Table 3: Palliative Care and the Right to the Highest Attainable Standard of Health

Examples of Human Rights Violations

  • A country does not provide for training in palliative care to its medical personnel. As a result, end-of-life patients do not receive adequate pain relief and physical, psychosocial, and spiritual care.
  • A State provides funding only for hospitals and not for hospices and home-based care facilities. As a result, patients must either forgo treatment or remain far from their homes and families.
Human Rights Standards Treaty Body Interpretation
ICESCR 12(1): The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

CESCR General Comment 14: Affirming the importance of “attention and care for chronically and terminally ill persons, sparing them avoidable pain and enabling them to die with dignity.” Para. 25 (2000).

CESCR General Comment 14: Indicating that access to “essential drugs, as defined by the WHO Action Programme on Essential Drugs” is part of the minimum core content of the right to health. Fourteen palliative care medications are currently on the WHO Essential Drug List. Para. 43, (2000).

CESCR General Comment 14: “States are under the obligation to respect the right to health by . . . refraining from denying or limiting equal access for all persons . . . to preventive, curative and palliative health services.” Para. 34 (2000).

CRC 24(1) States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. CRC Committee: Noting Belarus’ “adoption of the recent Order on Child Palliative Care” but “recommend[ing] that the State party establish a funding mechanism for the provision of palliative care for children and support the palliative care services provided by non-governmental organizations” who operate without sufficient financial support. CRC/C/BLR/CO/3-4 (2011), paras. 55,56.

Other Interpretations

SR Health: However, many countries have failed to adapt their drug control systems to ensure adequate medication supply; those systems were often enacted before contemporary treatment methods for chronic pain and drug dependence were known or devised. That constitutes an ongoing infringement of the right to health, as the Committee on Economic, Social and Cultural Rights has elaborated that access to essential medicines is a minimum core obligation of the right, and States must comply immediately with this non-derogable obligation regardless of resource constraints. A/65/255 (August 6, 2010).

SR Health: “The failure to ensure access to controlled medications for pain and suffering threatens fundamental rights to health and to protection against cruel, inhuman and degrading treatment.”

European Charter of Patients’ Rights, Art. 11: “Each individual has the right to avoid as much suffering and pain as possible, in each phase of his or her illness. The health services must commit themselves to taking all measures useful to this end, like providing palliative treatments and simplifying patients’ access to them.” 

Declaration on the Promotion of Patients’ Rights in Europe, Art. 5.9: “Patients have the right to enjoy support from family, relatives and friends during the course of care and treatment and to receive spiritual support and guidance at all times.”

WHO 1978 Declaration of Alma-Ata: The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

G.A. Res. 46/91, Annex, para. 11, UN Doc. A/RES/46/91 (December 16, 1991): Older persons should have access to health care to help them to gain or regain the optimum level of physical, mental, and emotional well-being and to prevent or delay the onset of illness.