An Upstream Human Rights Clinic

by Fran Quigley

During the semester they are enrolled in the Health and Human Rights Clinic that I teach at Indiana University McKinney School of Law, students have two core obligations. First, they directly represent individual low-income clients from our community, often in wage theft cases, unemployment appeals, or driver’s license access matters. (A commitment to addressing unmet needs affecting the social determinants of health in the community has led us in some varied and interesting directions . . .)

The students’ second obligation is to engage in policy research and advocacy on matters that affect their clients’ lives. We call this second category of the clinical agenda “upstream” work.

The name comes from an old parable, repeated by Archbishop Desmond Tutu, among others. The parable talks about a community of people living by a river, where one day they see a baby floating down with the current. The baby is on a makeshift, rickety raft, and appears likely to soon be plunged in the water and drown. What is the moral obligation of the people in the riverside community? To go in and rescue the baby, of course.

 But what if the next day brings another baby floating with the current, and the next day yet another? At some point, the parable goes, in the face of repeated suffering and vulnerability, it becomes the duty of the community to go upstream and see what is causing these problems, and to address the cause at its origin.

So our clinic “upstream” projects aim to understand and address the bigger policy issues that are causing our clients to suffer on a daily basis. Some of those project from recent semesters include:

• Research and resulting advocacy arguing that our state Medicaid program should not ration medicine access for Hepatitis C patients
• Research and resulting advocacy arguing for reforms that would increase access to driver’s licenses for low-income persons in our state
• Research and resulting advocacy arguing for reforms that would increase access to dialysis treatment for end-stage renal persons in our state who are undocumented immigrants
• Research and resulting advocacy to improve reporting of sub-standard factory conditions in Haiti
• Research and resulting advocacy in support of increasing the state minimum wage, cracking down on wage theft, and increased access to Medicaid in Indiana under the Affordable Care Act
• Research and resulting advocacy to the U.S. Department of Labor and our state agency to allow lay representation in Indiana administrative hearings determining unemployment benefits
• Research and resulting advocacy to recognize dependent covenants of habitability and rent payment in our state’s landlord-tenant law

The repetition of the phrase “research and resulting advocacy” here is not an accident. Other policy actors have more power (think legislators, campaign donors, media), and others have more familiarity with the policy-making apparatus (think lobbyists and political party activists). But few of these folks have the time and the research skills to truly dig in and put in the thoughtful hours needed to research human rights problems, describe them fully, and review possible solutions.

We have found that our students’ research skills, coupled with the time they are able and willing to put into a “white paper” report or petition or article, provide real value to the community advocates who work on these issues every day. And, of course, that research—coupled with our direct client representation—provides a platform for the students to directly advocate for human rights reforms.

For a law school clinic, upstream work does present administrative challenges. We are a state school, so we have had to be careful never to claim we advocate on behalf of the university at large or the state government—and to communicate clearly with those who do the lobbying for our university. We need to make sure our advocacy never strays anywhere near the non-profit danger zone of supporting political parties or candidates. And working with diverse coalitions of community advocates can lead to disagreements over tactics and even substance.

Yet students engaging in upstream work have the opportunity to develop skills in policy research, writing and advocacy, and to navigate those relationships with community collaborators, often in multidisciplinary settings. In terms of policy awareness, I have found there is valuable micro-plus-macro perspective on human rights that comes with students tackling individual clients’ day-to-day problems at the same time they look carefully at the root causes.

Our students’ work has helped raise awareness about these upstream issues in our community, and we hope we have helped push the movement toward impactful changes. But we count precious few total victories yet.

That need for persistence in policy research and advocacy may be the most valuable lesson of all for the students—and for their professor, too.