Opinion: there is a growing argument that the right to health can imply a right to palliative care
The theme for this year's Palliative Care Week is "Surrounding You With Support". This focuses on how people with palliative care needs are being supported in the community. Support can take many forms and, in this respect, can come from unexpected areas such as law. Law can potentially forge an environment which fosters improved access to care and support services.
Palliative care aims to improve the quality of life of patients and their families facing the problems associated with a life-threatening illness. It achieves this by providing relief from suffering and addressing physical, psychosocial and spiritual problems. Palliative care has expanded over time to provide care for people suffering from a wide range of serious illnesses. It is likely to have an increasingly important role in healthcare systems in the future due to an ageing population, an increase in the incidence of cancer and incurable chronic health conditions.
From RTÉ Radio 1's Today With Sean O'Rourke Show, Evelyn O'Rourke visits the Milford Care Centre in Limerick during Palliative Care Week 2018
Law and healthcare are often seen to have an uneasy relationship. Law is mostly spoken of when things go wrong and as a reaction to a problem such as professional negligence. But this is a limited interpretation of the relationship and fails to capture the variety of ways in which law can positively shape the provision and experience of healthcare for all parties. In this respect, law can be malleable and can serve as an efficient tool for advocacy. This potential has been recognised by the international palliative care community as seen by calls to define palliative care as a human right and efforts to emphasise the importance of human rights in shaping end-of-life care.
While the organisation, delivery and standards of palliative care differs across jurisdictions, common barriers to effective palliative care provision have been identified. These include a lack of government commitment, difficulties in accessing pain medicines, an absence of supportive policy and/or legislation and inadequate funding amongst other issues. It is in response to these barriers that the international palliative care community sought to draw upon a human rights framework in order to advance the development of palliative care.
From RTÉ Radio 1's Today with Sean O'Rourke show, an interview with the late Dr Gertrude Ronan about the palliative care at Our Lady's Hospice in Dublin
Over the past 20 years, an argument has been advanced in palliative care declarations and journal articles that the right to health can be interpreted in a manner which implies a right to palliative care. The right to health is provided for in Article 25 of the Universal Declaration of Human Rights as well as a host of other international treaties and conventions. The recognition of a right to palliative care has been advocated for in declarations such as the Cape Town Declaration 2002, the 2008 Panama Proclamation, and the 2013 Prague Charter. These provide a sense of the architecture and content of the proposed right to palliative care.
Key elements of the right oblige states to:
· Ensure the availability of appropriate drugs, including opioids
· Establish and integrate education programmes on palliative care at all levels
· Ensure the provision of palliative care at all levels of care
· Establish comprehensive health care policies which guarantee sufficient palliative care
· Ensure equitable access to palliative care
Unsurprisingly, commentators have identified challenges in explicitly recognising such a right. However, declaring that there is a human right to palliative care is an important tool for advocacy. It signals that palliative care is not the preserve of richer countries but is a universal right across states.
From RTÉ One News, over 12,000 people received palliative care in Ireland in 2018
There is still much to do at the international level to advance such a right. Nevertheless, in 2015 the Inter-American Convention on Protecting the Human Rights of Older Persons became the first treaty to explicitly articulate a right to palliative care. There has also been discussion of the right to palliative care at the UN Open-ended Working Group on Ageing. This may provide an opportunity to recognise a right to palliative care in the proposed UN Convention on the Rights of Older Persons.
In the meantime, we can reflect on our national legal framework. This provides a rich basis for substantial human rights engagement and its standard defining role can provide a valuable resource at the domestic level in delivering on the substantive content of the right to palliative care. This can be achieved by reflecting on rights of equality, autonomy, bodily integrity, and protection from inhuman or degrading treatment. In this way, the combination of rights can be drawn upon by healthcare professionals, patients, families, and palliative care organisations.
Law and human rights serve as a vital tool to shape and support the healthcare we receive at one of the most vulnerable points in our lives
Death and dying is something which everyone in society is ultimately faced with. It is a universal issue and palliative care providers do an excellent job in providing a high standard of care. Palliative care will continue to grow in importance in the coming years and there will undoubtedly be a greater demand on resources. It follows that law and human rights will serve as a vital tool to shape and support the healthcare we receive at one of the most vulnerable points in our lives.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ