McGill Centre for Medicine, Ethics and Law

HUMAN RIGHTS

HUMAN RESPONSIBILITIES HUMAN ETHICS

& PAIN MANAGEMENT

MARGARET SOMERVILLE

AM, FRSC, A.u.A (pharm.), LL.B. (hons), D.C.L., LL.D. (hons. caus.); D.Sc.(hons. caus.); D.Hum.L.(hons. caus.)

RISE UP AGAINST PAIN Canadian Pain Summit

Ottawa April 24, 2012

Copyright©2012Margaret Somerville Not to be copied or cited without permission of the author

• Experiential knowledge important in ethics - many advocates of access to pain management have personal experiences of pain • All “human ways of knowing” important in ethics “examined emotions” moral intuition human memory (history) imagination and creativity as well as reason All tell us it’s wrong to leave someone in pain

2

Asked:

Could ethics and law improve access to pain management? “Death of Pain” (1993 IASP meeting) double entendre message

we could kill the person with the pain or we could kill the pain. I’m adamantly against killing the person with the pain - euthanasia, and passionately in favour of killing the pain.

3

Argued to implement that goal in practice, we should recognize people in pain have a

“fundamental human right” to access to pain management and unreasonable failure to provide such access

is a breach of their human rights.

That is precisely what the Declaration of Montreal agreed to September 2010, establishes.

4

• To understand how the Declaration can help people in pain need to understand some features of human rights. • “Human rights” try to ensure rightness or ethics of our interactions with each other at most basic level of our humanness, at its essence, that which makes us human

• Recognizing human rights is very important in creating moral and ethical societies.

5

We don’t create human rights they exist independently of being recognized by

any human agency. that’s why no one can opt out of respecting them. What we do is articulate human rights. And that’s why human rights statements are called declarations.

6

New declarations, such as the Declaration of Montreal, continue to appear and need to do so. • Suggest “human rights” is shorthand for a tri-partite concept consisting of human rights; human responsibilities; and human ethics. • Sometimes we need to focus on one of these limbs,

sometimes on another, and sometimes on all of them.

7

8

THE RELATION OF HUMAN RIGHTS, HUMAN RESPONSIBILITIES AND HUMAN ETHICS

HUMAN ETHICS A. CONCEPTS:

HUMAN HUMAN RIGHTS RESPONSIBILITIES

B. PRACTICE -

IMPLEMENTATION THROUGH:

APPLIED ETHICS LAW C. GENERAL AREA OF ETHICS/LAW: environ- business professional social public consti- civil family environ- mental ethics ethics welfare int’l tutional liberties law mental ethics ethics law law law D. SPECIFIC AREA OF ETHICS / LAW: E. SPECIFIC ISSUE medical health health & consti-

INVOLVES e.g.: ethics care human tutional ethics rights protection

Declaration of Montreal provides: Finding that pain management is inadequate in

most of the world … And, recognizing the intrinsic dignity of all persons and that withholding of pain treatment is

profoundly wrong, leading to unnecessary suffering which is harmful;

we declare that the following human rights must be recognized throughout the world: 9

Article 1. The right of all people to have access to pain management without discrimination

Article 2. The right of people in pain to

acknowledgment of their pain and to be informed about how it can be assessed and managed

Article 3. The right of all people with pain to have

access to appropriate assessment and treatment of the pain by adequately trained health care professionals

10

IMPACT OF THE DECLARATION OF MONTREAL Human right to access to pain management means healthcare professionals and healthcare institutions have ethical, and sometimes legal, obligations

to offer patients such management. In formally recognizing a human right to access to pain management

Declaration makes it much more likely that right will be respected.

11

Declaration is not just a piece of paper; it’s a “verbal act”, its words change reality, just as a judge’s verdict is not just words,

but changes reality. The hope is the Declaration will help to change the horrible reality of people being left in pain.

The Declaration will also be an ethics guide in relation to pain management; and an educational tool for healthcare professionals and trainees.

12

• Sometimes, it will function as evidence to justify

giving necessary pain relief treatment, when others would prevent that.

• It will help to overcome harmful beliefs of some

healthcare professionals who withhold pain management because they fear legal liability or that patients will become addicted.

• It will deliver a strong message that it’s wrong not to

provide pain management, not wrong to provide it

13

• Declaration will inform and guide institutions and governments in formulating

health policy and law re pain management - politicians no need to fear losing votes for doing so • Help governments understand have both domestic and international obligations not to

unreasonably hinder own citizens’ or other people’s access to pain management. • Outrage and a human tragedy that people in serious pain

in developing countries have no access to opioids because of conditions attached to foreign aid

14

Need to apply the Golden Rule “Do unto others as you would that they would do unto you” to ensure everyone needing pain management

receives it The Declaration of Montreal spells out what those “others” have a human right to expect

when they are in pain.

15

Beautiful Sanskrit salutation “Namaste” roughly translates as: “The Light in me, recognizes the Light in you”. It affirms our common humanity across all barriers and borders. • One important application could be: “The pain in me recognizes the pain in you” – which is another way to express the insight of the “wounded healer”.

16

The Declaration of Montreal helps ensure we all especially healthcare professionals,

recognize others’ pain and see it as our privilege and obligation to do what we can to assuage it.

We need to stand up for the relief of suffering in those badly needing our help, and the DECLARATION OF MONTREAL, that Access to Pain Management is a Fundamental Human Right can help us to do that by implementing it in a CANADIAN PAIN STRATEGY.

17