Palliative Care in Russia: Medical Law and Spiritual Practice
Nataliya Shok, DSc, Professor, Department of Social and Humanitarian Sciences, Privolzhsky Research Medical University
In recent years, the issue of treating the syndromes of pain has become increasingly important. As Russian law currently states, ‘the patient has the right to the relief of pain caused by illness and (or) by a medical issue as appropriate with available methods and medical products’. This is stated in Federal Law No. 323, dated 21 November (Article 19, Clause 5). In addition, the patient has the right to palliative medical care which ‘provides a series of medical interventions dedicated to mitigating pain and relieving other serious symptoms of illness with the aim of improving the quality of life of terminally ill citizens’ (Article 36). This provides legal protection for the rights of patients regarding acute and chronic pain; it also adds the provision that the state will finance such care. For example, in 2015 Russia developed a nationwide programme for providing palliative care to its adult population, as well as a similar program to deliver such care to children. However, there are no requirements for a medical specialization for those responsible for treating the syndromes of illness.
Another point is that the legislation regarding palliative care is deeply secular. That is why the activities of the Russian Orthodox Church and its small non-profit organizations that provide spiritual and moral support for seriously ill patients remain outside its framework. Among the personnel of such organizations there are charity nurses, social workers and volunteers. In 2011, an agreement was signed between the Russian Orthodox Church and the Ministry of Health, under which training of charity nurses and volunteers was initiated. Most sisters of mercy provide assistance from outside the hospital staff. Today, the Association of Sisterhoods of the Russian Orthodox Church consists of 120 small communities that provide spiritual and social support: they communicate with priests on issues of spiritual assistance; they assist priests in meeting requests of patients for occasional religious rites, prepare the sick for the sacraments of confession, communion, baptism, and accompany the patients to church services.
Palliative care in Russia today is in a dual situation: from the one side, there is no formal 'physician for palliative care' qualification, specialist training programs for higher medical training; another side is the need to legislate a wider understanding of palliative care, including spiritual support, as well as the formation of a positive public opinion.
Another point is that the legislation regarding palliative care is deeply secular. That is why the activities of the Russian Orthodox Church and its small non-profit organizations that provide spiritual and moral support for seriously ill patients remain outside its framework. Among the personnel of such organizations there are charity nurses, social workers and volunteers. In 2011, an agreement was signed between the Russian Orthodox Church and the Ministry of Health, under which training of charity nurses and volunteers was initiated. Most sisters of mercy provide assistance from outside the hospital staff. Today, the Association of Sisterhoods of the Russian Orthodox Church consists of 120 small communities that provide spiritual and social support: they communicate with priests on issues of spiritual assistance; they assist priests in meeting requests of patients for occasional religious rites, prepare the sick for the sacraments of confession, communion, baptism, and accompany the patients to church services.
Palliative care in Russia today is in a dual situation: from the one side, there is no formal 'physician for palliative care' qualification, specialist training programs for higher medical training; another side is the need to legislate a wider understanding of palliative care, including spiritual support, as well as the formation of a positive public opinion.