Access to pain relief as a human right

1. Access to pain relief as a human right Human Rights and the UN system www.palliumindia.org

2. We thank PPSG

3. 3 weeks of suffering The difference that 6 cents worth of morphine made www.palliumindia.org

4. 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.” www.palliumindia.org

5. World Health Organization Highlights the importance of palliative care in various documents. Can they include palliative care in their biannual collaboration agreements? www.palliumindia.org

6. 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. www.palliumindia.org

7. 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. www.palliumindia.org

8. 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: www.palliumindia.org

9. 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. www.palliumindia.org

10. 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. www.palliumindia.org

11. 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. www.palliumindia.org

12. 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. www.palliumindia.org

13. 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. www.palliumindia.org

14. 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 www.palliumindia.org

15. UN High Commission on Human Rights UN’s main human rights body. Has an interest in rights of the elderly. www.palliumindia.org

16. 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 www.palliumindia.org

17. 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 www.palliumindia.org

18. 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 www.palliumindia.org

19. 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 www.palliumindia.org

20. 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 www.palliumindia.org

21. The usual excuses • 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. www.palliumindia.org

22. The usual excuses • We cannot afford it. We are poor. • Denial of pain treatment is not the only way in which human rights are violated. www.palliumindia.org

23. The usual excuses • We cannot afford it. We are poor. • Denial of pain treatment is not the only way in which human rights are violated. • It is not my job. www.palliumindia.org

24. The real reason We can get away with it. www.palliumindia.org

25. 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. www.palliumindia.org