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Download the Full Report HUMAN RIGHTS “All I Can Do Is Cry” Cancer and the Struggle for Palliative Care in Armenia WATCH “All I Can Do is Cry” Cancer and the Struggle for Palliative Care in Armenia Copyright © 2015 Human Rights Watch All rights reserved. Printed in the United States of America ISBN: 978-1-6231-32583 Cover design by Rafael Jimenez Human Rights Watch defends the rights of people worldwide. We scrupulously investigate abuses, expose the facts widely, and pressure those with power to respect rights and secure justice. Human Rights Watch is an independent, international organization that works as part of a vibrant movement to uphold human dignity and advance the cause of human rights for all. Human Rights Watch is an international organization with staff in more than 40 countries, and offices in Amsterdam, Beirut, Berlin, Brussels, Chicago, Geneva, Goma, Johannesburg, London, Los Angeles, Moscow, Nairobi, New York, Paris, San Francisco, Sydney, Tokyo, Toronto, Tunis, Washington DC, and Zurich. For more information, please visit our website: http://www.hrw.org JULY 2015 978-1-6231-32583 “All I Can Do Is Cry” Cancer and the Struggle for Palliative Care in Armenia Map of Armenia ................................................................................................................... i Key Terms in Palliative Care and Pain Treatment ................................................................. ii Summary ........................................................................................................................... 1 Methodology ...................................................................................................................... 7 I. Background ..................................................................................................................... 9 The Importance of Palliative Care and Pain Treatment .............................................................. 9 Background on Armenia.......................................................................................................... 12 Armenia’s Health Care System .......................................................................................... 12 Institutional Structure of Health Care ................................................................................ 13 Financing ......................................................................................................................... 13 Noncommunicable and Chronic Illnesses and Palliative Care Needs ................................. 14 II. The Plight of Patients .................................................................................................... 17 Availability of and Need for Palliative Care in Armenia ............................................................. 17 The Suffering Caused by Untreated Pain ................................................................................. 20 Patients’ Suffering ........................................................................................................... 20 Families’ Suffering ........................................................................................................... 22 The Positive Effect of Palliative Care Pilot Projects ................................................................... 23 III. Comparing Armenia’s Pain Treatment Practices with WHO Principles ........................... 26 Principle 1: “By Mouth” .................................................................................................... 27 Principle 2: “By the Clock” ............................................................................................... 28 Principle 3: “By the Ladder” ............................................................................................ 29 Principle 4: “For the Individual” ........................................................................................ 30 Principle 5: “Attention to Detail” ....................................................................................... 30 Principle vs. Practice .............................................................................................................. 31 IV. Medicines Availability ................................................................................................. 36 Barriers to the Accessibility of Opioid Medications .................................................................. 38 Limiting Prescribing of Opioids to Oncologists and Cancer Patients Only ........................... 38 Requirement of a Biopsy-Confirmed Cancer Diagnosis ..................................................... 40 Onerous Prescription Procedure ....................................................................................... 42 Recordkeeping ................................................................................................................. 45 Dispensing of Opioids ...................................................................................................... 45 Onerous Licensing Procedures ............................................................................................... 49 Tight Police Control ................................................................................................................. 51 Police perspective ............................................................................................................ 53 Barriers to Introduction of Oral Opioids ................................................................................... 55 V. Education/Training of Health Care Workers ................................................................... 57 Education and Training ........................................................................................................... 58 Misconceptions about Pain Relief Medications ................................................................. 59 Communication of Diagnosis – Conspiracy of Silence ...................................................... 60 VI. Government Reforms and Gaps in Palliative Care Policy in Armenia ............................. 64 Piloting Palliative Care ............................................................................................................ 65 Palliative Care Concept and National Strategy ......................................................................... 67 VII. Armenia’s Obligations to Improve Palliative Care ........................................................ 70 National Law .......................................................................................................................... 70 The Right to Health ................................................................................................................. 70 Palliative Care and the Right to Health .................................................................................... 72 No Interference with Palliative Care .................................................................................. 72 Facilitating the Development of Palliative Care ................................................................. 73 Ensuring Integration of Palliative Care into Health Services ............................................... 73 Pain Treatment Medication and the Right to Health ........................................................... 74 Pain Treatment and the Right to Be Free from Cruel, Inhuman and Degrading Treatment .......... 75 Recommendations ............................................................................................................ 77 To the Government of Armenia ................................................................................................ 77 On Availability of Medicines ............................................................................................. 77 On Policy Development .................................................................................................... 78 On Awareness and Education ........................................................................................... 78 To the International Community .............................................................................................. 79 To the International Narcotics Control Board ..................................................................... 79 To the World Health Organization .................................................................................... 80 To the European Union .................................................................................................... 80 To the Council of Europe .................................................................................................. 80 To International Donors .................................................................................................... 81 Acknowledgments ............................................................................................................ 82 Map of Armenia © 2015 LEGI/Human Rights Watch I JULY 2015 | HUMAN RIGHTS WATCH Key Terms in Palliative Care and Pain Treatment Palliative care: Health care that aims to improve the quality of life of people facing life- limiting illness, through pain and symptom relief, and through psychosocial support for patients and their families. Palliative care can be delivered in parallel with curative treatment, but its purpose is to care, not to cure. Life-limiting illness: A broad range of conditions in which painful or distressing symptoms occur; although there may also be periods of healthy activity, there is a strong possibility
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