Transcript Human Rights and the UN system

Access to pain relief as a
human right
Human Rights and the UN system
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We thank PPSG
3 weeks of suffering
The difference that 6 cents
worth of morphine made
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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.”
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World Health Organization
Highlights the importance of palliative
care in various documents.
Can they include palliative care in their
biannual collaboration agreements?
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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.
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WHO Discussion paper -NCDs
25 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.
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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:
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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.
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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.
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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.
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Human Rights Watch request to
INCB 2009
...fact-finding mission to India…to
meet 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.
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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.
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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
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UN High Commission on Human
Rights
UN’s main human rights body.
Has an interest in rights of the elderly.
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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/G
0910312.pdf?OpenElement
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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
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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
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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/SRRightHealthInde
x.aspx
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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
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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.
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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.
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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.
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The real reason
We can get away with it.
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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.
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