Human Rights and Human Rights and Palliative Care: A Palliative Care: A PrimerPrimer

Kiera Hepford Kiera Hepford Open Society FoundationsOpen Society Foundations

Costing for Change Seminar Costing for Change Seminar Brasov, Romania Brasov, Romania

October 26October 26thth - 28 - 28thth, 2011, 2011

International Palliative Care International Palliative Care Initiative: Open Society Initiative: Open Society

FoundationsFoundations

Palliative Care InitiativePalliative Care Initiative

To serve as a catalyst to create To serve as a catalyst to create palliative care as an essential palliative care as an essential aspect of health care policy and to aspect of health care policy and to build capacity for palliative care build capacity for palliative care services, education, and advocacy services, education, and advocacy around the world. around the world.

Human Rights have at their core Human Rights have at their core the recognition that all human the recognition that all human beings have an equal moral worth beings have an equal moral worth and inherent dignity and inherent dignity

Every individual has the right to Every individual has the right to the highest attainable standard of the highest attainable standard of healthhealth

Ukraine 1.78 mg / capita

≈ 81 kg

Ukraine 1.78 mg / capita

≈ 81 kg

www.equalpartners.info

Access to Pain Treatment as a Human Right (2009)

http://www.hrw.org/en/reports/2009/03/02/please-do-not-make-us-suffer-any-more

“Please , do not make us suffer anymore…….”

Global State of Pain Treatment

Access to Palliative Care as a Human Right (2011)

http://www.hrw.org/reports/2011/06/02/global-state-pain-treatment-0

International Bill of International Bill of RightsRights 1948: Universal Declaration of 1948: Universal Declaration of

Human RightsHuman Rights

International Covenant on Civil International Covenant on Civil and Political Rightsand Political Rights

International Covenant on International Covenant on Economic, Social and Cultural Economic, Social and Cultural RightsRights

International Covenant on Civil International Covenant on Civil and Political Rights and Political Rights

Article 7: “No one shall be Article 7: “No one shall be subjected to torture or to subjected to torture or to cruel, inhuman, or other cruel, inhuman, or other degrading treatment or degrading treatment or punishment”punishment”

International Covenant on International Covenant on Economic, Social and Cultural Economic, Social and Cultural

RightsRights

““That all States are obligated to That all States are obligated to

respect the right to health by respect the right to health by

refraining or denying or limiting refraining or denying or limiting access access

for all persons … and to for all persons … and to preventative preventative

curative and curative and palliative care palliative care servicesservices””

International Covenant on International Covenant on Economic, Social and Cultural Economic, Social and Cultural

RightsRights

““Access to ‘essential drugs’ as Access to ‘essential drugs’ as defined by the WHO” defined by the WHO”

Includes opioids, specifically Includes opioids, specifically morphinemorphine

Committee on Narcotic Committee on Narcotic DrugsDrugs

Calls upon member states to fulfill Calls upon member states to fulfill reporting obligations to INCBreporting obligations to INCB

Encourages member states to Encourages member states to educate regulators and educate regulators and healthcare professionals on healthcare professionals on medical use of narcotic drugsmedical use of narcotic drugs

1961 Single 1961 Single Convention on Convention on Narcotic DrugsNarcotic Drugs

““Narcotic drugs indispensible for Narcotic drugs indispensible for the relief of pain and suffering” the relief of pain and suffering”

Calls for a balanced approach to Calls for a balanced approach to ensure availability for medical ensure availability for medical needs while preventing diversion needs while preventing diversion

Committee on Narcotic Committee on Narcotic Drugs Drugs

Resolution Passed in March 2010:Resolution Passed in March 2010:

“ “Promoting adequate availability Promoting adequate availability of internationally controlled licit of internationally controlled licit drugs for medical and scientific drugs for medical and scientific purposes while preventing their purposes while preventing their diversion and abuse”diversion and abuse”

Committee Against Committee Against Torture Torture

Monitors States compliance with Monitors States compliance with the Convention against Torture the Convention against Torture and Other Cruel, Inhuman or and Other Cruel, Inhuman or Degrading Treatment or Degrading Treatment or PunishmentPunishment

Committee Against Committee Against Torture Torture

Reviews and considers Member Reviews and considers Member States reportsStates reports

Considers Individuals ComplaintsConsiders Individuals Complaints

Investigates Member States Investigates Member States

International Statements by International Statements by the Palliative Care the Palliative Care

CommunityCommunity Cape Town Declaration (2002)Cape Town Declaration (2002)

Korea Declaration (2005)Korea Declaration (2005)

Montreal Statement on the Montreal Statement on the Access to Pain Management as Access to Pain Management as a Fundamental Human Right a Fundamental Human Right (2005)(2005)

Council of Europe Recommendation 24 Council of Europe Recommendation 24 “Organization of Palliative Care” “Organization of Palliative Care”

12 November 200312 November 2003

Palliative care needs further developmentPalliative care needs further development Insufficient availability of opioidsInsufficient availability of opioids Governments should identify legal Governments should identify legal

barriersbarriers Legislation should make opioids availableLegislation should make opioids available Fear of abuse should not hinder accessFear of abuse should not hinder access

Pain & Policy Studies Group/World Health Organization Collaborating Center, 2004

WHO Access to Essential Medicines WHO Access to Essential Medicines ProgramProgram

Created an office for controlled Created an office for controlled substances as essential medicinessubstances as essential medicines

Appointed Willem Scholten as Appointed Willem Scholten as program directorprogram director

To improve access for opioid drugs in To improve access for opioid drugs in low and medium resource countrieslow and medium resource countries

WHO Access to Essential WHO Access to Essential Medicines Program for Controlled Medicines Program for Controlled

SubstancesSubstances

Recently published (2011) new policy Recently published (2011) new policy guidelines to ensure balance on guidelines to ensure balance on controlled substances for that acute controlled substances for that acute pain, chronic pain in cancer and pain, chronic pain in cancer and HIV/AIDS, chronic non-malignant pain HIV/AIDS, chronic non-malignant pain and pediatric pain and pediatric pain

IAHPC List of Essential IAHPC List of Essential MedicinesMedicines

34 medications are listed34 medications are listed 14 medications currently on 14 medications currently on

the existing WHO Essential Listthe existing WHO Essential List

United Nations Special Rapporteur on United Nations Special Rapporteur on the Right to the Highest Attainable the Right to the Highest Attainable

Standard of HealthStandard of Health

Dr. Paul Hunt, Former Special Rapporteur, Dr. Paul Hunt, Former Special Rapporteur, strongly supports palliative care as a strongly supports palliative care as a human rights issue at the UN Human human rights issue at the UN Human Rights Council in March, 2008, he said Rights Council in March, 2008, he said “Many other human rights issues need “Many other human rights issues need urgent attention such as palliative care.”urgent attention such as palliative care.”

UN General AssemblyUN General Assembly6565thth Session August 2010 Session August 2010

Anand Grover, Special Rapporteur Anand Grover, Special Rapporteur on the Right to Health at the on the Right to Health at the request of the Human Rights request of the Human Rights Council Council

Submitted a report recommending Submitted a report recommending “that human rights be integrated “that human rights be integrated into the international response to into the international response to drug control…”drug control…”

UN General AssemblyUN General Assembly6565thth Session August 2010 Session August 2010

““increase access to controlled increase access to controlled medicines.”medicines.”

““Many countries have failed to Many countries have failed to adapt their drug control systems adapt their drug control systems to ensure adequate medication to ensure adequate medication supply… constitutes an ongoing supply… constitutes an ongoing infringement of the right to infringement of the right to health.”health.”

Pain Treatment and the Right to be Pain Treatment and the Right to be Free from Cruel, Inhuman and Free from Cruel, Inhuman and

Degrading TreatmentDegrading Treatment

UN Rapportuer on Torture, Cruel, UN Rapportuer on Torture, Cruel, Inhuman and Degrading Inhuman and Degrading Treatment and Punishment noted Treatment and Punishment noted that “government failure to take that “government failure to take measures to ensure accessibility measures to ensure accessibility of pain threatens this of pain threatens this fundamental right”fundamental right”

- Professor Manfred Nowak- Professor Manfred Nowak

http://www.euro.who.int/en/what-we-publish/abstracts/palliative-care-for-older-people-better-

practices

Updated Edition 2011

UN General Assembly 2UN General Assembly 2ndnd Session Working Group on Session Working Group on

AgeingAgeingAugust 2011August 2011

Formed to strengthen better care Formed to strengthen better care for older personsfor older persons

– Develop health policies, including Develop health policies, including increased access to palliative care increased access to palliative care and access to medicines and access to medicines

Human Rights Council Human Rights Council

Established in 2006 to monitor Established in 2006 to monitor Member States compliance and Member States compliance and violation of human rights violation of human rights obligations obligations

- Universal Periodic Review- Universal Periodic Review

- Shadow Reports- Shadow Reports

- Complaints Procedures- Complaints Procedures

Human Rights Council Human Rights Council 1515thth Session, September 2010 Session, September 2010

Reference to CND resolution from Reference to CND resolution from

March 2010 that underscored the March 2010 that underscored the needneed

to promote access to controlled licit to promote access to controlled licit

substances for medical purposes. substances for medical purposes.

Human Rights Council Human Rights Council Geneva - June 2011Geneva - June 2011

Side Meeting Co-Sponsored by Side Meeting Co-Sponsored by the Permanent Mission of Brazilthe Permanent Mission of Brazil

Keynote Speaker - Professor Dr. Keynote Speaker - Professor Dr. Tabaré Vázquez, former President Tabaré Vázquez, former President of Uruguayof Uruguay

IAHPC, APCA, Pallium India, HRW IAHPC, APCA, Pallium India, HRW – UNAIDS, HelpAge International, UNAIDS, HelpAge International,

WPCAWPCA

Human Rights CouncilHuman Rights CouncilRealization on the Right To Health Realization on the Right To Health

of Older Persons of Older Persons 20112011

High Commissioner for Human High Commissioner for Human Rights, Navi Pillay:Rights, Navi Pillay: “ “Health lies at the heart of all human Health lies at the heart of all human

rights issues when we age.”rights issues when we age.”

““Adequate access to palliative care is Adequate access to palliative care is essential to ensure that these people essential to ensure that these people

(older persons) can live, and ultimately (older persons) can live, and ultimately die, with dignity.”die, with dignity.”

UN High Level Meeting UN High Level Meeting Non-Communicable DiseasesNon-Communicable Diseases

New York, 2011New York, 2011

Reaffirmed the right to the Reaffirmed the right to the highest attainable standard of highest attainable standard of healthhealth

National policies strengthen National policies strengthen

health systems that support the health systems that support the development of resources for the development of resources for the provision of palliative careprovision of palliative care

Strategies for the Strategies for the Advancement of Advancement of

Palliative Care as a Palliative Care as a Human Right Human Right

Submission to the office of the Submission to the office of the Special Rapporteur to the UN Special Rapporteur to the UN Human Rights Commission on the Human Rights Commission on the Right to HealthRight to Health

Partner with human rights Partner with human rights organizations to become involved organizations to become involved in advocacy for palliative care in advocacy for palliative care

Strategies for the Strategies for the Advancement of Advancement of

Palliative Care as a Palliative Care as a Human RightHuman Right

Use current declarations (Cape Use current declarations (Cape Town, Korea) as advocacy toolsTown, Korea) as advocacy tools

Contact WHO regional or country Contact WHO regional or country office to request technical office to request technical assistance in starting the assistance in starting the development of policies and development of policies and practicespractices

Strategies for the Strategies for the Advancement of Advancement of

Palliative Care as a Palliative Care as a Human RightHuman Right

Contact national pain societyContact national pain society

Contact national medical and Contact national medical and nursing associationsnursing associations

Contact international, regional, and Contact international, regional, and national palliative care national palliative care associationsassociations

Conclusion Conclusion

Palliative care and pain relief has Palliative care and pain relief has a foundation in international a foundation in international human rights lawhuman rights law

Increasing recognition among Increasing recognition among palliative care and human rights palliative care and human rights organizationsorganizations

New policies and regulations are New policies and regulations are being developed and integrated being developed and integrated