The Law on Palliative Care
"What is a palliative today may become curable in the future"
Irina Reznik, Mednovosti
The State Duma adopted in the third and final reading the law on palliative care, designed to resolve the problem that has caused such a heated discussion in society in recent years, and promises to keep its implementation under control. In the professional community, the changes are welcomed, although they admit that they do not solve all the problems so far.
There are a huge number of serious patients in Russia who need constant supportive therapy. As for people who have come to the end of their lives, palliative care is required for every second. But not everyone gets it: most patients in the terminal stage are completely abandoned, only relatives or employees of social institutions are trying to solve their problems, where those who do not have relatives get to. Of course, this cannot be considered the norm: in the civilized world, doctors try to help maintain the quality of life even for doomed people.
The new law clarifies the concept of "palliative medical care" and defines the procedure for its provision in outpatient settings and at home, as well as the procedure for social services for terminally ill people. The document regulates the provision of narcotic and psychotropic painkillers, and also establishes the right of terminally ill patients to receive medicines for free not only in inpatient conditions, as it was before, but also in a day hospital at their place of residence.
In addition, after the entry into force of the document, patients with serious illnesses will be able to apply for free provision at home with medical products "designed to maintain the functions of organs and systems of the human body." The complex of mandatory measures will also include psychological support for patients and their relatives. The procedure for providing assistance will be established by the Ministry of Health in its by-laws, while providing it, hospitals will be able to interact with social service organizations, public associations and NGOs.
Speaking at the parliamentary hearings "Legislative provision of palliative care in the Russian Federation", the chairman of the State Duma Committee on Health Protection Dmitry Morozov drew the attention of their participants to the fact that palliative care is required for patients with a variety of diseases, therefore the forms and conditions of such care should also be different. "A child who requires long–term respiratory support is one clinical situation, a patient with multiple metastases who needs to be anesthetized is another, an elderly person fading from NMC is the third," Morozov explained. – At the same time, we must be very careful in definitions, because what is a palliative today may become curable in the future. This area is very heterogeneous, and of course we need a clear state model with clear funding for each of these areas."
Such regional models of palliative care organization, which, with amendments to geographical, demographic and economic indicators, could be taken as a basis in each subject of the Russian Federation, were developed and proposed by a group of experts led by the Chairman of the Board of the Russian Association of Palliative Medicine, Head of the Department of Palliative Medicine of the Moscow State Medical University named after A.I. Evdokimov, Professor Georgy Novikov.
The models include the possibility of outpatient care in palliative care offices and at home by visiting nursing teams, assistance in day care and inpatient settings. Inpatient care is provided in palliative care centers/hospitals, palliative care units, hospices (medical and social care with the use of opioid analgesics) or in the nursing department (medical and social care without the use of opioids).
According to the Association's experts, from 37.4 to 89% of all dying patients need palliative care. However, today there are only 12 thousand inpatient beds in our country, where palliative patients receive the necessary complex of medical interventions, and 16 thousand beds for patients in need of medical and social assistance (nursing homes/departments, hospices). And this, of course, is very little.
According to Professor Novikov, in order to provide high-quality palliative care, it is necessary, first of all, to determine its real need, to continue the development of palliative care in multidisciplinary hospitals and oncological dispensaries, as well as to open a hospice in each region to help cancer patients in the terminal stage of the disease. In addition, palliative care centers (either independent or on a functional basis on the basis of medical organizations, for example, a multidisciplinary hospital or a hospital for war veterans) should be established at the level of federal districts, territories, republics and regions.
"According to the results of an epidemiological study conducted by the Moscow State Medical University named after A.I. Evdokimov on the instructions of the Ministry of Health of Russia, at least 20% of patients need the use of instrumental methods of palliative care," the expert said. – And this assistance could be financed from the funds of the CHI. This would solve many problems in the provision of palliative care using instrumental methods of treatment (recanalization of hollow organs, puncture of cavities and vessels, stenting, various blockades, implantable pumps and dispensers)."
The new law finally gives the "green light" to day hospitals, which can become an outlet for many families of incurable patients, especially when it comes to sick children. However, while there are still no hospitals/palliative care centers in the Procedures for providing palliative care, de facto existing in a number of regions, the expert notes. In addition, at present, the palliative care unit is included only in two Procedures for providing medical care – in the profiles "Oncology" and "Geriatrics". "It is quite obvious that the provisions on such assistance should be included in the Procedures for providing medical care in other fields: cardiology, pulmonology, rheumatology, neurology and endocrinology, etc.," Georgy Novikov believes. – And doctors of medical specialties should have a modern methodology for the treatment of chronic pain, symptom control and psychological support for patients and their loved ones."
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