A/HRC/18/37 possibility that a patient may be a victim of abuse and be able to manage health-related interactions, in a way which would make the abused individuals feel comfortable discussing their particular situation. 53. Various initiatives have been adopted in the area of domestic violence, particularly in respect of violence towards women, which could be drawn upon to raise awareness of abuse of older persons amongst medical professionals and the wider community. In addition to increased training, procedures need to be put in place for reporting abuses and addressing the consequences. For example, the 2006 Older Persons Act of South Africa, inter alia, requires a person who may witness the abuse of an older person, not only physical but also psychological, sexual, and economic abuse, to report the violation. The Act also establishes a system in which abusers of older persons are investigated and registered with a view to prohibiting them from operating or being employed in a residential facility or communitybased care for older persons. C. Palliative care 54. General comment No. 14 states that measures should be taken to ensure attention and care for those who are chronically and terminally ill, sparing them avoidable pain and enabling them to die with dignity (E/C.12/2000/4, para. 25). Palliative care is the primary approach, from a health perspective, of seeking to improve the quality of life of patients diagnosed with life-threatening illnesses through prevention and relief of suffering.31 55. Palliative care has grown significantly in the last 30 years and is progressively implemented within national health systems, although this has been done to varying extents. The wide range of measures taken in different States shows the growing importance of ensuring quality of life of older persons towards the end of their lives and providing support for their families. In some countries palliative care is recognized only in the context of certain chronic diseases such as cancer. Other States have integrated palliative care into their national health legislation and plans of action and created institutions which are devoted to palliative care. Some other countries have placed obligations on health institutions to have staff qualified in palliative care or have established group of experts on the issue. 56. Several issues arise with respect to the provision of palliative care to older persons, one of which concerns availability of palliative care and in particular, medicines utilized in such care. Moderate to severe pain is a common by-product of illnesses requiring palliative care, for which opioid-based analgesics are commonly prescribed. 32 State parties to the International Covenant on Economic, Social and Cultural Rights are required, as a core obligation under the Covenant, to ensure provision of essential drugs as defined under the WHO Action Programme on Essential Drugs. Despite this and the fact that oral morphine and other narcotic preparations are inexpensive and should not be difficult to obtain, the availability of such medications used in palliative care is often limited. That is due to a number of factors, such as restrictive drug regulations, failure to implement a properly functioning supply and distribution system, and inadequate health-care system capacity. Particularly concerning is the complex international narcotic control framework that severely inhibits access to medicines regulated under the framework. 33 Even when such medications are available, there often remains a lack of understanding of palliative care and 31 32 33 14 WHO, WHO Definition of Palliative Care (Geneva, 2010). Available from www.who.int/cancer/palliative/definition/en/ WHO, Pain Relief Ladder (Geneva, 2010). Available from www.who.int/cancer/palliative/painladder/en/ . See A/65/255, Section V: “Access to controlled medicines”.