A/HRC/22/53 opioids for medical purposes;68 and the absence of pain management policies or guidelines for practitioners.69 Applicability of torture and ill-treatment framework 54. Generally, denial of pain treatment involves acts of omission rather than commission,70 and results from neglect and poor Government policies, rather than from an intention to inflict suffering. However, not every case where a person suffers from severe pain but has no access to appropriate treatment will constitute cruel, inhuman, or degrading treatment or punishment. This will only be the case when the suffering is severe and meets the minimum threshold under the prohibition against torture and ill-treatment; when the State is, or should be, aware of the suffering, including when no appropriate treatment was offered; and when the Government failed to take all reasonable steps71 to protect individuals‟ physical and mental integrity. 72 55. Ensuring the availability and accessibility of medications included in the WHO Model List of Essential Medicines is not just a reasonable step but a legal obligation under the Single Convention on Narcotic Drugs, 1961. When the failure of States to take positive steps, or to refrain from interfering with health-care services, condemns patients to unnecessary suffering from pain, States not only fall foul of the right to health but may also violate an affirmative obligation under the prohibition of torture and ill-treatment (A/HRC/10/44 and Corr.1, para. 72). 56. In a statement issued jointly with the Special Rapporteur on the right to health, the Special Rapporteur on the question of torture reaffirmed that the failure to ensure access to controlled medicines for the relief of pain and suffering threatens fundamental rights to health and to protection against cruel, inhuman and degrading treatment. Governments must guarantee essential medicines – which include, among others, opioid analgesics – as part of their minimum core obligations under the right to health, and take measures to protect people under their jurisdiction from inhuman and degrading treatment. 73 D. Persons with psychosocial disabilities 57. Under article 1 of the Convention on the Rights of Persons with Disabilities, persons with disabilities include those who have long-term intellectual or sensory impairments, which, in interaction with various barriers, may hinder their full and effective participation in society on an equal basis with others. These are individuals who have been either neglected or detained in psychiatric and social care institutions, psychiatric wards, prayer 67 68 69 70 71 72 73 Palliative care is an approach that seeks to improve the quality of life of patients diagnosed with lifethreatening illnesses, through prevention and relief of suffering. WHO Definition of Palliative Care (see www.who.int/cancer/palliative/definition/en/). E/INCB/1999/1, p. 7. HRW, “Please Do Not Make Us Suffer”, p. 2. Amon and Lohman, “Denial”, p. 172. See for example ECHR, Osman v. United Kingdom, Application No. 23452/94 (1998), paras. 115122; Committee on Economic, Social and Cultural Rights, general comment No. 14. Amon and Lohman, “Denial”, p. 172. Joint letter to the Chairperson of the fifty-second session of the Commission on Narcotic Drugs, 2008, p. 4. 13