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PRIORITYMEASURE29
“Foster the development of andaccess topalliative care, to ensure a dignified, painless death.”
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 healthworkers in issues relating to appreciation andmanagement of pain, 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 attacking 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, alleviation and support for the older person; 8. Offer support to family members in coordinating the appropriate services, including
financial,medical and legal guidance.
Targets
1. A national programme of palliative care is in place; 2. Expanded offer of training programmes and skills upgrading in palliative care for
physicians, nurses and other professionals; 3. Pain relief drugs aremore available and readily accessible.
Tentative indicators
1. Percentage of older personswith terminal illnesseswhohave access to specialized care at home; 2. Percentage of primary healthcare centres
that have included palliative care as a basic service; 3. Number of physicians available in palliative care units permillion inhabitantswithin a
definedpopulation.
Related instruments,
forums andmechanisms
CESCR General Comment No. 14 on article 12 of the Covenant on Economic, Social and Cultural Rights, “The right to the highest
attainable standard of health” (E/C.12/2000/4, 2000), includes a series of obligations of States signatories, such as nondiscriminatory
access to facilities, goods and services, the supply of essential drugs as defined by theWHO, and the adoption and application of a public
health strategy. In the context of palliative care, personswith a terminal illnessmust have access to adequate health care, basicmedications
for controlling symptoms, and terminal illness care, and palliative care shouldbe included innational health policies.
The Committee on the Elimination of Discrimination againstWomen has held, in itsGeneral RecommendationNo. 27, that, with respect to the
right to health, States partiesmust providemedications to treat age-related chronic and non-communicable diseases, long term health and social
care, including care that allows for independent living, andpalliative care. (UnitedNations, “General recommendationNº 27onolderwomen and
protectionof their human rights” (CEDAW/C/2010/47/GC.1),Committeeon theEliminationofDiscriminationagainstWomen, 2010).
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. TheWHOModel List of EssentialMedicines currently includes 14palliative caremedications.
In his report of 1 February 2013, the Special Rapporteur onTorture held that governmentsmust 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 anddegrading treatment according to the definition in theConvention against Torture.
The San José Charter on the Rights of Older Persons calls for promoting “the development of and access to palliative care to ensure that
older personswith terminal illnesses diewith dignity and free of pain.”
Article 6 on the 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; appropriatelymanage 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.”
