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      Palliative care and human rights in patient care: an Armenia case study

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          Abstract

          This paper examines palliative care within the human rights in patient care framework, which clarifies state obligations and addresses the rights of both patients and providers. In the context of palliative care, these rights extend beyond the right to health and include patient rights to freedom from torture, cruel and inhuman treatment, non-discrimination and equality, bodily integrity, privacy and confidentiality, information, and right to a remedy. They also encompass provider rights to decent working conditions, freedom of association, and due process. The paper then looks at a case study of Armenia, acknowledging how the government’s commitment to palliative care, combined with awareness raising and advocacy by human rights organizations, created an enabling environment for the realization of human rights in patient care in the context of palliative care.

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          A first comparison between the consumption of and the need for opioid analgesics at country, regional, and global levels.

          The objective of this study was to propose a rough but simple method for estimating the total population need for opioids for treating all various types of moderate and severe pain at the country, regional, and global levels. We determined per capita need of strong opioids for pain related to three important pain causes for 188 countries. These needs were extrapolated to the needs for all the various types of pain by using an adequacy level derived from the top 20 countries in the Human Development Index. By comparing with the actual consumption levels for relevant strong opioid analgesics, we were able to estimate the level of adequacy of opioid consumption for each country. Good access to pain management is rather the exception than the rule: 5.5 billion people (83% of the world's population) live in countries with low to nonexistent access, 250 million (4%) have moderate access, and only 460 million people (7%) have adequate access. Insufficient data are available for 430 million (7%). The consumption of opioid analgesics is inadequate to provide sufficient pain relief around the world. Only the populations of some industrialized countries have good access. Policies should seek a balance between maximizing access for medical use and minimizing abuse and dependence. Countries should aim to increase the medical consumption to the magnitude needed to address the totality of moderate and severe pain.
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            Human rights in patient care: a theoretical and practical framework.

            The concept of "human rights in patient care" refers to the application of human rights principles to the context of patient care. It provides a principled alternative to the growing discourse of "patients' rights" that has evolved in response to widespread and severe human rights violations in health settings. Unlike "patients' rights," which is rooted in a consumer framework, this concept derives from inherent human dignity and neutrally applies universal, legally recognized human rights principles, protecting both patients and providers and admitting of limitations that can be justified by human rights norms. It recognizes the interrelation between patient and provider rights, particularly in contexts where providers face simultaneous obligations to patients and the state ("dual loyalty") and may be pressured to abet human rights violations. The human rights lens provides a means to examine systemic issues and state responsibility. Human rights principles that apply to patient care include both the right to the highest attainable standard of health, which covers both positive and negative guarantees in respect of health, as well as civil and political rights ranging from the patient's right to be free from torture and inhumane treatment to liberty and security of person. They also focus attention on the right of socially excluded groups to be free from discrimination in the delivery of health care. Critical rights relevant to providers include freedom of association and the enjoyment of decent work conditions. Some, but not all, of these human rights correspond to rights that have been articulated in "patients' rights" charters. Complementary to—but distinct from—bioethics, human rights in patient care carry legal force and can be applied through judicial action. They also provide a powerful language to articulate and mobilize around justice concerns, and to engage in advocacy through the media and political negotiation. As "patients' rights" movements and charters grow in popularity, it is important to link patient rights back to human rights standards and processes that are grounded in international law and consensus.
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              Author and article information

              Contributors
              gabrieladelu@gmail.com
              violetazopunyan@gmail.com
              naomi.burkeshyne@opensocietyfoundations.org
              panaida@osi.am
              adavid@osi.am
              Journal
              Public Health Rev
              Public Health Rev
              Public Health Reviews
              BioMed Central (London )
              0301-0422
              2107-6952
              7 August 2017
              7 August 2017
              2017
              : 38
              : 18
              Affiliations
              [1 ]ISNI 0000 0001 2289 9086, GRID grid.453407.1, Open Society Foundations, ; New York, USA
              [2 ]Center for Rights Development, Yerevan, Armenia
              [3 ]Open Society Foundations, Westminster, UK
              [4 ]Open Society Foundations - Armenia, Yerevan, Armenia
              Article
              62
              10.1186/s40985-017-0062-7
              5809943
              98ad7151-e588-4b3d-9049-b999258d93ab
              © The Author(s). 2017

              Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

              History
              : 18 March 2017
              : 11 July 2017
              Categories
              Review
              Custom metadata
              © The Author(s) 2017

              armenia,palliative care,opioid,human rights,pain,patient,provider,human rights in patient care

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