Access to pain relief as a human right

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


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.”


World Health Organization

Highlights the importance of palliative

care in various documents.

Can they include palliative care in their

biannual collaboration agreements?


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.


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:


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.


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.


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.


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.


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.


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


UN High Commission on Human Rights

UN’s main human rights body.

Has an interest in rights of the elderly.


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


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


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


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


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


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.


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.


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.


The real reason

We can get away with it.


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.


Documents

Access to pain relief as a human right