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| "Palliative care is not a charitable activity or a footnote of medicine," says the head doctor at Moscow's oldest hospice for the terminally ill, founded in 1994. "It is a fundamental aspect of patient care because, unfortunately, everyone dies." |
When
pharmacies ran out of the free pain medication he was entitled to under
Russia's public health system, dying cancer patient Viktor Sechin turned to
Aleftina Khorinyak, a doctor and longtime friend, for help.
For about a
month in early 2009, Khorinyak prescribed him a nonsubsidized version of the
opioid painkiller Tramadol to help ease the suffering caused by his terminal
cancer.
"They
didn't give him any Tramadol for 52 days. I could no longer bear watching him
suffer," Khorinyak recalls. "He moaned and thrashed about on his bed,
he was in such excruciating pain."
Sechin, who
was also severely disabled, succumbed to cancer two years later at his home in
the Siberian city of Krasnoyarsk, aged 57.
What
Khorinyak intended as gesture of compassion, however, has landed her in court
on charges of drug trafficking and document forgery. Both are criminal offenses
that carry a total of up to eight years in jail.
Her trial
has drawn strong condemnation from rights advocates, who accuse Russian
authorities of hounding the 71-year-old doctor on a mere technicality --
prescribing nonsubsidized Tramadol while Sechin was formally only allowed to
receive the medication free of charge under a state program to benefit
economically disadvantaged people.
Overly
Strict, Bureaucratic Policies
It has also
shone a rare spotlight on the plight of terminally ill patients in Russia, many
of whom continue to die in agony amid chronic drug shortages and a general lack
of awareness about how to treat pain.
Rights
advocates and health experts pin much of the blame on the stringent regulations
that govern the use of controlled substances in Russia. While the country has
an obligation under international law to regulate access to opioid medications,
its drug-control regulations are criticized for routinely denying patients
adequate pain relief.
Rights
groups see Khorinyak as a victim of these overly strict and bureaucratic
policies. "This woman essentially fell through the cracks of the system of
drug regulation in Russia," says Tanya Cooper, a researcher at Human
Rights Watch.
"The
regulations are inflexible. In this case, they don't allow the patient to
receive medication," Cooper adds. "This case shows that the drug
regulations that currently exist in Russia allow people with terminal cancer to
be left in pain for many days."
The
distribution of opiates is so restricted in Russia that patients are barred
from holding stocks of medication, forcing them to continuously seek new
prescriptions and queue up for their drugs. There are now fears that the
criminal charges against Khorinyak will further deter Russian doctors from
prescribing morphine and other potent painkillers.
'A
Fundamental Aspect Of Patient Care'
A number of
health advocates believe the denial of pain relief for terminal patients
amounts to torture and is a serious human rights violation. They stress that
Russia is a signatory of the International Covenant on Economic, Social, and
Cultural Rights, which guarantees the right to "the enjoyment of the
highest attainable standard of physical and mental health."
"Palliative
care is not a charitable activity or a footnote of medicine," says Diana
Nevzorova, head doctor at Moscow's oldest hospice for the terminally ill,
founded in 1994. "It is a fundamental aspect of patient care because,
unfortunately, everyone dies."
Russia is
home to roughly 100 hospices offering end-of-life care for patients and their
families -- a significantly lower per-capita ratio than in Western countries.
Britain, for instance, has more than 260 hospices and palliative inpatient
units for a population less than half that of Russia.
Nevzorova
says Russia's palliative-care system is still "in its infancy," with
the majority of hospices run by charitable organizations and medical staff
woefully untrained in modern methods of pain management.
'How Can We
Talk Of Progress?'
Awareness
of the right to a dignified, pain-free death is nonetheless slowly taking root
in Russia.
The ordeal
of popular bard Ada Yakusheva, who was denied pain medication until one day
before dying of cancer in October 2012 due to bureaucratic hurdles, sparked
public dismay.
Russia's
Health Ministry, too, appears to be waking up to the need for better palliative
care. Health officials issued a set of directives last year to improve
end-of-life treatment, ordering the creation of hospices and palliative-care
units across the country.
Nevzorova,
however, says the new rules have been met with disappointment by experts.
"The palliative care described in the government's decree addresses mostly
palliative medical care," she says. "It says nothing about the
philosophy of hospice care, about nursing, about social and psychological
support."
The charges
against Khorinyak illustrate the uphill battle waged by Nevzorova and other
doctors advocating a more compassionate approach to pain.
Khorinyak
was found guilty of drug trafficking and forgery of documents in May along with
another female friend of Sechin who purchased the nonsubsidized medication for
him. The verdict, however, was invalidated over a technical detail. A new trial
began in November.
Nevzorova,
while deeply sympathizing with the two women, says the case is drawing
much-needed attention to Russia's shortcomings in caring for its terminally ill
citizens.
"People
have an undeniable right to live and die with dignity. A country's level of
palliative care reflects its level of social development," she explains.
"If we don't start taking proper care of our dying patients, what kind of
progress can we talk about for our country?"
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