State Duma deputies on Thursday passed a law on palliative care.
Thanks to the document, the concept of “palliative care” has been expanded, and the procedure for providing it at home and in outpatient settings has been clarified.
And a few days before this event, in the framework of parliamentary hearings, the bill was discussed quite emotionally. What did the deputies talk about?
By coincidence, it was in February 17 years ago that I had to face complete hopelessness in an attempt to help my mother who died of cancer, barely stepping over the 67-year milestone. Three years of torment passed before my eyes, so I wouldn’t be willing to try everything I experienced during this time even for the worst enemy.
The bitter episode from personal life was involuntarily remembered under the vaults of the State Duma, where a government bill on palliative care was discussed at parliamentary hearings. Adopted in the first reading in January, it caused a very sharp and impartial discussion for deputies – they were most often accused of lack of sensitivity and kindness. According to the plan of the leadership of the State Duma, the parliamentary hearings on a hot topic should have been removed from the tension in society. And what is the result?
For almost four hours of the hearing, 28 people spoke. The general meaning of all the speeches was reduced to a simple simple conclusion: to provide medical, social, psychological and spiritual help to hopeless, terminally ill people is very, very necessary.
We also talked a lot about the main problem that exists in this area – the provision of pain relief.
This topic, the United Russia member Andrei Isaev reminded the audience, for many years was not subject to discussion, because it was believed that medicine should think more about those who can recover. But the ensuing series of suicides, due to the inability to receive painkillers, forced both society and the authorities to reconsider their attitude towards life and death, to turn, as they say, face to literally screaming problem.
This, in particular, was evidenced by the figures that the Minister of Health of the Russian Federation Veronika Skvortsova cited in her report at the hearing.
According to her, the total expenditure on the provision of palliative care in 2018 compared with 2017 increased by 24% – up to 21 billion rubles, and in 2019 it will reach 23 billion rubles.
As the minister assured, there are 12 329 palliative care beds and more than 16 thousand beds of nursing care in the regions. The number of hospices in the country increased from 23 to 73 (for children – from 5 to 14), professtandard was approved, and a new position was introduced in medical institutions – a palliative care doctor, and the number of specialists in this field increased more than 10 times over several years.
To the question of State Duma Speaker Vyacheslav Volodin, to what degree of readiness the regulatory framework of the department is, so that the bill under discussion clearly earns from the first days after its adoption, Skvortsova assured that the main provisions on the organization of the palliative medical care system passed all the necessary expertise and relevant discussion interested ministries. Together with Roszdravnadzor, a normative act regulating and clarifying the criteria for licensing palliative medicine was prepared.
– And how is the situation with the provision of patients with palliative medications in case the drug is not registered in Russia? – Volodin asked the head of the department, to which Skvortsova remarked that although the ministry does not welcome free access of unregistered drugs, “primarily for children”, no one forbids the importation of such drugs for a particular patient, and “permission is given to them very quickly – within 2.5 days. "
The minister added that the country "is already undergoing clinical trials of another 13 drugs," but instead of approval from the chairman of the State Duma, she received, in fact, a thrashing.
According to Volodin, the registration of new drugs, which our citizens will not wait for, takes an extremely long time. At the same time, the speaker said that the State Duma Committee on Health Protection, together with the Accounts Chamber, will analyze how drugs were registered in Russia in recent years, and expressed the hope that the Ministry of Health will go on an open dialogue in this matter.
The great devotee of palliative care, speaking at the debate, Nyuta Federmesser, head of the Vera Charitable Foundation, called the bill still sluggish and incomplete, including the fact that, according to the option under discussion, only people with disabilities can receive palliative care, although many potential candidates for such assistance die before they have time to disability.
In general, the hearings in the Duma were encouraging, but nothing more. And maybe President of the National Medical Chamber Leonid Roshal is right when he stated at the hearings about the need to develop and adopt a separate law on palliative federal assistance (now the relevant amendments are being made to the Federal Law “On the Principles of Health Protection and social aspects.
FIGURES AND FACTS
“About 2 million people die in Russia annually. From external causes – 200 thousand, from diseases – 1.8 million people. All of them will sooner or later need palliative care. At the same time, cancer patients account for only 16%. The remaining 84% of hospice forces do not help. ”
Professor, Head of Department
palliative medicine MSMU,
Chairman of the Board of the Russian
palliative medicine associations
HOW AT THEM?
In Germany, according to the portal www.dw.com, there is a fairly dense network, which includes more than 300 palliative departments in clinics, 236 stationary and about 1.5 thousand outpatient hospices. In addition, care for the dying is provided by over 300 mobile teams consisting of doctors, nurses, physiotherapists, clergymen and social workers.
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In 2015, a law was passed in Germany, in accordance with which palliative medicine was actually equalized in rights with the traditional one. All the costs of creating decent conditions for the dying are entrusted to the health insurance system. In 2016, such expenses exceeded a total of 600 million euros.
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The number of people in need of palliative care in Germany includes not only patients with end-stage cancer, but also, for example, suffering from incurable heart disease, Parkinson's disease, acquired immunodeficiency syndrome, severe kidney, lung or liver diseases. In most cases, it is about relieving a person of unbearable pain with the help of potent narcotic analgesics.
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Two thirds of the Germans, according to surveys, would like to die at home – in their usual environment, with their families. That is why in recent years the system of “specialized outpatient palliative care” has been actively developing in Germany.
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There are no quotas or regional norms for drug-containing drugs in the Federal Republic of Germany. The doctor, however, has the right to write out a prescription for each patient only twice a month. If he suddenly needed more, then it must be written down in the case history.
However, an increase in the dose to terminal patients is never denied. Any patient in Germany gets as many painkillers as he needs. It is believed that the patient should in no case endure the pain.
Photo: REX / FOTODOM.