Petitioners: Indian Association of Palliative Care, through Chairman of its Opioid Availability Committee, Dr M R Rajagopal Dr. Ravindra Ghooi, educationist and pharmacologist, Gurgaon, who had found it nearly impossible to obtain morphine for his mother in pain from cancer Ms. Poonam Bagai, a cancer survivor and chairman of an NGO for children with cancer, New Delhi. GROUNDS: I. Because relief from pain is the right of every patient, particularly patients suffering from incurable diseases. II. Because the right to equality and right to life and liberty enshrined under Articles 14, 19 and 21 of the Constitution of India is available to patients of all the States and Union Territories of India afflicted with advanced incurable diseases such as cancer to live and to die with dignity and without needless suffering for themselves and their families. III. Because this right to pain relief, which is available considerably in Kerala, to a little lesser extent in Karnataka and Tamil Nadu and to some extent in 14 States and Union Territories, is denied to patients of other States and Union Territories and this demands this Hon'ble Court's interference. IV. Because the right to life includes the right to live and to die with dignity and the ‘State’ coming under Article 12 of the Constitution of India is duty bound to recognize and give effect to the Fundamental Rights under Part- III and the Directive Principles of State Policy under Part – IV of the Constitution of India. V. Because the Central Government, represented by the respondent No. 1 herein, has already issued Directions to the Chief Secretaries of all the States to follow the guideline of the World Health Organization for reviewing the problem of non- availability of morphine to cancer patients and the suggested legislative measures in this regard and also circulated model rules formulated for their consideration which might be incorporated in the Rules to be framed by the respective States and also for suitable changes in the Drugs and Cosmetics Rules, 1945, but the State Governments have not followed them and therefore deserve to be enforced through writs, orders and directions of this Hon’ble Court. VI. Because unfortunately the directive from the Central Government made a mention of only morphine and not other opioids resulting in denying an alternative opioid to those patients who do not respond well to morphine. VII. Because many of the 14 State Governments and Union Territories which have made amendments to the Rules, have implemented the directions in Annexure P/3 only partially and not in totality. VIII. Because this partial implementation of the amended Rules and Annexure P/3 amounts to violation of fundamental and human rights of cancer patients and also causes much hardship to their relatives and the society and consequently these States also have to be directed to fully implement the directives. IX. Because the Medical Council of India and the Nursing Council of India also require to be directed to include palliative care in their routine medical and nursing curricula with due emphasis on the importance of palliation, pain management and morphine use in patients with advanced cancer and other incurable diseases. X. Because, even though pain relief and palliative care should be essential parts of health care, currently the health care delivery systems of the Government of India and the State Governments do not provide for palliative care. XI. Because the directions, orders or writs claimed herein are necessary for maintaining basic human dignity and humanitarian considerations legitimately due to the cancer patients. PRAYERS: It is, therefore, most humbly and respectfully prayed that this Hon’ble Court may be graciously pleased to issue appropriate directions, orders or writs of the following nature to the respondents: 1. Direct the those state and UT governments which have so far failed to do so, to modify their rules governing availability of morphine and other opioids required for pain control in accordance with the circular letter issued by the Central Government; 2. Direct those States which have already amended their narcotic regulations to issue appropriate guidelines and standard operating procedures to make the rules for morphine availability workable and to encourage the growth and spread of palliative care services at hospitals and through Non Government Organisations on the lines of the model standard operating procedures and MMR adopted by the State of Kerala; 3. Direct the Central Government, represented through the Health Ministry, to ensure that pain relief and palliative care are matters of priority under health care in India, and liable to be included, not only in National Cancer Control Program, but also in programs governing control and treatment of AIDS and other incurable diseases. 4. Direct the Central Government, represented through the Finance Ministry to modify its instruction to state governments in annexure 3 to give instructions a. To include not only morphine but also other opioids like methadone in the amended narcotic rules of the state governments b. In addition to amending the rules, to also create simple standard operating procedures for implementing the amended rules without involvement of multiple agencies 5. Direct the Central Government, represented through the Finance Ministry, the Health Ministry and other Ministries, to collect necessary data relating to consumption of opioids in the different States every year and prepare the necessary program and budget for improving palliative care for consideration by the Parliament in 2006, for: a. Preparation, in consultation with experts, of a palliative care service delivery plan that requires pain relief and palliative care to become an institution-wide priority for patients in cancer centers; b. adoption of palliative care policy in every State as an essential part of health care delivery system; c. development and funding of a network of Non Government Organisations in each State to provide community-based palliative care, and on the development of standards and guidelines for (b) and (c) above. 6. Direct action by the Medical Council of India and the Nursing Council of India to include palliative care in routine medical and nursing curricula, emphasizing the importance of palliation, pain management and morphine use in cases of cancer, AIDS and other diseases. 7. Fix a time frame for the implementation of the above, with penalties for inordinate delays; 8. Appoint a committee of experts to examine the issues that arise in the present case and to report to this Hon’ble Court; and 9. Pass such further or other writs, directions or orders, as this Hon’ble Court may deem fit and proper in the facts and circumstances of the case.
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