1. Human Rights and Palliative Care: A Primer Kiera Hepford Open Society Foundations Costing for Change Seminar Brasov, Romania October 26 th - 28 th, 2011

2. 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. 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.

3. Human Rights have at their core the recognition that all human beings have an equal moral worth and inherent dignity 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 Every individual has the right to the highest attainable standard of health

5. Ukraine 1.78 mg / capita ≈ 81 kg

6. www.equalpartners.info

7. 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…….”

8. 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

9. International Bill of Rights 1948: Universal Declaration of Human Rights 1948: Universal Declaration of Human Rights International Covenant on Civil and Political Rights International Covenant on Civil and Political Rights International Covenant on Economic, Social and Cultural Rights International Covenant on Economic, Social and Cultural Rights

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

11. International Covenant on Economic, Social and Cultural Rights “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 access refraining or denying or limiting access for all persons … and to preventative for all persons … and to preventative curative and palliative care services” curative and palliative care services”

12. International Covenant on Economic, Social and Cultural Rights “Access to ‘essential drugs’ as defined by the WHO” “Access to ‘essential drugs’ as defined by the WHO” Includes opioids, specifically morphine Includes opioids, specifically morphine

13. 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

14. 1961 Single Convention on Narcotic Drugs “Narcotic drugs indispensible for the relief of pain and suffering” “Narcotic drugs indispensible for the relief of pain and suffering” Calls for a balanced approach to ensure availability for medical needs while preventing diversion Calls for a balanced approach to ensure availability for medical needs while preventing diversion

15. Committee on Narcotic Drugs Resolution Passed in March 2010: Resolution Passed in March 2010: “Promoting adequate availability of internationally controlled licit drugs for medical and scientific purposes while preventing their diversion and abuse” “Promoting adequate availability of internationally controlled licit drugs for medical and scientific purposes while preventing their diversion and abuse”

16. Committee Against Torture Monitors States compliance with the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment Monitors States compliance with the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment

17. Committee Against Torture Reviews and considers Member States reports Reviews and considers Member States reports Considers Individuals Complaints Considers Individuals Complaints Investigates Member States Investigates Member States

18. International Statements by the Palliative Care Community Cape Town Declaration (2002) Cape Town Declaration (2002) Korea Declaration (2005) Korea Declaration (2005) Montreal Statement on the Access to Pain Management as a Fundamental Human Right (2005) Montreal Statement on the Access to Pain Management as a Fundamental Human Right (2005)

19. Council of Europe Recommendation 24 “Organization of Palliative Care” 12 November 2003 Palliative care needs further development Palliative care needs further development Insufficient availability of opioids Insufficient availability of opioids Governments should identify legal barriers Governments should identify legal barriers Legislation should make opioids available Legislation should make opioids available Fear of abuse should not hinder access Fear of abuse should not hinder access Pain & Policy Studies Group/World Health Organization Collaborating Center, 2004

20. WHO Access to Essential Medicines Program Created an office for controlled substances as essential medicines Created an office for controlled substances as essential medicines Appointed Willem Scholten as program director Appointed Willem Scholten as program director To improve access for opioid drugs in low and medium resource countries To improve access for opioid drugs in low and medium resource countries

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

22. IAHPC List of Essential Medicines 34 medications are listed 34 medications are listed 14 medications currently on the existing WHO Essential List 14 medications currently on the existing WHO Essential List

23. 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.” 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.”

24. UN General Assembly 65 th Session August 2010 Anand Grover, Special Rapporteur on the Right to Health at the request of the Human Rights Council 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…”

25. UN General Assembly 65 th Session August 2010 “increase access to controlled medicines.” “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.” “Many countries have failed to adapt their drug control systems to ensure adequate medication supply… constitutes an ongoing infringement of the right to health.”

26. 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” 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 - Professor Manfred Nowak

27. http://www.euro.who.int/en/what-we- publish/abstracts/palliative-care-for-older-people-better- practices Updated Edition 2011

28. UN General Assembly 2 nd Session Working Group on Ageing August 2011 Formed to strengthen better care for older persons Formed to strengthen better care for older persons –Develop health policies, including increased access to palliative care and access to medicines

29. Human Rights Council Established in 2006 to monitor Member States compliance and violation of human rights obligations Established in 2006 to monitor Member States compliance and violation of human rights obligations - Universal Periodic Review - Shadow Reports - Complaints Procedures

30. Human Rights Council 15 th Session, September 2010 Reference to CND resolution from Reference to CND resolution from March 2010 that underscored the need to promote access to controlled licit substances for medical purposes.

31. Human Rights Council Geneva - June 2011 Side Meeting Co-Sponsored by the Permanent Mission of Brazil Side Meeting Co-Sponsored by the Permanent Mission of Brazil Keynote Speaker - Professor Dr. Tabaré Vázquez, former President of Uruguay Keynote Speaker - Professor Dr. Tabaré Vázquez, former President of Uruguay IAHPC, APCA, Pallium India, HRW IAHPC, APCA, Pallium India, HRW –UNAIDS, HelpAge International, WPCA

32. Human Rights Council Realization on the Right To Health of Older Persons 2011 High Commissioner for Human Rights, Navi Pillay: High Commissioner for Human Rights, Navi Pillay: “Health lies at the heart of all human rights issues when we age.” “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.”

33. UN High Level Meeting Non-Communicable Diseases New York, 2011 Reaffirmed the right to the highest attainable standard of health 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 National policies strengthen health systems that support the development of resources for the provision of palliative care

34. Strategies for the Advancement of Palliative Care as a Human Right Submission to the office of the Special Rapporteur to the UN Human Rights Commission on the Right to Health 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 Partner with human rights organizations to become involved in advocacy for palliative care

35. Strategies for the Advancement of Palliative Care as a Human Right Use current declarations (Cape Town, Korea) as advocacy tools 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 Contact WHO regional or country office to request technical assistance in starting the development of policies and practices

36. Strategies for the Advancement of Palliative Care as a Human Right Contact national pain society Contact national pain society Contact national medical and nursing associations Contact national medical and nursing associations Contact international, regional, and national palliative care associations Contact international, regional, and national palliative care associations

37. Conclusion Palliative care and pain relief has a foundation in international human rights law Palliative care and pain relief has a foundation in international human rights law Increasing recognition among palliative care and human rights organizations Increasing recognition among palliative care and human rights organizations New policies and regulations are being developed and integrated New policies and regulations are being developed and integrated