Adri Nieuwhof, Human Rights Advocate, and Willem Scholten, Consultant – Medicines and Controlled Substances, Switzerland.
A new United Nations report addresses the denial of pain treatment as an example of abusive practices in healthcare settings. Juan Méndez, Special Rapporteur on torture and other cruel inhuman or degrading treatment or punishment, says that certain abusive practices violate the prohibition on torture and ill-treatment. Furthermore, the UN official reminds States of their obligation to regulate, control and supervise healthcare practices in order to prevent mistreatment.
Until now, the denial of healthcare has mainly been understood as an infringement on the “right to health”. Instead, Méndez looks at abusive healthcare practices through the lens of torture and ill-treatment. Here are some striking observations from his report.
In general, denial of pain treatment follows from neglect and poor government policies. Purely negligent conduct may constitute ill-treatment if it leads to severe pain and suffering. However, it becomes cruel, inhuman or degrading treatment or punishment when a person severely suffers from pain while the State is or can be aware of the suffering and the government failed to take steps to protect the person’s physical and mental integrity. It is torture when the State is involved and there is specific intent.
Governments need to take steps to overcome the obstacles to adequate pain treatment, including overly restrictive drug control regulations and misinterpretation of regulations in drug supply management; inadequate infrastructure; lack of prioritisation of palliative care; ingrained prejudices about using opioids for medical purposes; and the absence of pain management policies or guidelines for practitioners.
Governments must guarantee essential medicines – including opioid analgesics – as part of their minimum core obligations under the right to health, and as a measure to protect people from inhuman and degrading treatment. Moreover, ensuring the availability and accessibility of essential medicines is a legal obligation under the Single Convention on Narcotic Drugs, 1961.
Furthermore, the obligation to prevent torture not only applies to States and their public officials, such as law enforcement agents. It extends to doctors, healthcare professionals and social workers, also those who work in private hospitals, other institutions and detention centres. Moreover, States must investigate, prosecute and redress abusive practices in healthcare settings that meet the criteria of torture.
Méndez recommends States to:
- Adopt a human rights-based approach to drug control as a matter of priority to prevent the continuing violations of rights. Ensure that national drug control laws recognise the indispensable nature of narcotic and psychotropic drugs for the relief of pain and suffering; review national legislation and administrative procedures to guarantee adequate availability of those medicines for legitimate medical uses;
- Ensure full access to palliative care and overcome current regulatory, educational and attitudinal obstacles that restrict availability to essential palliative care medications, especially oral morphine. States should devise and implement policies that promote widespread understanding about the therapeutic usefulness of controlled substances and their rational use.
- Develop and integrate palliative care into the public health system by including it in all national health plans and policies, curricula and training programmes and developing the necessary standards, guidelines and clinical protocols.
UN report gives similar statement as Prague Charter
Access to palliative care – including access to essential medicines – is the core request of the Prague Charter – Palliative care is a human right.
Read more about the Prague Charter.
Please support the Prague Charter by signing the petition and urging governments to relieve suffering and recognise palliative care as a human right.
Look out later this week for a post from Jim Cleary, Pain & Policy Studies Group, University of Wisconsin, describing their latest research study to determine what accounts for the significant disparity in opioid consumption levels among countries.