The patient, a physician by profession, lived for a year on a ventilator, but knowing that it does not have the right to disable, refused medication and died in misery. Such cases leave open questions – who and how can and should make the decision about the termination of artificial life support person, what is the difference between euthanasia and refusal of medical intervention.
Photo: Yuliya Pushkina, IA PrimaMedia
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The Fund is “Live now” has organized an open discussion “the doctor, the lawyer or the patient: to whom belongs the right to die?”, where the experts discussed the ethical and legal aspects of the refusal of the medical intervention.
Leo Brylev
The Foundation initiated the discussion, when faced with controversial situations. About them in the beginning of the discussion said the doctor-neurologist, medical Director of the charity “Live now” the lion Brylev.
For a long time, the Fund saw a woman with als. She repeatedly said that she does not want artificial life extension, including connection to a ventilator. But when her condition completely deteriorated, the family, against the wishes of the patient, called an ambulance. In intensive care, the woman lived another month and a half and died alone, completely obezdwijivanie.
Another patient, himself a doctor by profession, lived for a year at home with a ventilator. This year has brought to his family joyful moments he and his wife were married. But the patient grew weaker and gradually came to the conclusion that it becomes a burden. Being a medic, he knew that he could not ask colleagues to switch off the ventilator because it can be equated to murder. Then he stopped taking the antibiotics and nutrition and died from dehydration and infectious complications experiencing physical pain.
A part of us went with these patients, and I would like to discuss this situation today, ‘ said Leo Brylev.
Dilute the concept of “euthanasia” and “refusal of medical intervention,” said the lawyer, the General Director of “Faculty of medical law” Polina Gabay.
Pauline Gabay
– Euthanasia is clearly prohibited in the Russian Federation. But the refusal of a patient from a medical intervention, as well as the failure or termination of resuscitation – another point. Very often these situations are mixed, although they have different legal framework, says the lawyer.
The rejection of medical intervention, any person has a right, enshrined in the Federal law “About bases of health protection of citizens in Russian Federation”. While the patient is in plain text are not asked to bring his death from the legal point of view, the situation can not be regarded as conducting euthanasia.
– According to the Federal law “About bases of health protection of Russian citizens”, euthanasia is a request by a person to hasten his death by various methods, including the cessation of activities on the artificial prolongation of life. At the same time from a legal point of view in the refusal of a patient from medical care direct connection with the desire to hasten death is not. This decision can be other reasons: unwillingness to suffer, religious motives, explains Polina Gabay.
By law, the refusal of medical intervention must be made in writing with indication of the consequences of that decision.
Doctors and lawyers agree that the main difficulty in working with the patient at the end of life – to know his decision because the human mind can be confused and assess its adequacy. Relatives of a terminally ill person is not always able to give a sober assessment of the situation.
– Under the existing legislation, we are absolutely powerless. What would the patient uttered, resuscitator allegedly forced to carry out CPR. And it’s awful. In fact, we are talking about destinatii. Rarely the situation can be mitigated in terms of a painless death of the patient, – says the doctor-resuscitator Alexey Troitsky.
To avoid such situations, to know the will of the patient necessary in advance, experts say.
In the West there is a practice where a person can write a waiver of those or other medical events. And if the doctor will begin to hold them, he can then ask, – said Lev Brylev.
Diana Nevzorova
But the priorities of the patient, like his decisions over the disease can change, said Deputy Director of Moscow’s multidisciplinary center for palliative care, chief freelance specialist in palliative care, Ministry of health of the Russian Federation Diana Nevzorova.
Now he can say, “I don’t want a ventilator, I don’t want a catheter”, and after a month you can live with a catheter to see his baby grow up, she said.
Meanwhile, the right to consent to a medical intervention discussed in a number of other changes to the legislation regulating palliative care, said Pauline Gabay.
– We proposed to develop a waiver form that must be certified by a notary. But while legislation to give a waiver in advance is impossible, – said the lawyer.
Talking about death is not very accepted even in those families where there are terminally ill people, says Leo Brylev. According to him, specialists of the Foundation “Live now”, a survey conducted among the family members of deceased patients and found that 2/3 of them have never discussed with a loved one suffering from an incurable disease, as if he wanted to die. Almost all the relatives are sure that he performed the last will close.
Yet the topic of death taboo is gradually becoming common, said head of the laboratory of the Institute for social analysis and prediction Ranepa Dmitry Rogozin.
– People are much more than before, ready to talk about death. Ten years ago it was impossible to imagine a round table on this topic. In two or three such conversations are quite often a sound and television – said the sociologist.
Anna Sonkin-Dorman. Photo Anna Galperina
To hear the will of man with terminal diagnosis and the patient becomes a global trend of modern medicine, encouraged by the palliative care physician, expert of the “Live now” Anna Sonkin:
– Research in the field of interaction between doctors and patients show that the best outcome from the perspective of patient satisfaction, relieve painful symptoms, prolongation of life takes place where it is implemented in the partnership between equals. Medicine should be like this.
We cannot consider the patient as an equal. But in many cases we need to allow people to not accept the decision that we would like to take.