Human Rights and
Palliative Care: A Primer
Kiera Hepford
Open Society Foundations
Costing for Change Seminar
Brasov, Romania
October 26th - 28th, 2011
International Palliative Care Initiative:
Open Society Foundations
Palliative Care Initiative

To serve as a catalyst to create
palliative care as an essential aspect of
health care policy and to build capacity
for palliative care services, education,
and advocacy around the world.
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Human Rights have at their core the
recognition that all human beings have
an equal moral worth and inherent
dignity
Every individual has the right to the
highest attainable standard of health
Ukraine 1.78
mg / capita
≈ 81 kg
www.equalpartners.info
“Please , do not make us suffer
anymore…….”
Access to Pain Treatment as a Human Right (2009)
http://www.hrw.org/en/reports/2009/03/02/please-do-notmake-us-suffer-any-more
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
Rights



1948: Universal Declaration of Human
Rights
International Covenant on Civil and
Political Rights
International Covenant on Economic,
Social and Cultural Rights
International Covenant on Civil and
Political Rights

Article 7: “No one shall be
subjected to torture or to cruel,
inhuman, or other degrading
treatment or punishment”
International Covenant on Economic,
Social and Cultural Rights

“That all States are obligated to
respect the right to health by
refraining or denying or limiting access
for all persons … and to preventative
curative and palliative care
services”
International Covenant on Economic,
Social and Cultural Rights


“Access to ‘essential drugs’ as defined
by the WHO”
Includes opioids, specifically morphine
Committee on Narcotic
Drugs
Calls upon member states to fulfill
reporting obligations to INCB
Encourages member states to educate
regulators and healthcare
professionals on medical use of
narcotic drugs
1961 Single Convention
on Narcotic Drugs


“Narcotic drugs indispensible for the
relief of pain and suffering”
Calls for a balanced approach to
ensure availability for medical needs
while preventing diversion
Committee on Narcotic
Drugs

Resolution Passed in March 2010:
“Promoting adequate availability of
internationally controlled licit drugs for
medical and scientific purposes while
preventing their diversion and abuse”
Committee Against Torture

Monitors States compliance with the
Convention against Torture and Other
Cruel, Inhuman or Degrading
Treatment or Punishment
Committee Against Torture

Reviews and considers Member States
reports

Considers Individuals Complaints

Investigates Member States
International Statements by
the Palliative Care Community

Cape Town Declaration (2002)

Korea Declaration (2005)

Montreal Statement on the Access
to Pain Management as a
Fundamental Human Right (2005)
Council of Europe Recommendation 24
“Organization of Palliative Care”
12 November 2003

Palliative care needs further development

Insufficient availability of opioids

Governments should identify legal barriers

Legislation should make opioids available

Fear of abuse should not hinder access
Pain & Policy Studies Group/World Health Organization Collaborating Center, 2004
WHO Access to Essential Medicines
Program

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Created an office for controlled
substances as essential medicines
Appointed Willem Scholten as program
director
To improve access for opioid drugs in
low and medium resource countries
WHO Access to Essential Medicines
Program for Controlled Substances

Recently published (2011) new policy
guidelines to ensure balance on controlled
substances for that acute pain, chronic pain
in cancer and HIV/AIDS, chronic nonmalignant pain and pediatric pain
IAHPC List of Essential
Medicines

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34 medications are listed
14 medications currently on the
existing WHO Essential List
United Nations Special Rapporteur on the
Right to the Highest Attainable Standard of
Health

Dr. Paul Hunt, Former Special Rapporteur,
strongly supports palliative care as a human
rights issue at the UN Human Rights Council in
March, 2008, he said “Many other human rights
issues need urgent attention such as palliative
care.”
UN General Assembly
65th Session August 2010

Anand Grover, Special Rapporteur on
the Right to Health at the request of
the Human Rights Council
Submitted a report recommending “that
human rights be integrated into the
international response to drug
control…”
UN General Assembly
65th Session August 2010

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“increase access to controlled
medicines.”
“Many countries have failed to adapt
their drug control systems to ensure
adequate medication supply…
constitutes an ongoing infringement of
the right to health.”
Pain Treatment and the Right to be Free
from Cruel, Inhuman and Degrading
Treatment

UN Rapportuer on Torture, Cruel,
Inhuman and Degrading Treatment
and Punishment noted that
“government failure to take measures
to ensure accessibility of pain
threatens this fundamental right”
- Professor Manfred Nowak
Updated Edition 2011
http://www.euro.who.int/en/what-wepublish/abstracts/palliative-care-for-older-people-betterpractices
UN General Assembly 2nd Session
Working Group on Ageing
August 2011

Formed to strengthen better care for
older persons
– Develop health policies, including
increased access to palliative care and
access to medicines
Human Rights Council

Established in 2006 to monitor
Member States compliance and
violation of human rights obligations
- Universal Periodic Review
- Shadow Reports
- Complaints Procedures
Human Rights Council
15th Session, September 2010
Reference to CND resolution from
March 2010 that underscored the need
to promote access to controlled licit
substances for medical purposes.

Human Rights Council
Geneva - June 2011
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Side Meeting Co-Sponsored by the
Permanent Mission of Brazil
Keynote Speaker - Professor Dr.
Tabaré Vázquez, former President of
Uruguay
IAHPC, APCA, Pallium India, HRW
– UNAIDS, HelpAge International, WPCA
Human Rights Council
Realization on the Right To Health of
Older Persons
2011

High Commissioner for Human Rights,
Navi Pillay:
“Health lies at the heart of all human
rights issues when we age.”
“Adequate access to palliative care is
essential to ensure that these people (older
persons) can live, and ultimately die, with
dignity.”
UN High Level Meeting
Non-Communicable Diseases
New York, 2011

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Reaffirmed the right to the highest
attainable standard of health
National policies strengthen health
systems that support the development
of resources for the provision of
palliative care
Strategies for the
Advancement of Palliative
Care as a Human Right

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Submission to the office of the Special
Rapporteur to the UN Human Rights
Commission on the Right to Health
Partner with human rights
organizations to become involved in
advocacy for palliative care
Strategies for the
Advancement of Palliative
Care as a Human Right

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Use current declarations (Cape Town,
Korea) as advocacy tools
Contact WHO regional or country
office to request technical assistance
in starting the development of policies
and practices
Strategies for the
Advancement of Palliative
Care as a Human Right
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Contact national pain society
Contact national medical and nursing
associations
Contact international, regional, and
national palliative care associations
Conclusion
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Palliative care and pain relief has a
foundation in international human
rights law
Increasing recognition among
palliative care and human rights
organizations
New policies and regulations are being
developed and integrated