Comments
According to WHO, palliative care improves the quality of life for patients and families coping with life-threatening illnesses, by mitigating pain and other symptoms and providing spiritual and psychological support from the time of diagnosis until the end of life, and through the mourning period.
Essential medicines are considered to be those that cover people’s priority health-care needs. They are selected in light of the prevalence of the diseases they treat and their safety, effectiveness and comparative cost-effectiveness. Existing health systems are supposed to have essential medicines available at all times, in sufficient quantities, in the appropriate pharmaceutical forms, with guaranteed quality, and at a price that is affordable for individuals and the community.
The Inter-American Convention on protecting the human rights of older persons defines palliative care as “active, comprehensive, and interdisciplinary care and treatment of patients whose illness is not responding to curative treatment or who are suffering avoidable pain, in order to improve their quality of life until the last day of their lives. Central to palliative care is control of pain, of other symptoms, and of the social, psychological, and spiritual problems of the older person. It includes the patient, their environment, and their family. It affirms life and considers death a normal process, neither hastening nor delaying it.”
Possible lines of action
1. Create a national programme of palliative care for older persons suffering from a life-threatening illness or one that limits their life expectancy. 2. Devote sufficient economic resources to guarantee the availability and accessibility of essential drugs for pain relief, and better access to technology. 3. Train health workers in issues relating to respect and pain management, and the health consequences of age-based discrimination. 4. Create accessible, fair and safe procedures for handling complaints and imposing penalties on health professionals guilty of discriminating against or disrespecting the dignity of older persons with terminal illnesses. 5. Promulgate and enforce laws and regulations, including health protocols and hospital procedures, that will protect the right to die without pain and with access to modern treatments. 6. Provide psychosocial support to the family to minimize the stress associated with illness and care, and to improve family well-being. 7. Provide the family with information and training regarding the illness so that it can participate more effectively in care, relief and support for the older person. 8. Offer support to family members in coordinating the appropriate services, including financial, medical and legal guidance.
Related instruments, forums and mechanisms
General comment No. 14 of the Committee on Economic, Social and Cultural Rights (2000) on the right to the highest attainable standard of health (article 12 of the Covenant on Economic, Social and Cultural Rights) includes a series of obligations of States parties, such as non-discriminatory access to facilities, goods and services, the supply of essential drugs as defined by WHO, and the adoption and application of a public health strategy. In the context of palliative care, persons with a terminal illness must have access to adequate health care, basic medications for controlling symptoms, and terminal care, and palliative care should be included in national health policies.
The Committee on the Elimination of Discrimination against Women has held, in its general recommendation No. 27 on older women and protection of their human rights, that, with respect to the right to health, States parties must provide medications to treat chronic and non-communicable diseases, long-term health and social care, including care that allows for independent living, and palliative care.
Access to essential medicines, according to the WHO definition, is part of the minimum essential contents of the right to the highest attainable standard of health. The WHO Model List of Essential Medicines currently includes 14 palliative care medications.
In his report of 1 February 2013, the Special Rapporteur on Torture held that governments must guarantee access to essential medicines as part of their minimum core obligations under the right to health, and that the denial of relief from pain and suffering may constitute inhuman and degrading treatment according to the definition in the Convention against Torture.
The San José Charter on the rights of older persons in Latin America and the Caribbean calls for promoting “the development of and access to palliative care to ensure that older persons with terminal illnesses die with dignity and free of pain.”
Article 6 (“Right to life and dignity in old age” ) of the Inter-American Convention on protecting the human rights of older persons establishes that “States Parties shall take steps to ensure that public and private institutions offer older persons access without discrimination to comprehensive care, including palliative care; avoid isolation; appropriately manage problems related to the fear of death of the terminally ill and pain; and prevent unnecessary suffering, and futile and useless procedures, in accordance with the right of older persons to express their informed consent.”
