A/HRC/18/37 the use of narcotics in pain relief amongst medical practitioners. More comprehensive training on palliative care and the use of narcotic drugs is needed. These barriers to availability of good quality palliative care are not unique to older persons as a group, but older persons are disproportionately affected due to the increased incidence of chronic and terminal illness amongst them. 57. Older persons may also be less likely to receive palliative care services than other, younger age groups. More research is needed to determine whether this distribution is inequitable or whether the needs of older persons are being met through other services.34 The right to health clearly proscribes discrimination in respect of age, including within palliative health care services. States are obliged to respect the right to health by refraining from denying or limiting equal access for all persons to palliative health services (E/C.12/2000/4, para. 34). Age-based discrimination that is sanctioned on the basis of risk/benefit profiling cannot under any circumstances be considered appropriate in the context of palliative care, which aims to improve quality of life, rather than its length.35 58. The biomedical approach to ageing, combined with increased longevity, has resulted in additional ethical dilemmas. The increasing difficulty or impossibility of refusing life-extending interventions has been seen as a challenge confronting both patients and medical practitioners, which has been linked to three factors: the gradual move away from “choice” about interventions towards routine treatment; the connection of clinical interventions with expressions of care; and the increasing availability of interventions creating high expectations in respect of health outcomes, which results in blurring of the boundaries between curative interventions and those which simply prolong life.36 59. The Special Rapporteur is of the view that a holistic approach to health should also address the process of dying. While this report does not consider issues of patient autonomy in respect of deciding to end life, it is nonetheless necessary to ensure that patients be able to make autonomous, informed decisions regarding the quality of health during the process of dying. That includes choices about access to adequate pain relief and other necessary interventions, location of death, and the ability to refuse treatment designed to prolong life when it is not desired by the patient. This requires clear, candid and non-judgmental discussion with medical practitioners, who should be adequately trained to deal with these delicate issues in order to enable older persons to “die with dignity”, as required from a human rights prospective. 60. The Special Rapporteur believes that the end of life of persons forms an integral part of their life. Consequently, he stresses that older persons must be treated with as much dignity during the process of dying as they should have been in the earlier phases of their life course. Palliative care requires important funding and mobilisation of numerous actors and stakeholders within the medical sector, and it is absolutely crucial in order to prolong the lives of older persons affected by life-threatening diseases and to ensure their death in dignity. 34 35 36 Jenni Burt & Rosalind Raine, “The effect of age on referral to and use of specialist palliative care services in adult cancer patients: a systematic review” Age and Ageing vol. 35, No. 5 (September 2006), pp. 471 and 473. Jenni Burt and Rosalind Raine, “The effect of age on referral to and use of specialist palliative care services in adult cancer patients: a systematic review”, Age and Ageing, vol. 35, No. 5 (September 2006), p. 469. Sharon R. Kaufman, Janet K. Shim and Ann J. Russ, “Revisiting the Biomedicalization of Aging: Clinical Trends and Ethical Challenges” The Gerontologist, vol. 44, No. 6 (December 2004), p. 732. 15