2. • Experiential knowledge important in ethics
- many advocates of access to pain management
have personal experiences of pain
• All “human ways of knowing” important in ethics
“examined emotions”
moral intuition
human memory (history)
imagination and creativity
as well as reason
All tell us it’s wrong to leave someone in pain
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3. Asked:
Could ethics and law
improve access to pain management?
“Death of Pain” (1993 IASP meeting)
double entendre message
we could kill the person with the pain
or we could kill the pain.
I’m adamantly against
killing the person with the pain - euthanasia,
and passionately in favour of killing the pain.
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4. Argued to implement that goal in practice,
we should recognize people in pain have a
“fundamental human right”
to access to pain management
and unreasonable failure to provide such access
is a breach of their human rights.
That is precisely what
the Declaration of Montreal
agreed to September 2010, establishes.
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5. • To understand how the Declaration
can help people in pain
need to understand
some features of human rights.
• “Human rights” try to ensure rightness or ethics
of our interactions with each other
at most basic level of our humanness,
at its essence, that which makes us human
• Recognizing human rights is very important
in creating moral and ethical societies.
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6. We don’t create human rights
they exist independently of being recognized by
any human agency.
that’s why no one can opt out of respecting them.
What we do is articulate human rights.
And that’s why human rights statements
are called declarations.
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7. New declarations,
such as the Declaration of Montreal,
continue to appear and need to do so.
• Suggest “human rights” is shorthand
for a tri-partite concept consisting of
human rights; human responsibilities;
and human ethics.
• Sometimes we need to focus on one of these limbs,
sometimes on another, and sometimes on all of them.
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8. THE RELATION OF HUMAN RIGHTS, HUMAN RESPONSIBILITIES AND HUMAN ETHICS
HUMAN ETHICS
A. CONCEPTS:
HUMAN HUMAN
RIGHTS RESPONSIBILITIES
B. PRACTICE -
IMPLEMENTATION
THROUGH:
APPLIED ETHICS LAW
C. GENERAL AREA
OF ETHICS/LAW:
environ- business professional social public consti- civil family environ-
mental ethics ethics welfare int’l tutional liberties law mental
ethics ethics law law law
D. SPECIFIC AREA
OF ETHICS / LAW:
E. SPECIFIC ISSUE medical health health & consti-
INVOLVES e.g.: ethics care human tutional
ethics rights protection
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9. Declaration of Montreal provides:
Finding that pain management is inadequate in
most of the world …
And, recognizing
the intrinsic dignity of all persons
and that withholding of pain treatment is
profoundly wrong, leading to unnecessary
suffering which is harmful;
we declare that the following human rights must
be recognized throughout the world:
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10. Article 1. The right of all people to have access to
pain management without discrimination
Article 2. The right of people in pain to
acknowledgment of their pain and to be
informed about how it can be assessed and
managed
Article 3. The right of all people with pain to have
access to appropriate assessment and
treatment of the pain by adequately trained
health care professionals
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11. IMPACT OF THE DECLARATION OF MONTREAL
Human right to access to pain management
means healthcare professionals
and healthcare institutions
have ethical, and sometimes legal, obligations
to offer patients such management.
In formally recognizing
a human right to access to pain management
Declaration makes it much more likely
that right will be respected.
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12. Declaration is not just a piece of paper;
it’s a “verbal act”, its words change reality,
just as a judge’s verdict is not just words,
but changes reality.
The hope is the Declaration will help to change
the horrible reality of people being left in pain.
The Declaration will also be
an ethics guide in relation to pain management;
and an educational tool
for healthcare professionals and trainees.
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13. • Sometimes, it will function as evidence to justify
giving necessary pain relief treatment, when others
would prevent that.
• It will help to overcome harmful beliefs of some
healthcare professionals who withhold pain
management because they fear legal liability or that
patients will become addicted.
• It will deliver a strong message that it’s wrong not to
provide pain management, not wrong to provide it
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14. • Declaration will inform and guide
institutions and governments in formulating
health policy and law re pain management
- politicians no need to fear losing votes for doing so
• Help governments understand have both
domestic and international obligations not to
unreasonably hinder own citizens’ or
other people’s access to pain management.
• Outrage and a human tragedy that people in serious pain
in developing countries have no access to opioids because
of conditions attached to foreign aid
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15. Need to apply the Golden Rule
“Do unto others
as you would that they would do unto you”
to ensure everyone needing pain management
receives it
The Declaration of Montreal spells out
what those “others”
have a human right to expect
when they are in pain.
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16. Beautiful Sanskrit salutation “Namaste”
roughly translates as:
“The Light in me, recognizes the Light in you”.
It affirms our common humanity
across all barriers and borders.
• One important application could be:
“The pain in me recognizes the pain in you”
– which is another way to express
the insight of the “wounded healer”.
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17. The Declaration of Montreal helps ensure we all
especially healthcare professionals,
recognize others’ pain
and see it as our privilege and obligation
to do what we can to assuage it.
We need to stand up for
the relief of suffering in those badly needing our help,
and the DECLARATION OF MONTREAL,
that Access to Pain Management
is a Fundamental Human Right
can help us to do that
by implementing it in a CANADIAN PAIN STRATEGY.
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