Why can’t euthanasia be allowed in Russia?

Bogus stories about the alleviation of sufferings before death are rather a change of civic agenda to bioethical, thinks philosopher Sergey Shevchenko

Why can’t euthanasia be allowed in Russia? Photo: alev.biz

The issue of euthanasia was discussed on social media last week. Words of head of the Ministry of Health of Russia Veronika Skvortsova became an impetus for the talks. She claimed that this issue should be resolved considering citizens’ opinion. Expert in bioethics, philosopher Sergey Shevchenko talks about the pitfalls of such voluntary termination of life and how the problem is solved abroad.

We are against the legalisation of euthanasia in Russia tomorrow already because the access to effective painkillers in our country is very unstable

Euthanasia has been recently discussed in many Russia mass media because of Minister of Health Veronika Skvortsova’s words. She claimed in the air in the studio of Komsomolskaya Pravda radio: “I won’t forecast how this issue will be resolved in our country, the population itself will have to decide if it is ready for it or not”. It is unlikely the problem of euthanasia will really be discussed to make a specific decision because the advocacy of any position on euthanasia is fraught with serious political risks. At the same time, comparable little money will be allocated for euthanasia services or psychologists’ work to solve this problem. Any infrastructural projects are much more important from this point of view.

Separate fibs about euthanasia are rather a change of civic agenda to bioethical. And it is a great pity in this respect that the serious bioethical problem can serve a simple tool for a split, even though in remotely looming public solidarity. Some conservatives, those who “are for the value of human life” are again polarised with those who “are for freedom of choice”. Here we can note that the Orthodox church and other traditional religions expressed their opinion against euthanasia a long time ago. They consider the value of human life is bigger than the value of free choice.

As strange as it might sound, the problem of palliative care is at the moment rarely raised as a topic of noticeable public discussion. It is strange because “decent death” is an important ethical benchmark in our society. One of the representatives of the palliative care system in Russia said the following about the problem: “We see the sufferings of people who have terminal illnesses more than anyone. But at the same time, we are against the legalisation of euthanasia in Russia tomorrow already because the access to effective painkillers in our country is very unstable”. And if a person suffers very much and doesn’t receive the necessary painkiller on time, it is quite natural that he wishes to stop the sufferings even by terminating his life. It doesn’t mean that it is his voluntary wish and a good solution to the problem. The person makes this decision almost under torture. It isn’t the situation one can make a well-thought-out decision on life and death.

As for Russia, apart from hospices, we have other ways of palliative care, for instance, special wards in cancer care units, the so-called “sisters’ wards”, but they aren’t widely used. The level of palliative care in Moscow is, of course, much higher than in the provinces. It approaches the level of developed countries.

Sergey Shevchenko: “As strange as it might sound, the problem of palliative care is at the moment rarely raised as a topic of noticeable public discussion. It is strange because “decent death” is an important ethical benchmark in our society”

Egregious case of Rear Admiral Apanasenko’s suicide

To sum up the level of palliative care in Russia in general correctly, one can remember the case of Rear Admiral Apanasenko who killed himself in 2014. This happened because he was suffering from cancer and wasn’t administered anaesthetic on time. As an officer, he could associate his life and fate with the homeland. And in such tough sufferings, his homeland didn’t provide him with the expected care. Due to the absence of one seal in the prescription, which wasn’t put by negligence, his relatives weren’t given the medication on time.

One can see not only a gesture of physical pain but also anguish at the disappointment in the rear admiral’s death, not only euthanasia. Of course, it is only one interpretation among a number of cases. But after this happened, a discussion about painkillers broke out. If a patient who can hope for special care has such problems, what should we say about the bulk of patients? There were made some steps simplifying the reception of strong painkillers after this case. But doctors and experts in this sphere say it isn’t enough.

In conclusion, at the moment we don’t have accessible painkilling, it is even incorrect the table euthanasia. When high-quality palliative care works for everyone, then one can start a public discussion.

Euthanasia problems in the West. Should it be applied to patients in depression?

While Russia is far from discussing euthanasia, there have been laws permitting euthanasia in the West (USA, Oregon) since 1977 already. Euthanasia was legalised in many European countries, for instance, in Switzerland, Belgium, the Netherlands as well as in Japan and some US states. Such a concept as euthanasia tourism has appeared recently. In other words, people visit a country where euthanasia is allowed, they pay money and they are killed.

Countries where euthanasia has been legalised. Photo: wikipedia.org

Stories of euthanasia that cause a great public outcry are sometimes raised in the mass media. People with clinical resistant depression in these stories ask for euthanasia because no medication improves their state. I am not ready to reproach these people, but in general this causes misunderstanding. As a rule, I see in Russian social networks that this causes reproach and comments like: “It is just murder”.

Neurodegenerative diseases such as Alzheimer’s and Parkinson's disease are another case. They look worse than cancer because a person loses his identity, and his relatives observe this gradual dissolution of identity. It is clear why the problem of euthanasia is more topical in western countries where the average lifespan is about 80 years. But at the same time in most of these countries, for instance, in the Netherlands, all citizens have access to high-quality medical care.

Even not rich medium-class representatives in the USA have situations when complications of dental diseases end with death because a dentist is expensive, while insurance often doesn’t cover his services. Euthanasia in the health care system doesn’t look a free humane decision for terminal patients in such a situation.

Let’s imagine that a person doesn’t have medical insurance, he has to pay a lot of money for cancer therapy. He will feel guilty in front of his family and can say: “I will better die than be a heavy burden for my family”. One of the important arguments against euthanasia is precisely the fact that this procedure can be used to stimulate suffering people who can’t pay for treatment to euthanasia or another way of termination of life. Such problems are raised at public discussions in many countries. These stories draw attention to the topic of social justice. In other words, euthanasia can become an “easy solution” not only for the suffering person but also for both social groups and institutions that are ready to sacrifice a lot in the fight for some economic expediency.

By Sergey Shevchenko