Hospice Pain

coping with end of life

A spate of suicides in Russia by terminally ill cancer patients has made end of life care a major topic of public discussion. Eleven such suicides were reported in Moscow in the first three months of this year, most attributed to excruciating pain, despite the fact that the capital accounts for 40 percent of all painkiller “consumption” in the country.

The difficult ordeal of securing opiates to ease patients’ cancer pain was the subject of government meetings and outraged editorials. Getting needed pills can require waiting in line for hours – first at one’s local clinic, then at a specialized cancer facility (often on the other side of town). The prescription is only valid for a few days, so if the drugstore in one’s area does not have that specific medication, it means repeating the ordeal all over again, all within the bounds of the nine-to-five workday.

Needless to say, getting pain relief during long holiday stretches, like the 12-day marathon in early January, is impossible. The process has long been criticized as inhumane, and doctors writing prescriptions find themselves in a bind, often refusing to prescribe something strong, like morphine, for fear they will be charged with dealing drugs.

The health ministry has taken some steps to make the process more humane: increasing the number of days a prescription is valid and no longer requiring patients to return used pain relief patches to the hospital. But the process is still painfully slow. Instead of solving the problem, the government is actually warning publications not to write about it. Roskomnadzor, the media and internet watchdog, made two warnings to the Orthodox website Pravoslavie i Mir (Orthodoxy and the World) after it posted stories about suicides, saying that publishing such information violates stringent child-protection rules against publishing information about drugs and instructions for committing suicide.

“Doctors try to avoid (writing prescriptions for painkillers), convincing the patient that their pain level is not a seven, but a five (on the scale of 1 to 10). Then the doctor will have less hassle, less paperwork, which, if filled out incorrectly, can lead to a prison sentence.”

Nyuta Federmesser, head of the privately-run Vera Moscow Hospice, which specializes in treating
terminal cancer patients. (Novaya Gazeta interview)

“The victim’s wife explained that her husband suffered from constant pain due to cancer and often told her that he was tired of the illness.”

The quote Roskomnadzor demanded be edited out of a Pravoslavie i Mir story.

“If we can’t say that a person committed suicide, then obviously we soon won’t be able to say that a person died at all, but then what should we write? That he was suddenly resurrected, rather than committed suicide? And why?... The first thing we need to do is stop the pain, we have to fight the pain, and then we can discuss the consequences of covering this and whether journalists are using the right words.”

Anna Danilova, editor of Pravoslavie i Mir (to Kommersant)

“According to our laws, the patient is either covered under state insurance and receives everything for free, or he is paying out of pocket for everything. Today, doctors prefer not to prescribe any treatment, because the hospital cannot afford it, rather than to prescribe something – this is the problem.”

Pavel Trakhtman, department head at the Rogachev Children’s Cancer Clinic in Moscow, on how the declining value of the ruble means that state funding now only covers about a quarter of the cost of treating a patient, as many medications and chemotherapy drugs are imported. (BFM.ru)

Several doctors have been convicted on drug-related charges after giving out prescriptions for painkillers to patients in pain.

Aleftina Khorinyak, a doctor in Krasnoyarsk, prescribed Tramadol to a patient who was attached to a different clinic, after his family begged her for help during the long May holidays in 2009. Two years later, in 2011, Russia’s drug control agency opened an investigation of Khorinyak, accusing her of drug trafficking. Prosecutors asked the court to jail Khorinyak for nine years. She was convicted in 2013, but after a public outcry, her conviction was overturned. Her case led to some improvements in pain treatment access.