“Everyone has the right to die”: how terminally ill Russians seek euthanasia

Euthanasia is the termination of the life of a terminally ill person. It is called a “dignified” or “good death”, since its goal is to end the suffering of the patient with his consent or with the permission of loved ones. The practice of voluntary death was welcomed back in Ancient Greece, when suicide of the elderly and disabled was encouraged. Today, such a procedure causes heated debate: in 5 countries it is legalized, another 5 states are pondering the legality of “voluntary murder”.

Story

The term “euthanasia” was first used in the 16th century by the philosopher Francis Bacon to define the act of easy death. The idea, then as now, is to help a terminally ill patient die. In case of an incurable disease, a person can voluntarily ask a doctor for a lethal injection in order to die without pain and suffering. Since the twentieth century, euthanasia has gained particular popularity. But the criminal and distorted use of this practice by the Nazis completely discredited the idea itself.

Content:

• Story
• Modern Application
• Types of euthanasia
• Euthanasia procedure
• How does a person feel
• Legislative regulation in countries around the world
• Suicide tourism
• Pros and cons
• Statistics
• Is there an alternative

At the dawn of the last century, eugenics, the science of selection of the human species, was gaining momentum in Europe. In Germany in the 20s of the last century, people who promoted the idea of ​​​​the purity of the Aryan race were obsessed with it. The idea took root in society that the nation needed to be cleansed of “defects.” This category included patients with mental disorders, hereditary diseases, and congenital pathologies. Over time, the list of undesirables expanded, and it began to include everyone who was unable to work or was simply not liked by the authorities. Books and scientific works were published on the topic of sterilization and disposal of patients.

In 1923, the work “Permission to destroy life unworthy of life” fell into the hands of Adolf Hitler. The work belonged to two professors - psychiatrist Alfred Goha and lawyer Karl Binding. It was about the legality of the physical destruction of the mentally retarded, criminals and seriously ill people. These ideas will form the basis of future “death camps.” The unofficial mass use of forced euthanasia in Germany began in 1939, before which it was considered murder. The Knauer family turned to the Fuhrer for permission to euthanize their son, since he was severely crippled. The boy was euthanized in a Leipzig clinic, and in the same year an office was organized to handle such cases.

All children under 3 years of age were required to undergo a “peer assessment,” during which they were determined to be terminally ill. Those who could not become full-time workers in the future were euthanized. Adults with severe pathologies and mental disorders were sterilized. By 1940, the term “children” in documents began to apply to persons under 17 years of age, and a little later “child euthanasia” began to be applied to all age groups. There were discussions about the method of killing in the circles of responsible persons; injections were considered an economically unprofitable method. Criminologist Albert Widman proposed a quick and affordable option - carbon monoxide.

The following people ended up in the “gas chambers”:

• people with mental disorders;
• epileptics;
• disabled people;
• Gypsies, Jews and Poles;
• patients who have been treated for more than 5 years.

Such killings were called euthanasia only because of the sonority of the term; in documents they were sometimes called “disinfection” and codenamed “T-4.” By 1941, the mass disappearances had caused outrage among the clergy, aristocracy and some politicians. By the end of that year, Hitler issued an official decree to stop “disinfection,” but the program was unofficially stopped only after World War II. During the hostilities, soldiers with injuries, children and adults, and captives of the non-Aryan race were also subjected to “euthanasia.”

The trials of the perpetrators and those responsible for “T-4” began only in 1950. Only a few received punishment in the trials. Most of the psychiatrists who advocated killing continued their medical practice, and their trials never took place. Falkenhauser, the head physician of one of the mental hospitals who practiced starvation as “euthanasia,” was sentenced to 3 years in prison for hundreds of starvation deaths. Only in 2001 did the German Society of Psychiatry admit its guilt and ask for forgiveness from the relatives of the victims.

Why are not only terminally ill people in favor of euthanasia?

27-year-old Ruslan from Simferopol does not like to talk about the present and lives only in the past. Five years ago, everything “was perfect” for him. Then Ruslan worked as a stationery seller and worked part-time at a construction site, jumped with a parachute and practiced martial arts, loved nature and dated girls. But when the young man turned 22, everything changed: Ruslan began to suffer from social phobia - a mental disorder characterized by a fear of being in society.

Due to social anxiety, Ruslan developed severe insomnia. He took handfuls of antipsychotics and sleeping pills to help him sleep and contemplated suicide. “I remember the horror when you think that the day will soon come when the sleeping pills will stop working, and you will die terribly painfully for a week with a complete lack of sleep,” he explained to Paper .

Over two years of treatment, Ruslan managed to overcome insomnia, but social phobia became increasingly stronger. Now the man lives on antidepressants, which are helping less and less. “I was quite a cheerful person, but now I am psychologically broken. I have no more hope. You can’t call this life - I just exist,” he explained, emphasizing that in the future he would most likely commit suicide if social phobia does not recede and euthanasia is not legalized in Russia.

However, not all patients are able to die without outside help. They are often helped in this by relatives, neighbors and even Internet activists.

Modern Application

Today, the practice that the Reich used under the name “euthanasia” is recognized as a crime. Because of this, the perception of easy death in society has been greatly distorted; most states consider it murder. However, in 2001 the Netherlands legalized this procedure. Since then, a fierce debate has begun about the legality of euthanasia for humanitarian reasons. In countries where it is permitted, the “good death” is applied to terminally ill people for whom medicine cannot help. Also, in countries where it is legal, euthanasia can be performed on newborns with brain atrophy. Children and adults who live only with the help of life-supporting equipment are helped to die with the consent of their relatives.

To perform euthanasia, doctors must be completely sure that the patient cannot be saved. For these purposes, the patient undergoes a comprehensive examination, including by a psychiatrist. Even after a personal request to “die with dignity,” the patient needs to make two statements, with long breaks between them. Switzerland has allowed euthanasia for mentally ill people if their illness cannot be cured. The Swiss Federal Tribunal argued its decision by arguing that mental disorders in some cases cause as much suffering as physical ones.

Cost of voluntary death

When discussing the issue of a “good death”, you need to know how much euthanasia costs and where it is allowed to be organized: in a hospital or perhaps it can be carried out at home. Thus, the approximate cost of assisted death in Switzerland is 4,000 euros. There are several organizations there that accompany the patient from his very arrival in the country, providing all the necessary assistance: both legal and medical. In Belgium, for example, the cost of the procedure itself is already included in the citizen’s insurance package; all that remains is to buy a kit costing about €60 (approximate price $70).

Types of euthanasia

Depending on whether the doctor is directly involved in the process, two forms of the “act of easy death” are distinguished: active and passive. Also, on the part of the patient, the process can be voluntary or involuntary (from an aesthetic point of view, it is not called “forced”).

Passive

This type of life termination is also called the “delayed syringe method.” They speak of a passive form when the patient is not helped by treatment. In this case, medical care aimed at prolonging life is stopped. The patient receives only symptomatic therapy, for example, pain relief. This type of procedure allows a person to pass away naturally and without suffering. Some of the supporters of this idea doubt that such a process can even be called “euthanasia.”

Active

The active form of the process causes more controversy and doubt. It implies the direct participation of a health care worker in the death of a person. It is used only in precedent cases. In Switzerland, anyone can request it, including healthy relatives or spouses of a deceased person. To carry out the act, the doctor must introduce or give the patient a substance that will gently stop the body’s functioning. Typically, this is a large dose of painkillers that lead to death in your sleep.

The controversy surrounding this form of euthanasia is caused by the fact that not every health worker is ready to take on such responsibility. Even in countries where the service is legalized, only certain specialists are ready to carry out the procedure.

Voluntary

Proponents of euthanasia call voluntary death the exercise of the right to die. Everyone has the right to manage their own life, and decent care is part of this right. A voluntary procedure occurs when the patient himself asks the doctor to end his life. Realization of the idea requires a long period and testing of all possible treatment methods. The patient also works with a psychiatrist. For people with mental disorders, confirming a desire to die is quite difficult. Therefore, such an opportunity is currently only available in Switzerland.

Involuntary

Involuntary euthanasia is a very controversial issue for doctors and relatives of the patient. It occurs when the patient cannot independently express the desire to leave. At the same time, it must be precisely proven that there is no chance of returning him to a full life. An additional factor in the decision is the pain the person may be experiencing. Without the consent of the patient himself, euthanasia can be used only in countries where it is permitted and after a unanimous decision of a council of doctors and relatives.

How does euthanasia happen?

The euthanasia procedure has several stages, including not only the medical part. Before a patient gets the desired relief from his suffering, he needs to go through a series of steps, starting with filing an application. Once an application is submitted, it is reviewed by the appropriate committee.

A commission consisting of doctors, psychologists and lawyers examines the entire medical history, identifying indications for euthanasia. At the next stage, the person needs to undergo an examination confirming his psychological integrity and awareness of the decision made. Along the way, decisions can be made about the availability of possible treatments or therapies that reduce negative experiences. If, after going through all the stages, the patient’s decision remains the same, and the commission confirms the admissibility of euthanasia, then legal and medicinal preparation for the procedure begins. A mandatory preliminary step is to inform the patient how euthanasia is carried out, with what substances, as well as a rough description of the sensations experienced.

Legal issues in various countries are drawn up in relation to the current legislation, but at the same time they necessarily imply the presence of a patient’s application, permission, supported by the opinion of an expert commission. It is possible to draw up a will, disposition of acquired property, and also organize funerals.

Before the introduction of a lethal substance, the patient takes an anesthetic, and only after the onset of complete deep anesthesia is direct euthanasia. The procedure itself is performed in several versions. The earliest is the oral ingestion of a lethal substance by the patient himself. This version can provoke unwanted states of vomiting and nausea due to the taste and aromatic properties of the substance, which ultimately called into question the entire procedure. The injection form shows full effectiveness. Substances used for euthanasia are made on the basis of a barbiturate, which inhibits the leading functions of the central nervous system.

Euthanasia procedure

Each state that has legalized euthanasia has its own regulations for its implementation. The legislation clearly controls the criminal legal side of the issue. Medicine is responsible for the accuracy of arguments about human incurability.

General factors for the procedure:

1. The patient must be terminally ill, feel a desire to die and declare this at least 2 times.
2. If the patient is conscious, he must sign the application for the procedure himself.
3. To euthanize an unconscious person, a statement from relatives is required.
4. The process is possible only if the patient’s quality of life is too reduced and there is no chance of recovery.
5. The application is reviewed by a council of doctors and legal authorities.

If the decision is made to carry out an active “act of dying with dignity”, the process takes place in two stages. First, the patient is injected intravenously with painkillers, and within half an hour the person is immersed in anesthesia. After this, barbiturate-based substances are introduced, which stop the respiratory function. A doctor monitors the procedure to make sure that the person actually leaves without suffering.

The passive form may take an indefinite period of time. A person receives all the medications so that his condition does not bring agony. However, the patient, without receiving drugs to prolong life, dies from the very cause of his condition. Euthanasia is also carried out at the request of relatives if a person has been on life support for a long time and there is no chance of recovery. In such cases, the authorities must ensure that relatives do not benefit financially from the death of the patient.

In what case can we talk about euthanasia?

We talk about euthanasia only when we are dealing with intentional murder. In one case, the life of a hopelessly, terminally ill person is taken in order to spare him unnecessary suffering, either through direct intervention (for example, barbiturate injections) or by “leaving him to die” by ceasing to feed the patient. In another case, a severely disabled newborn child loses his life when he is killed outright or condemned to certain death, with food and basic treatment cut off simply to avoid causing further pain to his parents. This means that euthanasia itself is placed at the level of intentions:

- euthanasia is spoken of only when there is an intention to end the life of a given person or hasten his death;

— we are not talking about euthanasia when they try to alleviate the suffering of a person who is in the last stage of a serious illness by prescribing him medications that can only indirectly accelerate the physiological process of dying. In this case, they do not set themselves the goal of “helping the patient die,” but try to reduce his pain with the help of drugs that, only as a side effect, can hasten the approach of the end. Death here is not deliberately caused in a direct manner, but is a possible consequence of pain therapy.

Euthanasia can be placed among a number of different medical methods:

- euthanasia is present when a drug that causes death is used, and also if the patient is deprived of everything that he needs to live (food), or everything that is beneficial for him (resuscitation, which would allow him to come to his senses) and independently support life, or such treatment that can give a chance to continue life under normal conditions);

- there is no euthanasia in the case when treatment that would have an adverse effect on the patient is stopped or omitted (for example, treatment that would only prolong life itself in inhumane conditions without alleviating the patient’s condition);

- there is no euthanasia in the case of cessation of resuscitation, when the state of cerebral death is irreversible (any treatment no longer gives any result, does not alleviate suffering, does not give any chance for further recovery, but only prolongs the time of agony and, in addition, brings unbearable suffering to the family and disproportionate expenses to the state);

- there is no euthanasia in the case of non-resuscitation of a poorly formed newborn child, or in a severe pathological case, if it naturally leads to death (when life can only be continued artificially, without hope of improvement and the emergence of the ability for independent existence);

- there is no euthanasia if a patient is “allowed to die in peace” with a fatal disease, which naturally leads to death in a short time - in a case where any therapy would only prolong life for a short time in unbearable conditions.

How does a person feel

The question of how the patient feels during the process is very theoretical. Doctors also argue about it, some of whom support the idea, while others do not. It has been suggested that the patient may feel as if he is suffocating. The author of this theory remains unknown, but he has a lot of followers. This is argued by the fact that barbiturates slowly depress the central nervous system, stopping breathing. The “opposition” of this assumption believes that this is unfounded, since the person at this moment is in a state of deep anesthesia. It is just as impossible to answer the question of what a person feels during euthanasia as it is to answer the question: what happens after death.

The attitude of the church towards euthanasia

Many argue that the right to choose when to die is a basic human right. At the same time, the ban on euthanasia is a punishment, because it is the Lord who decides the fate of a person. A mortal does not have the right to be born and die where he wants.

While those who belong to the Christian religion may argue that the time, place and manner of death should be left in the hands of God. But there are other religions that believe that dying in an act of religious fanaticism is a fundamental right and leads to an afterlife in heaven.

All this may be "true" in the eyes of believers, but whenever a question of procedure arises, the argument almost immediately turns into "suicide", defined as death by one's own hand. Similar opinions on euthanasia have been documented. However, there remain countries that fully support human rights.

Legislative regulation in countries around the world

Such a controversial procedure requires a solid legislative basis. In countries where it is legalized, doctors act within the law. In some countries, only the passive form is allowed. However, even where it is considered murder, passive euthanasia is still used, although it is not brought up for general discussion.

Legalization

Only a small part of states abroad are ready to give a person the right to make an independent decision about death. “Easy death” is fully legalized in:

• Canada;
• the Netherlands;
• Switzerland;
• Belgium;
• Luxembourg.

In the US, this service is legal only in California, Oregon, Montana, Vermont. In Washington, euthanasia was legalized, but banned in 2012. In some European countries the passive form is allowed. There is no clear prohibition on “easy death” in:

• Israel;
• Germany;
• Albania;
• Spain;
• France.

On March 9, 2022, the Constitutional House of India legalized only passive euthanasia. In states where the procedure is permitted, it can be applied to citizens over 18 years of age. The main requirement for euthanasia of a child is his awareness of what is happening. In 2014, Belgium allowed a “good death” for young children if there are all legal and medical justifications for this. Also in Belgium, the attending doctor can prescribe a kit for the procedure if the patient requests it. The patient carries out forced suicide himself with the help of a set of drugs and instructions.

Prohibition on the procedure

Active euthanasia is equivalent to premeditated murder in those countries where it is not permitted by separate law. Behind the scenes, a passive form of the procedure is carried out in almost all states. The moment when a patient receives only symptomatic treatment without a prognosis for prolonging life is passive euthanasia. Active in most countries is considered as assistance in suicide or premeditated murder.

In Russia, the project “On the Protection of Citizens’ Health” prohibits doctors from “satisfying a patient’s request to hasten his death.” The doctor is criminally liable for any assistance in the intentional suicide of a patient. According to this law, active euthanasia remains prohibited. In cases where it is impossible to save the patient, the same passive form is used.

In the Australian state of Northern Territory, a bill has been in force since 1995 that allowed assisted death. But already in 1997 the law was repealed. In 2022, it became known that another Australian state, Victoria, would legalize the “right to an easy death” in 2020.

The most controversial attitude towards euthanasia can be found in Japanese laws. In 1995, a doctor from Yokohama was sentenced to 2 years in prison for killing his patient. The patient was suffering from the last stage of cancer and was expected to live a few more days. After the verdict was passed, the court listed the conditions for “assisted dying”:

1. The sufferer must have unbearable pain.
2. All methods of pain relief have already been tried and have not yielded results.
3. The patient himself expressed a desire to die.
4. The patient's imminent death is inevitable.

Despite this list of criteria, the Japanese Constitution prohibits any type of euthanasia and makes it a criminal offense. The controversy about its legalization in the “land of the rising sun” has been going on since 1962.

Medical assistance in death is prohibited in all post-Soviet countries. There is a clearly negative attitude towards such actions in all Islamic states. However, the Sunnah and the Koran, the main religious and legislative scriptures, allow refusal of treatment. Thus, in Islam, anyone can refuse treatment, thereby gaining the right to a passive form of the procedure.

Suicide or the right to care?

Most people believe that unbearable pain is the main reason why people agree to euthanasia, but some studies in the US and the Netherlands found that less than a third of requests for euthanasia were due to severe pain.

In terminally ill people, quality of life may be seriously impaired by physical conditions such as:

• incontinence;
• nausea and vomiting;
• dyspnea;
• paralysis;
• difficulty swallowing.

Psychological factors that make people consider the procedure include depression, fear of loss of control or dignity, feelings of burden, or aversion to dependency. Where euthanasia is permitted, such situations are not considered murder.

The term “mercy killing” is distinguished and used in situations where the patient suffers greatly. Killing is stopping the taking of measures that would allow a person to survive.

The following are not euthanasia:

1. Discontinuation of medically futile treatment when the burden of such treatment outweighs the benefit.
2. Providing treatment aimed at relieving pain and other symptoms, even though the treatment very rarely may result in some predictable risk of shortening life, known as the "double effect," when the doctor reduces pain rather than ending life processes.
3. When a mentally competent person decides to refuse treatment. Doctors cannot force patients to undergo treatment against their will, and it is legal for a patient to refuse treatment. If the patient dies, it is not euthanasia.

Arguments for the procedure may be as follows:

1. It does not include stopping or starting medically futile treatment, alleviating pain when the goal is to eliminate the pain but not the patient, or withholding medical treatment from a competent patient. Euthanasia is illegal in the UK under the common law crime of murder.
2. Voluntary euthanasia is when a competent patient agrees but does not commit to making a decision to end his life.
3. Assisted suicide is when someone helps another person commit suicide. In the UK it is illegal under the Suicide Act 1961, which states that a person "who aids, abets, counsels or procures the suicide of another person or the attempt of another to commit suicide is liable on indictment."

If such actions are not self-interested, then this is the norm for both parties. They also introduce the definition of a person's living will: a document prepared by a mentally competent person in which a person states that he does not want to receive medical treatment and care if he becomes incompetent in the future and can no longer express his wishes himself.

Suicide tourism

You can obtain the right to assisted death only in a few states. In this regard, a service such as medical or suicide tourism has appeared. Seriously ill people who cannot undergo euthanasia in their own country come specifically for this purpose to places where it is permitted. So far, only Sweden and Zurich (Switzerland) officially accept “tourists”. There are clinics in these countries that provide this service to both local residents and foreigners.

The scientific publication Journal of Medical Ethics claims that over the past 5 years the number of foreigners who came to Zurich for an “easy death” has doubled. In May 2011, a referendum was held in which Zurich residents had to vote for or against the abolition of suicide tourism. 84.5% of respondents voted for euthanasia to remain legal.

List of used literature:

1. Akopov V.I. Collection of reports from the first international conference “Society, Medicine, Law” / V.I. Akopov, A.A. Bova. – Kislovodsk, 1999. 5 p.
2. Zubris G. Eitanasia is illegal / G. Zubris // Medical newspaper No. 3. - 1997.
3. International Code of Medical Ethics.
4. Millard D.W. The problem of euthanasia / D.U. Millard and clinical psychiatry. No. 4. – 1996. 101 p.
5. Sudo Jacques. Euthanasia / Jacques Sudo – M. 1987.
6. Uranova V.N. Medical associations. Collection of official documents / V.N. Uranova. – M. 1995.
7. Foot Philip Euthanasia / Philip Foot // Philosophical Sciences No. 6.– 1990.62 p.
8. Yarovinsky M.Ya. Good death / M.Ya. Yarovinsky // Medical assistance No. 9. –1996. 35 s.

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Pros and cons

Such a sensitive topic cannot go unnoticed by the public. Few people remain neutral on the question of whether euthanasia is permissible in principle and what its pros and cons may be. Supporters and opponents of this idea, as a rule, start from different dogmas and aspects. Some rely on religion, others on moral and ethical standards. Hence there are two fundamentally different opinions.

Religion

The main opponent of artificially stopping life is religion. Despite completely different dogmas, world faiths have almost identical attitudes towards euthanasia. In any religion, life is the highest gift and good, something absolutely sacred. Hence the strong resistance to euthanasia.

In Christianity, as in many other religions, only God has the right to give and take life. Therefore, suicide or murder is considered the highest sin, equated to a challenge to God. Only those suicides who were in a state of mental disorder at the time of their unauthorized death are not considered sinners. This position applies to all branches of Christianity: Protestantism, Orthodoxy, Catholicism.

Judaism regards shortening one's life by even a minute as a mortal sin. The main argument of the Jews is that the body does not belong to man. We use it temporarily as a vessel, but we cannot fully manage it ourselves. Even passive euthanasia, according to the rabbis, goes beyond Jewish religious principles.

Hinduism, including all its manifestations, is more ambiguous about this procedure. This extensive religion is based on the idea of ​​karma - the law of consequences from actions. If a person lived his life well and left it well, good things await him in rebirth. "Good" care occurs when a Hindu:

• located at home (or on the banks of the Ganges River);
• conscious and said goodbye to his family;
• There should be no bowel movements in the form of vomiting, urination, or bleeding.

Hence, artificially prolonging life in agony and unconsciousness is considered a bad end. Consciously and honorably leaving through voluntary euthanasia is permissible in Hinduism if a person does it on his own and does not regret his departure.

Buddhism actively supports end-of-life care, that is, palliative care. Active euthanasia is unacceptable in this teaching. Since Buddhism is not centralized, its interpretation varies greatly depending on the region. Thus, some Buddhists refuse treatment, including pain relief. This allows them to face death with dignity and a clear mind.

Islam is also categorically against artificially stopping life. No one can compare himself with Allah and decide who lives and who dies. However, patience and submission to the will of God are important qualities for Muslims, so arbitrary refusal of therapy is allowed. It is also permitted not to artificially prolong life if reason has faded. The moral and legal problem is to accurately establish where reason has faded and where it has not yet.

Bioethics

An integral participant in euthanasia is a doctor, even if we are talking about a passive and voluntary form. In this case, the medic needs to either stop saving the person or kill him. Both violate bioethical norms. Any negative action or inaction in saving a person contradicts the Hippocratic oath: “I will not give anyone the deadly means they ask from me and will not show the way for such a plan.”

There are not many doctors who wholeheartedly support this idea. To commit such an act, the doctor needs to violate both professional ethics and his own morality. The situation is even more complicated with seriously ill children or unconscious patients. Not many doctors agree to intentionally end someone's life. Some experts view euthanasia as selfishness: “I can’t kill myself, so do it for me.”

WHO, in a 1987 declaration, defines the act of interrupting the life of a patient, even at his request or the request of relatives, as unethical actions. Nevertheless, this practice has already been legalized in several countries, and other states are discussing the possibility of legalizing it. And where it is “in law”, someone will conduct it. This means that even among doctors there is a split in opinion. Some people view lethal injection as the only way to help a person avoid suffering.

In 1952, the UN received a petition from doctors, scientists and prominent cultural figures from Great Britain and the USA. The petition stated that the right of a terminally ill person to demand an easy death should be added to the Universal Declaration of Human Rights. The appeal collected 2,500 signatures, but was rejected by the UN as inhumane.

A 1994 survey of Russian doctors showed that half of respondents over the age of 41 “have never thought about whether euthanasia is acceptable.” Among doctors aged 21 to 30 years, 49% agree with the procedure. A survey of medical students in 2000 found that 78.4% were in favor of euthanasia.

Modern ethics

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The survey described above shows that the majority of young doctors have a positive attitude towards carrying out the “act of a good death”. In the modern world, ideas about the human right to choose and responsibility for one’s own life are increasingly developing. Euthanasia in the 21st century is far from new, but it still remains a revolutionary practice. The trend of gradual legalization suggests that over time humanity will either improve treatment methods or accept the fact of euthanasia.

What is an alternative to euthanasia and AS

Palliative care for patients is considered an alternative in Russia. Palliative medicine physicians are responsible for using methods and procedures that can provide relief to a terminally ill patient, such as pain relief and severe symptoms.

— Palliative medical care is developing in Russia today by leaps and bounds. However, if we compare our level of development with other countries, then, of course, we are far behind and will take some time to catch up,” says Evgeniy Glagolev, executive director of the Russian Association of Hospice Care.

In Russia, palliative care is represented primarily by hospices: there are about a hundred of them in the country. Hospices are free health care facilities for patients with terminal illness. The environment in a good hospice is reminiscent of scenes from Hollywood films where they show homes for the elderly. Such institutions have a small number of patients (about 30–50 people), caring nurses, psychological assistance and an individual approach to patients. In addition, hospices have outreach services that serve and assist patients who remain at home: there are usually more of them than those who are hospitalized.

According to the latest data from the Ministry of Health, which keeps records only of terminally ill patients, there are now up to 600 thousand in Russia in need of palliative care, including 36 thousand children. In fact, there are most likely even more people who need help, says Glagolev. It is difficult to give exact figures: there are different assessment methods. According to one of them, at least 260 thousand cancer patients and 520 thousand patients with other diseases, as well as about 200 thousand minors, need such help. According to Glagolev, less than half of those in need receive palliative care.

— Hospices are very expensive to maintain. Naturally, there is not enough government funding, like everywhere else,” says Glagolev. “However, the Ministry of Health has a clear plan for the development of palliative care, according to which by 2022 the country will have a sufficient number of palliative beds per capita. The plan is being carried out successfully. It’s easy to open beds; it doesn’t even require a lot of money, especially taking into account the ongoing modernization of the healthcare system, when many departments are closing. But it is very difficult to ensure that high-quality palliative care with all the components is actually provided on allocated beds - and I see this as a big problem.

Glagolev gives the following example: the state allocates about 1,800 rubles per bed-day for a hospice patient, while in reality, for quality care, a patient needs about 10 thousand rubles daily.

The specialist admits that patients with incurable diseases often have thoughts about euthanasia. “The objectives of palliative care are neither to hasten nor to delay the onset of death. However, all the research on this topic says that people are afraid not of the fact of death itself, but of the suffering associated with dying. Not only yours, but also your loved ones. Nobody wants to be a burden to relatives. I know for sure that if you stop painful symptoms, remove pain, alleviate the painful condition, then very often the question of euthanasia goes away by itself,” says Glagolev.

Pediatrician Anna Sonkina, who studied the experience of euthanasia in the Netherlands, agrees with him: “We can only think about legalizing euthanasia in Russia after the development of palliative care.”

The head of the department of suicidology at the Moscow Research Institute of Psychiatry, Evgeny Lyubov, in a conversation with Bamaga , explained that at least a third of all seriously ill patients are prone to suicide, but only a small part decides to do so. Lyubov emphasizes that there are no accurate statistics on such suicides in Russia: they are “masked” by accidental overdoses, falls, and so on. However, according to his estimates, only about 5% of suicides in Russia occur due to incurable diseases; psychological problems are much more dangerous. “Most death callers are depressed, feel burdened, lonely and physically suffering. And they need help,” the specialist explained.

Indeed, not all Russians can receive the necessary palliative care. Thus, even in Moscow, according to the Vera Foundation, no more than a quarter of terminally ill patients received quality care and pain relief in 2015. Sometimes this situation leads to a wave of suicides. This was the case, for example, in February 2015, when in one month in Moscow, eleven people who suffered from cancer and did not receive the necessary medical care committed suicide. After one of these cases - the suicide of Rear Admiral Vyacheslav Apanasenko - Russia nevertheless significantly facilitated the prescription of narcotic painkillers for cancer patients.

However, it is not only cancer patients who face similar problems. Moreover, most free hospices only accept them, refusing patients with other diagnoses.

Statistics

The UN and WHO do not provide global reports on the development of assisted death. However, statistics from individual countries show a sad demand for such a service. In the Netherlands and Belgium, the annual increase in euthanasia performed has been 5% since 2008. Statistics Switzerland published data for the period 1998 to 2009. In 1998, 43 deaths were registered, in 2009 there were already 300 deaths from euthanasia. In Zurich, 300 foreigners receive this kind of “charity service” every year, and this figure is growing.

Every year the number of people over the age of 80 who have resorted to an “easy death” is decreasing. The number of cancer patients under the age of 40 who have resorted to euthanasia is steadily growing. Such indicators are associated with an increase in cases of malignant tumors and the lack of a cure. According to data from Switzerland, 44% of cases of “legal suicide” are cancer patients, 25% are diseases of the cardiovascular system and central nervous system, and another 3% are depression.