Post on 30-Jan-2016
description
Access to pain relief as a human right
Human Rights and the UN system
04/22/23 www.palliumindia.org
We thank PPSG
3 weeks of suffering
04/22/23 www.palliumindia.org
The difference that 6 cents worth of morphine made
Single convention 1961
“…It is therefore important that, by
complying with the conventions, national
laws should not impede the use of these
drugs in cancer patients.”
04/22/23 www.palliumindia.org
World Health Organization
Highlights the importance of palliative
care in various documents.
Can they include palliative care in their
biannual collaboration agreements?
04/22/23 www.palliumindia.org
World Health Assembly (WHA) 2012
The decision making body of WHO.
Its recommendation could persuade
WHO to make recommendations on
steps countries could take on drug
regulations, health policy and health
professionals’ education.04/22/23 www.palliumindia.org
WHO Discussion paper -NCDs25 July 2012
Suggested indicator for control of NCDs:
Access to palliative care assessed by
morphine-equivalent consumption of
strong opioid analgesics (excluding
methadone) per death from cancer.
04/22/23 www.palliumindia.org
Commission on Narcotic Drugs (CND)
Resolution E/CN.7/2010/L.6/Rev.1, entitled
“Promoting adequate availability of internationally controlled licit drugs for medical and scientific purposes while preventing their diversion and abuse,” includes the following statement:
04/22/23 www.palliumindia.org
Commission on Narcotic Drugs (CND) Resolution
…invites the (INCB)….to include in its annual report for 2010…information on
the consumption of narcotic drugs and psychotropic substances used for medical and scientific purposes worldwide,
…an analysis of impediments to their adequate availability and actions to be taken to overcome those impediments and,
when available, specific information about the status of and progress made by countries.
04/22/23 www.palliumindia.org
International Narcotics Control Board (INCB)
Main focus:
Prevention of abuse, misuse & diversion
But they have consistently pointed
out the need for improved availability
for medical needs.
04/22/23 www.palliumindia.org
International Narcotics Control Board (INCB) 1995
An efficient national drug control regime
must involve not only a programme to
prevent illicit traffiking and diversion, but
also a programme to ensure the adequate
availability of narcotic drugs for medical
and scientific purposes.
04/22/23 www.palliumindia.org
Human Rights Watch request to INCB 2009
...fact-finding mission to India…tomeet both with relevant government officials and representatives of palliative care organizations, such as the Indian Association of Palliative Care, Pallium India, and other leading palliative care groups.
04/22/23 www.palliumindia.org
United Nations Office on Drugs and Crime (UNODC)
Their discussion paper in 2011 for the
first time mentioned the need for the
need for improved access to opioids.
04/22/23 www.palliumindia.org
UN Committee on Economic, Social and Cultural Rights
It is critical to provide “attention and
care for chronically and terminally ill
persons, sparing them avoidable pain
and enabling them to die with
dignity.”www.soros.org/voices/terminally-ill-freedom-pain-human-right
04/22/23 www.palliumindia.org
UN High Commission on Human Rights
UN’s main human rights body.
Has an interest in rights of the elderly.
04/22/23 www.palliumindia.org
UN Special Rapporteur on Health and Torture
“The de facto denial of access to pain
relief, if it causes severe pain and
suffering, constitutes cruel, inhuman
or degrading treatment or
punishment.”
http://daccessdds.un.org/doc/UNDOC/GEN/G09/103/12/PDF/G0910312.pdf?OpenElement
04/22/23 www.palliumindia.org
UN Special Rapporteur on Health and Torture
“All measures should be taken to
ensure full access and to overcome
current regulatory, educational and
attitudinal obstacles to ensure full
access to palliative care.”http://www2.ohchr.org/english/bodies/hrcouncil/docs/10session/
A.HRC.10.44AEV.pdf
04/22/23 www.palliumindia.org
Right, not charity
Countries are obliged to take steps to ensure that patients have access to palliative care and pain treatment.
Article 12 of the International Covenant on Economic, Social and Cultural Rights
Article 7 of the International Covenant on Civil and Political Rights
04/22/23 www.palliumindia.org
UN Committee on Economic, Social and Cultural Rights
States are under the obligation to respect the right to health by . . . refraining from denying or limiting equal access for all persons . . . to preventive, curative and palliative health services.
http://www.ohchr.org/EN/Issues/Health/Pages/SRRightHealthIndex.aspx
04/22/23 www.palliumindia.org
WHO essential drug list includes 14 palliative medications
Access to essential drugs, as defined
by the WHO Action Programme on
Essential Drugs, is a core obligation of
all countries.
http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.En
04/22/23 www.palliumindia.org
The usual excuses
1. We cannot afford it. We are too poor.
Wrong! It is not a question of cost.In India, oral morphine is available for
Rs. 10/100 mg (2 cents/100 mg)In Uganda, one weeks’ supply of morphine
costs as much as a loaf of bread.
04/22/23 www.palliumindia.org
The usual excuses
1. We cannot afford it. We are poor.2. Denial of pain treatment is not the
only way in which human rights are violated.
04/22/23 www.palliumindia.org
The usual excuses
1. We cannot afford it. We are poor.2. Denial of pain treatment is not the
only way in which human rights are violated.
3. It is not my job.
04/22/23 www.palliumindia.org
The real reason
We can get away with it.
04/22/23 www.palliumindia.org
The real reason:We can get away with it.
The patient and family are weakened,
physically, socially, emotionally and
spiritually, by disease and treatment.
They have no voice;
no collective
bargaining power.
04/22/23 www.palliumindia.org