The international palliative care community has articulated a simple but challenging
proposition that palliative care is an international human right. International human
rights covenants and the discipline of palliative care have, as common themes, the
inherent dignity of the individual and the principles of universality and nondiscrimination.
However, when we consider the evidence for the effectiveness of palliative care, the
lack of palliative care provision for those who may benefit from it is of grave concern.
Three disciplines (palliative care, public health, and human rights) are now interacting
with a growing resonance. The maturing of palliative care as a clinical specialty
and academic discipline has coincided with the development of a public health approach
to global and community-wide health problems. The care of the dying is a public health
issue. Given that death is both inevitable and universal, the care of people with
life-limiting illness stands equal to all other public health issues. The International
Covenant on Economic, Social and Cultural Rights (ICESCR) includes the right to health
care and General Comment 14 (paragraph 34) CESCR stipulates that "States are under
the obligation to respect the right to health by, inter alia, refraining from denying
or limiting equal access for all persons, ... to preventive, curative and palliative
health services." However, these rights are seen to be aspirational-rights to be achieved
progressively over time by each signatory nation to the maximum capacity of their
available resources. Although a government may use insufficient resources as a justification
for inadequacies of its response to palliative care and pain management, General Comment
14 set out "core obligations" and "obligations of comparable priority" in the provision
of health care and placed the burden on governments to justify "that every effort
has nevertheless been made to use all available resources at its disposal in order
to satisfy, as a matter of priority, [these] obligations." This article describes
recent advocacy activities and explores practical strategies for the palliative care
community to use within a human rights framework to advance palliative care development
worldwide.