Palliative Care and Human Rights in the Indian Constitution. and International Law. Dr. Katherine Irene Pettus, PhD. Feb. 2, 2015

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1 Palliative Care and Human Rights in the Indian Constitution and International Law Dr. Katherine Irene Pettus, PhD Feb. 2, 2015 Rotary and Freemasons Club, Trivandrum Thank you for inviting me to come and address you this evening. It is a great honour to be here with Dr. Raj and with all of you. I am going to talk briefly about the human right to palliative care and pain medicine in international law, and in the Indian Constitution. India has a long and illustrious history developing and promoting human rights in the modern world, participating in the drafting of the Universal Declaration in 1948, which is really something to be proud of. You have so much to be proud of here in Kerala, having one of the leading model community supported palliative care services in the world, and Dr. Raj, of course, who received international recognition as a human rights leader last year in the US. The framers of the Indian Constitution were influenced by the concept of human rights and guaranteed Indian citizens most of human rights contained in the Universal Declaration of Human Rights. They incorporated civil and political rights Page 1 of 5

2 into Part III of Indian Constitution, and health, education and cultural rights into Part IV as Directive Principles of States Policy. The inclusion of important provisions of UDHR in the Constitution of India has given them supremacy over all other statutory provisions. Tonight I want to convince you that in order for all Indian citizens to enjoy these human rights, your government must provide palliative care and pain medicine. However, governments won t do that unless citizens claim those rights. When UNESCO was putting together the Universal Declaration, the Chair, Julian Huxley, wrote to Mahatma Gandhi and asked him what he thought of human rights. This is what he said: I learned from my illiterate but wise mother that all rights to be deserved and preserved come from duty well done. Thus the very right to live accrues to us only when we do the duty of citizenship of the world. From this one fundamental statement, perhaps it is easy enough to define the duets of Man and Woman and correlate every right to some duty to be performed. Every other right can be shown to be a usurpation hardly worth fighting for. The right to palliative care and pain management can be correlated with the duty of citizens who have political rights and are NOT suffering to demand that their governments provide it. Page 2 of 5

3 One of the places I work is the Human Rights Council in Geneva, which appoints experts called Special Rapporteurs who report on how countries are meeting their obligations to provide the right to health, to education, to freedom from torture, to housing, etc. The Special Rapporteur for health until last year was an Indian physician, Dr. Anand Grover, who wrote a joint letter with the Special Rapporteur for the right to be free from torture:. The failure to ensure access to controlled medicines for the relief of pain and suffering threatens fundamental rights to health and to protection against cruel inhuman and degrading treatment. International human rights law requires that governments must provide essential medicines which include, among others, opioid analgesics (such a morphine) as part of their minimum core obligations under the right to health. Governments also have an obligation to take measures to protect people under their jurisdiction from inhuman and degrading treatment. Failure of governments to take reasonable measures to ensure accessibility of pain treatment, which leaves millions of people to suffer needlessly from severe and often prolonged pain, raises questions whether they have adequately discharged this obligation Page 3 of 5

4 Special Rapporteurs such as Anand Grover are articulating both moral and legal arguments about why certain things such as access to pain medicine are human rights. As I said earlier, though, human rights are only realised when they are claimed. When patients claim them and when families claim them. When you say to the doctor or nurse on the floor It is my right, or it is my mother s right to be given adequate pain medicine, under Indian law and international law. It is unacceptable for my family member to suffer like this. If you do not say those words or words like them, human rights just remain words on paper. Citizens and civic organisations such as yours can take the lead in claiming them for people who can t do so for themselves. Either because they are too ill, in too much pain, or too exhausted, or their caregivers don t know that they have this right and can demand it of their doctors and hospitals. People must know they have the right before they can demand it with authority, and only then will hospitals and physicians begin to provide it. Another great Indian thinker and Nobel prize winner is the economist Amartya Sen, who argues that all human rights are related to freedom, and in particular freedom from fear. A right to palliative care and pain medicine frees us from the fear of death, which is universal, the fear of suffering extreme pain, of watching our family members die in pain and not being able to help; and the fear of becoming debt Page 4 of 5

5 slaves to a medical system that will do everything to cure, but little to comfort when cure is no longer possible. Providing palliative care and pain medicines also supports the right not to be held in slavery or servitude, because severe pain as we know, enslaves us, and enslaves the family members who must care for seriously ill people who have no palliative care, and a system that makes people continue to pay for inappropriate aggressive treatment that causes further suffering and traumatises everyone concerned. Until people are guaranteed the rights to palliative care and pain medicine, people like us, who are not suffering from serious pain or illness have the obligation to represent those who are: to be their voice, their hands and legs. You can be active at the local level, promoting the Kerala Declaration, at the national level, promoting a right to palliative care for all Indians, and at the international level, in the Human Rights Council, where India currently has a seat. Kerala can be the city on the hill, lighting way for the rest of the world in palliative care. You have the resources here, you have the rich history of leadership in human rights, and you have Dr. Raj and Pallium India. Page 5 of 5