Ha llegado el momento de reconocer los Cuidados Paliativos como un Derecho Humano The time has come to recognise palliative care as a human right

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Willem Scholten, Especialista – Medicamentos y Sustancias Controladas, y  Adri Nieuwhof, Defensora de los Derechos Humanos, Suiza

Adri Nieuwhof

Adri Nieuwhof

Willem Scholten

Willem Scholten

Los profesionales de la salud y sus organizaciones están promoviendo los Cuidados Paliativos y el acceso al tratamiento del dolor como derechos humanos. Esto queda demostrado en varias declaraciones entre las que se encuentran el Manifiesto de Praga, de la Asociación Europea de Cuidados Paliativos (EAPC); la Declaración de Montreal,  de la Asociación Internacional para el Estudio del Dolor (IASP) y el Manifiesto de la Morfina. Sin embargo, no son reconocidos internacionalmente como derechos humanos debido a que las organizaciones internacionales no gubernamentales (ONGs) no pueden conceder tal reconocimiento; los derechos humanos necesitan el reconocimiento de los Estados.

Así,  “El Derecho de todos a disfrutar del máximo nivel de salud física y mental alcanzable” se halla recogido en el Pacto Internacional sobre los Derechos Económicos, Sociales y Culturales (PIDESC, articulo 12),  en ligeramente distintas palabras en la Constitución de la Organización Mundial de la Salud (OMS),   y también  en los tratados regionales de derechos humanos así como en las constituciones nacionales de más de 115 países. No existe ningún estado que no haya firmado el PIDESC o la Constitución de la OMS y de hecho, más de 150 países firmaron ambas dos. El derecho a la salud  como tal, está en consecuencia firmemente recogido y  generalizado.

Sin embargo, el derecho a la salud está redactado en términos muy generales y sin más concreción. Cada cual puede interpretarlo a su manera. Por ello, el Comité de Naciones Unidas sobre los Derechos Económicos, Sociales y Culturales (CESCR)  ofrecen una definición oficial y acreditada en su Comentario General 14 GC14). .  Desafortunadamente, los Cuidados Paliativos y el acceso al tratamiento del dolor están contemplados en un modo limitado: GC14 menciona el acceso a medicinas esenciales, incluyendo la morfina, y el derecho de los enfermos crónicos y terminales a aliviar el dolor evitable y el derecho a morir con dignidad. El CECSR podría ser requerido a enmendar y extender el GC14, si bien el resultado de tal petición es incierto.

La adopción de una resolución en un cuerpo internacional como la Asamblea Mundial de la Salud (WHA)   es otra vía para profundizar en el Derecho a la Salud. La 67 Asamblea Mundial de la Salud en mayo de 2014 ofrece una excelente oportunidad ya que Los Cuidados Paliativos estarán pronto el orden del día. se discuta una resolución sobre los Cuidados Paliativos”.  Por tanto, debemos instar a los gobiernos para que el Derecho a los Cuidados Paliativos y el Derecho al acceso al Tratamiento del Dolor queden incluidos en tal resolución.

Cada estado debe presentar un borrador de la resolución en la Secretaría de la OMS en noviembre de 2013 para ser presentada al Consejo Ejecutivo de la OMS de enero de 2014. A pesar de todo, no podemos asumir que un borrador de resolución incluya automáticamente el reconocimiento de los Cuidados Paliativos y el acceso al tratamiento del dolor como un Derecho Humano. Los profesionales de la salud de todo el mundo deberán presionar a los Ministerios de Salud y a los diplomáticos que les representen en Ginebra para motivar la inclusión de estos derechos. El Derecho a los Cuidados Paliativos y al acceso al tratamiento del dolor deberían ser igualmente reconocidos para todos, sin importar edad o enfermedad. No debería de ningún modo quedar restringido a los enfermos terminales o moribundos.

Apoya el Manifiesto de Praga 

– por favor, ayúdanos a alcanzar las 10,000 firmas!
Lee más sobre el Manifiesto de Praga Prague Charter QR EAPCwebsite

Por favor, apoya el Manifiesto de Praga firmando esta petición instando a los gobiernos a aliviar el sufrimiento y reconocer los Cuidados Paliativos como un Derecho Humano.Prague Charter QR Avaaz

Traducido al español por Eduardo Garralda. Nuestro agradecimiento a Eduardo Garralda por su trabajo en la traducción de este texto. 

THE TIME HAS COME TO RECOGNISE PALLIATIVE CARE AS A HUMAN RIGHT

Willem Scholten, Consultant – Medicines and Controlled Substances, and Adri Nieuwhof, Human Rights Advocate, Switzerland

Willem Scholten

Willem Scholten

Adri Nieuwhof

Adri Nieuwhof

Palliative care and access to pain treatment are promoted as rights by health care professionals and their organisations. This is shown in several declarations including the Prague Charter of the European Association for Palliative Care (EAPC); the Declaration of Montreal of the International Association for the Study of Pain (IASP) and the Morphine Manifesto. But they are not internationally established human rights, as international non-governmental organisations (NGOs) cannot vest human rights; a human right needs recognition by States.

Indeed, “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” is enshrined in the International Covenant on Economic, Social and Cultural Rights (ICESCR, article 12), in slightly different wording in the Constitution of the World Health Organization (WHO),  and also in regional human rights treaties and the national constitutions of more than 115 countries. There is no State that did not sign either the ICESCR or the WHO Constitution and more than 150 countries signed both. The Right to Health as such is therefore firmly established.

However, the Right to Health is worded in very general terms and without further specification. Everybody can interpret it at his or her own discretion. Therefore, the UN Committee on Economic, Social and Cultural Rights (CESCR) provided an authoritative explanation in its General Comment 14 GC14).  Unfortunately, palliative care and access to pain treatment are addressed here in a limited way: GC14 mentions access to essential medicines, which includes morphine, and the right that chronically and terminally ill persons should be spared avoidable pain and should be enabled to die with dignity. The CECSR could be asked to amend and extend the GC14, however, the outcome of such a request is uncertain.

Adopting a resolution in an international body such as the World Health Assembly (WHA)  is another way to further specify the Right to Health. The 67th WHA in May 2014 offers an excellent opportunity because palliative care will be on the agenda. It is likely that a resolution on palliative care will be tabled for discussion. Therefore governments should now be asked to include the rights to palliative care and access to pain treatment in such a resolution.

A draft resolution needs to be submitted by a State to the WHO Secretariat by November 2013 to be tabled in the WHO Executive Board of January 2014. However, we cannot assume that a draft resolution will automatically include the recognition of palliative care and access to pain treatment as human rights. Health care workers from all around the world will have to lobby the Ministries of Health and the diplomats representing them in Geneva to inspire them to include these rights. The rights to palliative care and to access to pain treatment should be equally vested for all, no matter what their age or ailment. It should not be limited to the terminally ill or the dying.

Support the Prague Charter 

– please help us to reach 10,000 signatures!
Read more about the Prague Charter.Prague Charter QR EAPCwebsite

Prague Charter QR AvaazPlease support the Prague Charter by signing the petition urging governments to relieve suffering and recognise palliative care as a human right.

This entry was posted in ADVOCACY & POLICY, Opioid access and tagged . Bookmark the permalink.

5 Responses to Ha llegado el momento de reconocer los Cuidados Paliativos como un Derecho Humano The time has come to recognise palliative care as a human right

  1. Dear Professors,
    Your words ‘ The right to palliative care should not be limited to the terminal ill or the dying ‘ express a universality in Thought, in Word and Action, because the Total Care is the excellence of Care EveryChild, EveryWoman, EveryMan-in-Pain must receive. The totality of Care within his/her own Individuality, Subjectivity and Humanity, in order to be Cared-Cradled-and-Loved.
    Luisella Magnani
    http://www.luisellamagnani.it

  2. Pingback: The time has come to recognise palliative care as a human right | EAPC Blog | All Things Palliative - Article Feed

  3. Dear WIllem and Andri

    Willem. Nice question and not before time although I have to disagree, from a medical point of view – not sufferer- on the point about Pain management which was only brought about as a result of the whole medical service being corrupt in not wanting a cause found or a cure. Or by silencing anyone who dares mention such a dirty word…?

    May I continue your point about “Rights of Man” as different to Human Rights as in The Act. Here in the UK we have had stuffed down our throat for too long and is now being questioned by our government as it is being used in exactly the way you describe. Wrongly in my view. As they are two completely different and conflicting aspects of “Rights…”

    Nice and extremely correct point about Pain – may I add all illness – being a business and nothing to do with the well being of the patient at all – this excludes the dedicated front line clinicians doing the best they can with the terrible tools techniques and understanding called EBM or Scientifically Proven.

    ALL illness let alone treatment resistant Pain – even post accident/incident pain – only comes about as a result of a person having their “Rights of Life” being abused by significant people in their lives – The Closest Loved ones…?

    Human Rights can be simplified as the Right To enter from conception this life with comfort warmth food safety and loving – meaning free of traumatic events, the cause of ALL illness.

    For thirty years I have ONLY treated medical failures, no one EVER attends my surgery with “I feel as I am always tired I am becoming ill can you help.” Treat this simple tiredness and the person will NEVER become ill in their life. Not being tired is a Human Right not a gift.

    During my time as multiple symptom treatment specialist long ago it became very apparent to me for successful treatment I have to get past or deal with at least six enemy’s of which I will mention the first and biggest threat to resolution of their multiple ills.

    1. The Patient – the very last thing they desire is for someone to know the cause of their Pain and threaten to create an immune system response without any medications, preparations or exercise automatically from within using their own immune system(S.) There are in the main Two reason for this
    1. Illness is an advantage and not in the slightest a disadvantage.
    2. They come with an extremely powerful belief system “If the best Doctors in the world using the very latest Science cannot cure me how can you with no medical qualifications and worse by Talking too me, not only in your surgery but via Telephone or Skype.

    These two reason are the bedrock of why I support ALL front line clinicians in the way I do and work hard to bring down So called Medical Science which could not put enough proof on the Sharpe head of a pin to prove what they say, in so much as there is not one disease modifying treatment on the planet other than Talking Cures.

    There are papers on my website free to use in their entirety for education purposes.

    Best wishes

    Peter Smith Talking Cures

  4. Reblogged this on Irishhospicelibrary's Blog and commented:
    Reflections from the EAPC blog on Palliative Care as a human right and the current international position on recognising this right.

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