)... The Supreme Court cannot support the defendant’s position that expert physicians are not entitled to express their opinion on the type and method of compensation according to their medical specialization. In this respect, the Supreme Court points to the role of expert opinions of attending physicians in this case with recommending conclusions, which the defendant did not accept in its decision and did not address, even though case law places emphasis on such opinions.”
As also follows from the above findings, from the number of court proceedings, from the number of appeals before second-level administrative authorities, and from the author’s own experience, contradictions frequently arise in assessment activity, resulting in unlawful decisions being issued. Certain steps would need to be taken to increase overall expertise, and perhaps to introduce control or supervision in this field as well, so that we can reduce unlawful decisions in the future.
Modern society fully recognizes persons with severe disabilities as equal persons and their full integration into society. Their rights are guaranteed by several laws, and at the same time, no real progress has been made toward allowing them to enforce these rights more effectively, which, besides other documents, are also guaranteed by the Constitution of the Slovak Republic, to which the state has committed itself to recognize and fully respect.
If we amend laws and seek to achieve effective and fair assessment that is person-centered, a question then arises as to whether unifying assessment activity will be enough, and whether effective monitoring mechanisms should not also be introduced concerning assessment physicians and overall assessment activity.
The Convention on the Rights of Persons with Disabilities guarantees persons with disabilities equal rights and the right to independent life. Yet this area of assessment activity needs to be regulated so that misuse of this activity can never happen, and so that persons for whom severe disability makes self-advocacy difficult do not have to fight for several years for basic benefits that would enable them to secure independent living and participation in society on an equal basis with others.
The obligations arising from the UN Convention on the Rights of Persons with Disabilities are based on a human-rights approach. In it, disability is not approached as a fixed status determined by the presence of a medical diagnosis but as the result of interactions between an individual and barriers in societal attitudes and the environment that limit a person’s participation in social life on an equal basis with others. A human-rights approach in assessment activity must be based on respect for the principles of dignity, autonomy, and independence, the assessed person’s right to choice, non-discrimination and equal opportunities, respect for human diversity and humanity. In assessment activity, the rights of the assessed person, their views, will, and preferences for solutions must be respected. The process and outcomes of assessment activity must be fair and respect the physical and psychological integrity of persons with disabilities, without any signs of mistreatment. Social aspects of assessment activity are anchored in respect for the human right to live independently and inclusively in the community, to which all support and assistance is provided (Repková, 2022).
The state also secures social rights in line with the Universal Declaration of Human Rights. The state assumes obligations and duties under international law to realize, respect, and protect human rights. The obligation to realize means that the state must take all measures to facilitate the exercise of human rights. Human rights and social justice are the foundation of social work and social policy. Responsibility for implementing social policy lies primarily with the Ministry of Labour, Social Affairs and Family of the Slovak Republic.
CONCLUSION
The aim of our contribution was to point to the fundamental human rights and freedoms that are the basis of assessment activity, paying particular attention to social assessment activity. We pointed to certain core documents in which the right to independent living and equal treatment is guaranteed and that the state must ensure they are respected.
We outlined some areas for unifying assessment activity, and we raised questions as to whether such an amendment would be effective in relation to persons with disabilities, since problems in this area arise precisely from the fact that assessment activity is non-unified and fragmented, and its quality is often contested in court proceedings.
In our view, greater attention should also be paid to the protection of the rights of persons with disabilities, especially regarding targeting and to prevent abuse on the other side as well in assessment activity, where the very people who should be protected and treated equally can be easily harmed.
Author: PhDr. Bc. Mária Szegfüová Vysoká škola zdravotníctva a sociálnej práce sv. Alžbety v Bratislave - doktorandka. Univerzita Komenského – právnická fakulta, Bratislava. Author works as a social worker, lecturer, and supervisor. She dedicates her scientific and professional work to themes of human rights, justice, public administration, social policy. She has long pointed out the problems of integration and the application of the Convention on the Rights of Persons with Disabilities.
List of bibliographic references
Convention on the Rights of Persons with Disabilities. 2010. [online]. Oznámenie Ministerstva zahraničných vecí Slovenskej republiky no. 317/2010 Z. z. 2010. [cit. 2023-02-23]. Available at: https://www.slov-lex.sk/pravne-predpisy/SK/ZZ/2010/317/
FEDOROVÁ, K. 2019. Ochrana práv osôb so zdravotným postihnutím. Bratislava: Wolters Kluwer SR s.r.o., 2019. 128 s. ISBN 978-80-571-0027-0.
GLASOVÁ, K. 2008. Filozofia v praxi sociálneho pracovníka. Bratislava: Vysoká škola zdravotníctva a sociálnej práce Sv. Alžbety, n. o., 2008. 116 s. ISBN 978-80-89271-44-3.
Charter of Fundamental Rights of the European Union 2016. [online]. Official Journal of the European Union. (2016/C 202/02) [cit. 2023-02-21]. Available at: https://eur-lex.europa.eu/legal-content/SK/TXT/PDF/?uri=CELEX:12016P/TXT&from=LT
HETTEŠ, M. 2015. Ľudské práva a sociálna ochrana v sociálnej práci. Bratislava: Vysoká škola zdravotníctva a sociálnej práce sv. Alžbety, 2015. 242 s. ISBN 978-80-8132-128-3.
LEVICKÁ, J. 2016. Teoretické východiská sociálnej práce. Trnava: Fakulta zdravotníctva sociálnej práce. 2016. 88 s. ISBN: 978-80-8082-962-9.
Government Decree No. 5/2015 Z. z. Government Decree of the Slovak Republic implementing certain provisions of Act No. 219/2014 Z. z. on social work and conditions for performing certain professional activities in social affairs and family matters and on amendments to certain laws.
REPKOVÁ, K. 2022. Sociálna posudková činnosť. Bratislava: Inštitút pre výskum práce a rodiny, 2022. 132 s. ISBN 978-80-7138-179-2.
Judgment of the Supreme Court of the Slovak Republic, file No. 1Sžso/32/2013 of 15.4.2014
SZEGFÜOVÁ, M. 2023. The significance of human rights and freedoms in social assessment activities In MAZUR, S. - CINTULOVÁ, L. - BRÉDOVÁ, S. 2023. Research studies and theoretical analysis of the actual problems in multidimensional sphere. Kraków: SAE, 2023. ISBN 978-83-65547-22-4. p. 101-116.
Universal Declaration of Human Rights 1948. [online]. New York. [cit. 23.02.2023]. Available at: https://www.ustavnysud.sk/documents/10182/992240/DE01_48.pdf/0d4bbd21-2476-4881-a7b3-145f72f2564b
Act No. 219/2014 Z. z. on social work and conditions for the exercise of certain professional activities in social matters and family affairs and on amendments and supplements to certain laws.
Act No. 365/2004 Z. z. on equal treatment in certain areas and protection from discrimination and on amendments and supplements to certain laws (anti-discrimination act).
Act No. 447/2008 Z. z. on financial allowances for compensation for severe disability and on amendments and supplements to certain laws.
Act No. 448/2008 Z. z. on social services.
Constitution of the Slovak Republic No. 460/1992 Zb.