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					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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