home > Literature > The right to the truth about the latest diagnosis. Questions for self-control

The right to the truth about the latest diagnosis. Questions for self-control

Ethics of genetics

Key concepts: terminal states, clinical and biological death, "brain death", persistent vegetative states, resuscitation, active and passive

euthanasia, "social" euthanasia and "euthanasia of newborns", palliative medicine, hospice, personality, individual, body, "border situation", ethics, genetics, genomics, genome, gene therapy, prenatal diagnosis, eugenics, "new eugenics", transgene , nature, human, personality, freedom, genetic passport, artificial selection, biopolitics, totalitarianism, dignity of the individual, gene patenting, predictive medicine, the Human Genome Project.

Thematic plan of the seminar.

1. Understanding death and dying in various cultural and philosophical traditions.

2. The problem of human death criteria and moral and ideological understanding of personality. History of resuscitation. Biological and clinical death. The problem of brain death.

4. Psychology of terminal patients. The concept of E. Kübler-Ross “death as a “growth stage””. The right to the truth about the latest diagnosis. Palliative medicine.

5. Worldview foundations of "death support" The value of human life and the principle of autonomy of the human person (metamorphoses of humanism). Definition, types and forms of euthanasia. The problem of suicide and euthanasia. Euthanasia in Nazi Germany. Legislative prohibition of euthanasia in Russia. Hospice movement against the legalization of euthanasia.

7. The problem of attitude to the dead body. Lessons in the history of pathological anatomy. Moral and ethical problems of autopsy.

8. History of genetics. International research project "Human Genome": features, results, prospects. “Universal Declaration on the Human Genome and on Human Rights” (UNESCO, 1997). Gene Patenting: An Ethical and Legal Assessment.

9. Ethical principles of genomics:

A) privacy and confidentiality of genetic information(family, insurance companies, employers);

b) autonomy(voluntariness, awareness);

V) justice(incurable diseases, eugenics);

G) equal accessibility(free exchange of scientific information or

patenting);

e) quality(laboratory licensing and ethical review).

10. Therapeutic and predictive medicine - a paradigm shift. Ethical problems of applying the methods used by medicine for the diagnosis and correction of mutant genes (genetic screening and testing, genealogical method, prenatal diagnosis). Moral aspects of medical genetic counseling (directive and non-directive model).

11. Types of gene therapy - compensation for genetic defects (correction of a mutant gene) and the introduction of new properties into the cell (gene as a medicine). The degree of admissibility of interference in the human genetic apparatus. Genetic harm (changing the properties of existing organisms), genetic risk (the emergence of new dangerous organisms) and the problem of genetic security.

12. Ethical problems of germ cell gene therapy. Eugenics. Liberal and conservative assessment of the possibilities of changing and (or) improving human nature. Moral and ethical aspects of gene therapy of somatic cells. “Do No Harm” - the rationale for the priority of the therapeutic effect of gene therapy intervention over the possibility of causing damage. Adverse effects of somatic cell gene therapy.

13. Transgenic animals and plants. "Green revolution". Law of the Russian Federation “On state regulation in the field of genetic engineering activities” (1996).

14. Ethical corridor of stem cell transplantation technologies. Embryo Status and Moral and Ethical Problems of Therapeutic Cloning. Position of Christian Churches in Europe.

Topics of reports:

1. Resuscitation and moral and ethical problems of "dying management".

2. Medical criteria for human death: moral problems.

3. The problem of the equivalence of brain death and human death.

4. Influence of the patient's depressive self-assessment on the doctor's confidence in the hopelessness of the cure.

5. Truths and lies about "easy death" in medicine and the media (media). (How and why does the media create the image of an “easy death”?)

6. Professional ethics as a form of self-defense of the doctor's personality.

7. The moral responsibility of the doctor "in the face of death."

8. Roman F.M. Dostoevsky "Crime and Punishment" and problems of modern bioethics.

9. The problem of experiencing death in the work of L. N. Tolstoy “The Death of Ivan Ilyich”.

10. The phenomenon of “criminal statehood” (Karl Jaspers on the legalization of euthanasia in Nazi Germany).

12. Gene therapy: hopes and dangers.

13. International documents on ethical and legal regulation of human genome research.

14. Treatment with genes - fantasy or reality?

15. XXI century medicine and bio-power.

16. Eugenics as a form of solving the problem of quality and quantity of people.

7. Positive and negative eugenics.

8. The power of biotechnology and biopolitics.

Abstract topics:

1. "Physics" and "metaphysics" of death.

2. Euthanasia: the history of the problem.

3. The right to the truth about the latest diagnosis.

4. Attitude to the dead body in philosophical anthropology and pathological anatomy.

5. Death and dying as a stage of life.

6. Criteria for the death of a person and the status of a person.

7. History and logic of eugenics

8. Genomics under the “ethical microscope”.

9. Human cloning and the crisis of European humanism.

10. "Green Revolution": today and tomorrow.

11. Transgenic organisms and ecological catastrophe.

12. Moral assessment of biotechnology.

13. Therapeutic cloning in the context of the spiritual and moral dilemma "God-manhood-man-God".

Control questions:

1. What distinguishes and unites the concepts: “genome”, “genomics”, “gene therapy”, “medical genetics”?

2. Why and how is “predictive medicine” related to bioethics and biopolitics?

3. What is the moral and ethical inadmissibility of "artificial selection" in relation to a person?

4. What is the “genetic risk” of gene therapy procedures?

5. Can genetic engineering be ethically acceptable and genetically safe?

6. What is the difference between “old” and “new” eugenics?

7. List five ethical principles for the study of the human genome.

11. What is the content of the principle equal accessibility?

13. What is the basis of the ethical argumentation of the inadmissibility of germ cell gene therapy?

14. What is preferable from the point of view of the ethics of science - the right of ownership of the discovery or the right to free access to scientific discoveries?

15. Under what conditions can a “genetic passport” restrict a person's freedom?

16. What are the moral and ideological grounds for the liberal recognition of the acceptability of human cloning?

17. What is the motivation for the cognitive activity of a conservative scientist?

18. List specific examples of "utopian activism" in the history of science.

Is euthanasia prohibited by law in Russia, if so, in what documents?

19. What are the main arguments of the opponents of euthanasia.

20. What are the criteria currently used to ascertain the death of a person in Russia?

21. What are hospices and are there any in Russia?

22. What types of care are provided to patients in the hospice?

23. Is it legal for a doctor to give a terminally ill patient a diagnosis?

24. Name the main arguments of the opponents of perjury in medicine.

25. What are the limits of reliability of an unfavorable medical prognosis and diagnosis considered as grounds for active euthanasia?

Mandatory literature:

1. I.V. Siluyanova. Bioethics in Russia: values and laws. M. 2001., pp. 101-120.

2. Introduction to bioethics. Ed. B.G. Yudin, P.D. Tishchenko. M.1998.

3. V.I. Ivanov, V.L. Izhevskaya, E.L. Dadali. Bioethical problems of medical genetics. / Medical law and ethics. 2002, no. 4, p. 41-67.

4. Favorova O.O., Kulakova O.G. Bioethical problems of gene therapy. / Medical law and ethics. 2002, No. 4, pp. 87-101.

5. Federal Law “On a temporary ban on human cloning” dated May 20, 2002, No. 54-FZ.

6. Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens of 22.07.1993. No. 5487-1

7. Federal Law "On State Regulation in the Field of Genetic Engineering Activities" dated 05.07.96 86-FZ

8. Ethical and legal aspects of the project "Human Genome" (International documents and analytical materials). M.1998.

9. Ivanov V. I., Izhevskaya V. L. Human genetics: ethical problems of the present and future. Problems of Eugenics / Biomedical Ethics. Ed. Pokrovsky V. I. M., Medicine, 1997.

10. Grishina E. M., Ivanyushkin A. Ya., Kurilo L. F. Moral and ethical aspects of determining and choosing the sex of the fetus / / Medical Law and Ethics, M. - 2001, - No. 2, - p. 40-48.

Additional literature:

1. Altukhov Yu. P. About human cloning / Orthodoxy and problems of bioethics. Ed. prof. Siluyanova I. V. M., 2001, p. 67-71.

2. Balashov N. New achievements in the field of genomics: the view of an Orthodox Christian. / Medical Law and Ethics. No. 4, 2000, p. 39-50.

3. Zelenin A.V. Gene therapy: ethical aspects and problems of genetic safety. / Genetics., 1999, Vol. 35, pp. 1605-1612.

4. Obukhov M. Will humanity cross the “fatal line”? / Orthodoxy and problems of bioethics. Ed. prof. Siluyanova I. V. M., 2001, - p. 64-67.

5. Fundamentals of the social concept of the Russian Orthodox Church. Chapter XII.

Bioethics. / Newsletter of the Department for External Church Relations of the Moscow Patriarchate. 2000, no. 8, p. 77-80.

6. Tishchenko P. D. Bio-power in the era of biotechnology. M., 2001, 177 p.

7. Favorova O.O. Treatment with genes - fantasy or reality? / Sorovsky educational journal. 1997, No. 2, p. 21-27.

8. . Elisabeth Kübler-Ross. About death and dying. Per. from English. K. "Sofia", 2001. 320 p.

9. Voyno-Yasenetsky V.F. Essays on purulent surgery. M., Medgiz., 1946.

10. Andrey Kuraev, deacon. Christian philosophy and pantheism. M., 1997. p. 23.

11. Heidegger M. Overcoming metaphysics / Time and being (articles and speeches). M., 1993, p. 189-190.

12. Barbour Yen. Religion and science: history and modernity. M., 2000, p. 229.

13. Rozanov V.V. Regarding one concern, Mr. L.N. Tolstoy / The Legend of the Grand Inquisitor F.M. Dostoevsky. M., 1996.

14. Anatoly (Berestov) hieromonk. Medical and moral problems of euthanasia. / Orthodoxy and problems of bioethics. M., Life, 2001, p. 23-27.

15. Berdyaev N.A. Experience of Eschatological Metaphysics / The Kingdom of the Spirit and the Kingdom of Caesar. M., 1995.

16. Lossky V.N. Theological concept of the human person / Theology and Theophany. M., 2000.

17. Florovsky George. Metaphysical premises of utopianism / The Way, No. 4. Paris, 1926,

Lesson 5.

Moral problems of organ and tissue transplantation.

Ethical and legal aspects of psychiatry and psychotherapy.

Key concepts: transplantology, donor, recipient, (homo-), (allo-), transplant, commercialization, brain death, persistent vegetative state, personality, organ explantation, routine sampling, presumption of consent (“unsolicited consent”), presumption of disagreement (“solicited consent”) ”), “donor card”, “organ donation”, waiting list, histocompatibility, xenotransplantation, rejection, xenozoonosis, fetal tissues, nonviolence, utilitarianism, altruism psychiatry, psychology, consciousness, unconsciousness, psychopathology, personality development, worldview, capacity, involuntary / forced hospitalization, human rights, "punitive psychiatry", criminal and civil law, psychotherapy, personality, etiology of psychopathy, deviation, sexopathology, "sexual revolution", drug addiction, classification of psychopathologies..

Thematic plan of the seminar.

1. Transplantation: history of development. The main ethical problems of transplantation. Legal contradictions in domestic legislation and

their ethical grounds (Criminal Code of the Russian Federation (Article 120), Law of the Russian Federation “On Transplantation of Human Organs and (or) Tissues” (1993), Law “On Burial and Funeral Business” (1996), international documents).

2. The problem of commercialization of transplantation. Moral and ethical grounds for the ban on the sale and purchase of human organs and (or) tissues.

3. Development of neuroresuscitation and formation of criteria for brain death. The definition of "brain death": medical (level), philosophical, moral, ethical and legal problems. Persistent vegetative states. Precedents for the rehabilitation of patients with persistent vegetative states. The specifics of the attitude of staff towards patients in a persistent vegetative state and their relatives.

4. Basic ethical and organizational requirements (principles) to ascertaining the death of a person according to the criteria of brain death: principle unified approach, principle collegiality, principle organizational and financial independence of brigades.

5. Ethical principles of explantation (withdrawal) of organs and tissues from a corpse. Types of regulation: routine fence, presumption of consent, presumption of disagreement. Arguments of supporters of the presumption of disagreement.

6. Basic ethical and legal principles of organ harvesting from a living healthy donor. Donor rights.

7. Problems of distribution of donor organs. Medical and ethical criteria for a fair distribution of donor organs (waiting list): histocompatibility, urgency, priority.

8. Xenotransplantation long-term risk assessment. Medical reasons for not using animal organs.

9. Moral and ethical aspects of the use of organs from incompetent donors (children, mentally ill persons) and donors with a sharp restriction of freedom of choice (prisoners sentenced to death).

10. Moral and ethical aspects of the unacceptability of the use of fetal tissues in transplantology.

11. Psychopathology and culture. Features of psychiatry as a medical discipline. Significance of the sociocultural context for psychiatry and psychotherapy. “The image of a person” and the concept of “disease” in psychiatry and psychotherapy. The meaning of psychiatric explanatory concepts (mythological, mechanistic, energy, organic, mental theories). Natural science (biological, anatomical and physiological) model in psychiatric thinking and the formation of scientific psychiatry. Worldview and the problem of the etiology of mental illness ("psychopathy", "obsession", "viciousness", "foolishness", "bliss", "wretchedness").

12. Features of the relationship between the doctor and the patient in psychiatry and psychotherapy. Patient incompetence and vulnerability. Physician's personal responsibility. Features of the “do no harm” principle in medical interventions in psychiatry and psychotherapy.

1Z. Freud on the specifics of the relationship between a doctor and a patient in psychiatry (the concepts of “transfer” and “countertransfer”). The specifics of medical secrecy in psychiatry. Mercy and respect for the human dignity of persons with mental disorders. The concept of “professional independence” and legal guarantees for the protection of the professional independence of a psychiatrist.

14. Abuse of psychiatry. Instruction of the Ministry of Health, the Ministry of Internal Affairs, the Ministry of Justice, the Prosecutor General of the USSR of 1948 “On the procedure for the application of compulsory treatment and other medical measures in relation to mental patients who have committed a crime.” The concepts of "political psychiatry", "punitive psychiatry", "independent psychiatry". Forensic psychiatric examination.

Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens in its provision” (1993) Moral and ethical aspects of consent and refusal of psychiatric care. Grounds for hospitalization and involuntary treatment. Rights of a patient in a psychiatric hospital (Article 37).

15. Ethical problems of medical sexology and sexologists. The role of moral and ideological orientations in understanding the "norm" and "pathology" of sexual behavior. International Classification of Diseases 8th (1965), 9th 9th (1975), 10th (1993) Revision: the concepts of “sexual perversion” and “sexual preference”. Two European sexual revolutions. Mental health and moral culture.

16. Drug addiction. Moral and ethical foundations and psychiatric methods of overcoming drug addiction. Modern mass culture and drugs. Christianity as a spiritual and practical antidote to drug addiction.

Topics of reports:

1. 1. Contradictions of legal regulation of transplantation and their ethical grounds.

2. Medical criteria for the death of a person and the moral status of a person.

3. Persistent vegetative states and brain death: the problem of equivalence.

4. Ethical and legal problems of the distribution of donor organs and ways to solve them.

5. Comparative characteristics of the presumption of consent ("unsolicited consent") and the presumption of disagreement ("solicited consent").

6. World experience in solving the problem of graft removal from living and deceased donors.

7. Moral problems of searching for a “potential donor”.

8. Danger of reification of human organs and tissues in transplantology.

9. Materialism in psychiatry.

10. Depressive disorders in the light of moral anthropology.

11. Personality structure and psychosomatics.

12. Is there a crisis in the relationship between the doctor and the patient?

13. Counseling and psychotherapy: is commonality possible?

14. Principles of organization of monastic counseling. Constantinople hospitals.

15. The first and last classifications of psychoses - a comparative analysis.

16. Forensic psychopathology

17. The ideological "testament" of Pinel.

18. Spiritualism on the etiology of psychoses.

19. The dispute between "psychics" and "somatics".

20. The lack of unity of "scientific" views as a methodological and ethical problem of psychology, psychiatry and psychotherapy.

21. Lombroso and criminal anthropology (genius and insanity).

22. “Antipsychiatry” is a cultural phenomenon of the 20th century.

23. K. Jaspers and the basic concepts of “general psychopathology”.

24. Modern theories of personality psychopathology.

Abstract topics:

1. Ethical problems of transplantation.

2. The principle of utility in utilitarianism.

3. Commercialization of transplantology and the principle of justice.

4. The problem of the relationship between social and biological in human death.

5. Xenotransplantology: medical and ethical problems and prospects.

6. Psychotherapeutic pluralism as an ethical problem.

7. Ethics and philosophy of psychopathology.

8. Methodological role of the ethical and philosophical worldview in psychiatry.

9. The essence of personality as the main problem of psychopathology.

10. Modes of scientific character in psychiatry.

11. "The image of man" in modern psychotherapy.

12. “Political psychiatry” and “independent psychiatry” are reasons for incompatibility.

13. Europe: two sexual revolutions.

14. Drug addiction as a form of personality psychopathology.

15. Humanitarian and natural science paradigms in psychiatry.

Control questions:

1. What are the main legal documents regulating transplantation in Russia?

2. Who performed the world's first successful human heart transplant?

3. Is it permissible, according to our domestic and foreign legislation, to buy and sell human organs and (or) tissues?

4. 4. What are the criteria for the death of a person (tradition and innovation)?

5. Are the concepts of "persistent vegetative state" and "brain death" equivalent?

6. What are the three main ethical and organizational principles that should be followed when ascertaining the death of a person according to the criteria of brain death?

7. What is the presumption of consent and the presumption of disagreement of the donor?

8. What kind of presumption is the most ethically acceptable?

9. What kind of presumption is legally fixed in Russia?

10. Is it possible to use organs and tissues of a living healthy donor in Russia, if “yes”, what are the sufficient (mandatory) conditions that must be met?

11. What criteria underlie the decision made by physicians when distributing donor organs to recipients?

12. Name two main reasons why xenotransplantation cannot go beyond the scope of a scientific experiment and become a clinical practice.

13. What is the moral evil of trafficking in human organs?

14. Is it logical to say that a person retains the right to his body after death?

15. Is it possible to provide a natural scientific justification for donation?

16. Is it moral to extend the life of some people at the expense of others?

17. Does death have an ethical meaning?

18. . How does the dependence of psychiatry, psychology and psychotherapy on the sociocultural context manifest itself? Give examples.

19. Why is the understanding of personality a major problem in psychopathology?

20. What are the limitations of the natural science model of psychiatric thinking?

21. What is the main difference between psychiatry and other medical disciplines?

22. Does psychology study the “soul” of a person?

23. List the features of the relationship between the doctor and the patient in psychiatry.

24. Is it possible to carry out property transactions with a patient when providing psychiatric care?

25. List the rules prohibiting intimate relationships between a doctor and a patient (AMA).

26. Expand the content of the concept of "professional independence of a psychiatrist."

27. List the rights of a patient in a psychiatric hospital (Article 37 of the Law of the Russian Federation “On Psychiatric Care”).

28. Medical secrecy in psychiatry and surgery: what is the difference?

29. Name the permissible and possible forms of cooperation between a psychiatrist and a priest.

30. What is the difference between the concepts of “sexual perversion” and “sexual preference”?

31. Is it permissible to provide pastoral assistance to a drug addict in psychiatric treatment? Why?

Mandatory literature:

1. Siluyanova I. V. Bioethics in Russia: values and laws. M., 2001, pp. 161-174.

2. Law of the Russian Federation "On transplantation of human organs and (or) tissues" dated 22.12.1992. No. 4180-1.

3. Instructions for ascertaining the death of a person based on the diagnosis of brain death. / Medical Law and Ethics, 2000, No. 3, p. 6-14.

4. Shumakov V. I., Tonevitsky A. G. Immunological and physiological problems of xenotransplantation. M., Science. 2000. 144 p.

5. Introduction to bioethics. Ed. B.G. Yudin, P.D. Tishchenko. M.1998.

6. Sgreccia Elio, Tambone Victor. Bioethics (textbook). M., 2002, pp. 322-345.

7. Mirsky M. B. History of Russian transplantology. M., Medicine. 1985.

8. Stetsenko S. G. Regulation of donation as a factor in the regulation of transplantation. /Medical Law and Ethics. 2000, no. 2, p. 44-53.

9. Salnikov V. P., Stetsenko S. G. Transplantation of human organs and tissues: the problem of legal regulation. St. Petersburg, 2000.

10. Council on Ethical and Judicial Affais AMA - Ethical Issues in the Distribution of Organs for Transplantation. Arch.Jntern. Med. 1995, 155, 29-40.

11. Federal Law “On burial and funeral business” dated 12.01.1996, No. 8-FZ.

12. Constitution of the Russian Federation (12.12.1993)

13. Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens of 22.07.1993. No. 5487-1

14. Law of the Russian Federation "On psychiatric care and guarantees of the rights of citizens in its provision" dated 02.07.1992. No. 3185-1

15. Law of the Russian Federation "On medical insurance of citizens of the Russian Federation" dated 28.06.1991 No. 1499-1

16. Federal Law "On Narcotic Drugs and Psychotropic Substances" of 08.01.1998 No. 3-FZ

17. Korkina M.V., Lakosina N.D., Lichko A.E. Psychiatry. M. Medicine. 1995

18. Clinical psychiatry. Translation from English. supplemented. Ch. editor T.B. Dmitriev. M .: "Geotar-medicine". 1998.

19. A. Kempinski. Existential psychiatry. M.-S.-Petersburg. 1998.

20. T.B. Dmitrieva Psychiatry as an object of ethical regulation./ Actual problems of bioethics in Russia. Materials of the International scientific-practical conference. M., -2000, - p. 58-68.

21. Ethics of practical psychiatry. Guide for doctors. Ed. prof. V.A. Tikhonenko and A.Ya. Ivanyushkin. M. RIO GNTSSiSP them. V.P. Serobsky. 1996.

22. Jaspers K. General psychopathology. M. Practice. 1997.

23. Bryazhnikov N.S. Ethical problems of psychology. Teaching aid. MPSI, M., 2002.

Additional literature:

1. 1.Transplantology. Management. Ed. Academician V. Shumakova. M. 1995.

2. Belyaev V. Head of Professor Dowell. Amphibian Man. M. 2002.

3. Bulgakov M. Heart of a dog. Sobr. op. in five volumes. T. 3, M., 1989, pp. 119-211.

4. Fundamentals of the social concept of the Russian Orthodox Church. Chapter XII. Bioethics./ Newsletter of the Department for External Church Relations of the Moscow Patriarchate. 2000, No. 8, pp. 80-81.

5. Mironenko A. Cannibalism at the end of the twentieth century. Transplantation: ethics, morality, law./ Medical newspaper. No. 11, November, 2000, p. 16-17.

6. Avdeev D.A. Spiritual essence of mental disorders. M. Russian chronograph. 1998.

7. Bratus B.S. Christian and secular psychotherapy. / Moscow Psychotherapeutic Journal. No. 4, 1997, pp. 7-20.

8. Spiritual foundations of drug addiction. Ed. hierom. Anatoly (Berestov). M.2002.

9. Kannibakh Yu. History of psychiatry. Moscow. MDG IHL VOS.1994.

10. Markova N.E. Cultural intervention. M. 2001.

11. Melekhov. D.E. Psychiatry and problems of spiritual life./Psychiatry and actual problems of spiritual life. M. St. Philaret Moscow Higher Orthodox Christian School. 1997.p.5-62.

12. Metropolitan Anthony of Surozh. Spirituality and sincerity. / Moscow Psychotherapeutic Journal. No. 4, 1997s. 27-33.

13. Mikhailov G. Our soul. Ontology of psychic reality. St. Petersburg, 1999.

14. Fundamentals of the social concept of the Russian Orthodox Church. Chapter XI. Health of the individual and the people. / Newsletter of the Department for External Church Relations of the Moscow Patriarchate. 2000, no. 8.

15. Prokopenko. A.S. Mad psychiatry. Secret materials on the use of psychiatry in the USSR for punitive purposes. M. "Top Secret". 1997.

16. Siluyanova I.V. Bioethics in Russia: values and laws. M. Chief doctor. 2002. pp. 120-138.

17. Foucault M. The history of madness in the classical era. St. Petersburg. 1997.

Annex 1

Glossary

abstinence- abstinence from the use of psychoactive substances.

advocacy- actions and measures that influence people who make socially significant decisions.

Questionnaire- a type of questionnaire used to collect data in a public opinion poll. The questionnaire is a document containing a set of questions formulated and interconnected according to certain rules.

Outreach work(English outreach - external contact) - a form of promotion of services provided by medical services and public organizations to the target community.

Safe conditions for humans- the state of the environment, in which there is no danger of the harmful effects of its factors on humans;

Secondary exchange of injection equipment- a form of work in which a significant amount of syringe exchange occurs through the so-called "secondary networks". These can be pharmacies and health clinics or, more commonly, networks of project volunteers who are drug users.

State sanitary and epidemiological rules and regulations - regulatory legal acts that establish sanitary and epidemiological requirements (including criteria for the safety and (or) harmlessness of environmental factors for humans, hygienic and other standards), non-compliance with which creates a threat to human life or health, as well as the threat of the emergence and spread of diseases;

State Sanitary and Epidemiological Supervision– activities to prevent, detect, suppress violations of the legislation of the Russian Federation in the field of ensuring the sanitary and epidemiological welfare of the population in order to protect the health and environment of adults and children.

Narcotics Anonymous groups- a social movement of self-help groups that aim to recover from drug addiction. Founded by analogy with the earlier movement "Alcoholics Anonymous". Drug addiction treatment in groups is carried out according to the "12 Steps" program - a system of recovery based on the recognition of one's addiction and communication with the "Higher Power".

Mutual Aid Group- regularly gathering groups of people united by a common life problem or situation. The organizers and responsible persons in the group are the participants themselves. The group can be led by a facilitator who must also share the problem or situation that brings the other members together. Self-help groups are recognized as an effective method for improving the quality of life and developing the activism of people with chronic diseases belonging to stigmatized groups.

support groups- regularly gathering groups of people united by a common problem or situation. They serve to exchange experience, information and provide support. The organizer of such groups is a public or state organization. The group is led by a professional facilitator, usually a member of the host organization. Support groups are considered to be an effective method for improving the quality of life of people, especially those living with chronic diseases and those belonging to stigmatized groups.

Risk group (At - risk population).- a group whose members are vulnerable or may be harmed by certain medical, social or environmental circumstances; the group in which the implementation or implementation of the intervention program is planned.

Group social- a relatively stable set of people united by a common interest, as well as cultures, values and norms of behavior that are in more or less systematic interaction.

Volunteer (volunteer)- a person who voluntarily, i.e. of his own free will, he decided to devote part of his life to other people, helping them cope with life's difficulties. Volunteers are people of various professions, ages, social strata who have realized that there are problems in the world that can only be dealt with by everyone together.

Volunteer- a person who voluntarily participates in any activity that does not provide for material reward. In public and state organizations - a person who works in them without pay. Volunteering is usually associated with ideological and social motives.

Discrimination- unreasonable restrictions on the rights and freedoms of people, usually because of their belonging to a group stigmatized in society. It is a direct consequence of stigma.

Access to care (access to care) - the degree of proximity to the population of the necessary health services and the adequacy of satisfaction of patients, taking into account their demographic characteristics and incomes, with medical care (in terms of time, volume and quality).

Morbidity- an indicator of public health that characterizes the prevalence, structure and dynamics of registered diseases among the population as a whole or in its individual groups for a certain period of time (year) and serves as one of the criteria for evaluating the work of a doctor, medical institution, health authority.

Illness (illness)- any subjective or objective deviation from the normal physiological state of the body.

task- a measurable state or level of an object (process, phenomenon, system) at each stage of achieving the final goal, which has an appropriate justification and time limits.

Health care (in the narrow,departmental meaning)- the totality of all industry resources and achievements of medical science in the form of clinical and organizational technologies aimed at the prevention and restoration of health and ability to work.

Health care (as a system of measures to preserve, strengthen and restore the health of the population)- a system of socio-economic and medical measures, the purpose of which is to preserve and improve the level of health of each individual and the population as a whole and to make a positive contribution to the development of social production and the creation of the national income of the country.

Performance indicators - indicators that allow evaluating the organization and provision of medical care, as well as the effectiveness and efficiency of medical care (financial stability of institutions, the use of qualified personnel, patient satisfaction, etc.)

Quality indicators of medical care (quality indicator)- indicators that are used to characterize both the positive and negative aspects of medical activity, its individual stages, sections and directions (the frequency of repeated hospitalizations, the proportion of doctors and health facilities that carry out clinical guidelines, etc.).

Innovation - development and implementation of various kinds of innovations that generate significant changes in social practice.

Integration- the process of combining the efforts of various subsystems (divisions) to achieve the goals of the organization.

Interview– a method of collecting social data at the individual level.

Client- a legal or natural person using the services of another natural or legal person. In support services, customers are all people who receive service services directly or remotely, for example, when reading printed materials. In support services for people with HIV, clients are also sexual partners, close relatives and relatives of HIV-positive people.

commercial sex- the provision of sexual services for payment to one or more partners. In any case, the sexual partner is constant.

Legalization- a policy aimed at the partial or full legalization of certain drugs.

Marginalization- a policy that desocializes a group of drug users.

Mobile syringe exchange- a mobile station located in a bus or minibus. Moves along a certain route and schedule to certain points in the city with a large concentration of drug users. Provides access to Harm Reduction services.

Monitoring- purposeful activity associated with constant or periodic observation, assessment and forecast of the state of the observed object (process, phenomenon, system) in order to develop it in the desired direction.

2) the process of tracking the state of a system or phenomenon by certain methods.

Monitoring (controlling) quality (quality control)– application of effective methods (tools), measures and statistical methods for measuring and predicting quality.

Motivation- the process of motivating a person to act in order to achieve goals.

Addiction- a disease caused by dependence on a narcotic drug or psychotropic substance.

drug scene- a concept based on the analysis of the most common drugs, the presence of traffic, the socio-demographic characteristics of the community of drug users, the presence of medical, social, etc. services for drug users, economic situation, epidemiological situation in a particular region.

- 36.84 Kb

Federal State Autonomous Educational Institution of Higher Professional Education

"BELGOROD STATE NATIONAL RESEARCH UNIVERSITY"

Department of Psychiatry, Narcology, Clinical Psychology

Abstract on the topic:

"Right to the truth about the latest diagnosis"

Performed

Student group 091209

Cherevatova Olga Grigorievna

checked

Mitin Maxim Sergeevich

Belgorod 2012

Introduction………………………………………………………………………. 3 page

Perjury…………………………………………………………….. 5 pages

Psychology of terminal patients………………………………………… 5 pages

Points for and against"…………………………………………………. 7 page

The sequence of stages of the patient's reaction……………………………... 8 pages

How to and how not to behave with a dying patient………. 10 pages

Conclusion…………………………………………………… ………………. 12 pages

List of used literature………………………………………… 13 pages

Introduction

The domestic tradition of not informing a seriously ill patient about his diagnosis, based on the medical tradition of sparing the patient's psyche, has been debatable for many years. The legislator does not dare to put an end to this issue. Doctors, relatives and even friends can know about a fatal diagnosis, and the patient himself often remains in the dark until the last moment. What is more from such silence - benefit or harm - neither the attending physicians, nor psychologists, nor deontologists (specialists in medical ethics) can unambiguously say. On one side of the scale - the right of a person to know what is happening to him, on the other - the negative consequences of such knowledge, characteristic of representatives of our culture with its fear of death. The decision often remains on the conscience of the doctor.

In many areas of medicine, patient awareness is one of the conditions for successful treatment. Only by informing the patient of the diagnosis, one can hope for the correct treatment outside the health facility, adherence to the regimen, changing the lifestyle to one that will contribute to his recovery. But how to inform the patient of an oncological diagnosis, so as not to finish him off with the terrible truth? And although any patient over the age of 14 has the right to full information about their health status and diagnosis, it is often impossible to get a truthful answer even in response to a direct question: “Doctor, do I have cancer?”.

In the West, the problem of silence has been radically solved - to inform the patient about everything related to his health, even in the case of hopeless diseases, if the mere fact of reporting a diagnosis does not give instant complications. Simply put, no one will immediately tell a person with a myocardial infarction a week ago about a freshly diagnosed carcinoma (one of the forms of cancer), even in America, which is concerned about the rights of the patient. But from those patients whose risk of dying this very hour is not documented, nothing will be hidden.

In theory, it is possible NOT to report the diagnosis only if the patient himself does NOT want to know it, and then if the disease is NOT dangerous to others. But for the humanism of physicians, there is a gap in the fundamentals of the legislation of the Russian Federation on health protection: the actions of a doctor to conceal a diagnosis can be considered legitimate if three conditions are met at the same time: this is done to free the patient from moral suffering in the event of a fatal illness that does not endanger the health of other people . That is, cancer in the last stage with metastases for the benefit of the patient can be called anything, but any infectious disease is not.

However, the problem is that there is no approach that will be a boon for everyone. And here comes into force not only the medical aspect (reflection of the news on the state of health, possible refusal of therapy or, on the contrary, more conscious treatment planning, etc.) aspect, but also the moral and ethical one. Which is higher: the right of a person to know that he is dying, or the false maintenance of hope in him in an attempt to ease the last days?

"Perjury"

The duty of "perjury" in relation to incurable and dying patients was a deontological (from the Greek deon - duty, logos - word, doctrine) norm of Soviet medicine. The doctor's right to "perjury" in order to ensure the right of a terminally ill person to ignorance was considered as a feature of professional medical ethics in comparison with universal morality.

The basis of this feature are quite serious arguments. One of them is the role of the psycho-emotional factor of faith in the possibility of recovery, maintaining the struggle for life, and preventing severe spiritual despair. Since it was believed that the fear of death brings death closer, weakening the body in its fight against the disease, the communication of the true diagnosis of the disease was considered tantamount to a death sentence. However, there are cases when lying did more harm than good. Objective doubts about the well-being of the outcome of the disease cause anxiety in the patient and distrust of the doctor. The attitude and reaction to the disease in patients are different, they depend on the emotional and psychological make-up and on the value-worldview culture of the person.

Is it possible to open a diagnosis to a patient or relatives? Maybe we should keep it a secret? Or is it advisable to inform the patient of a less traumatic diagnosis? What should be the measure of truth? These questions will inevitably arise as long as healing and death exist.

Psychology of terminal patients

At present, numerous foreign studies of the psychology of terminal patients (terminus - end, limit) are available to Russian specialists. The conclusions and recommendations of scientists, as a rule, do not coincide with the principles of Soviet deontology. Studying the psychological state of terminal patients who learned about their fatal illness, Dr. E. Kübler-Ross and her colleagues came to the creation of the concept of "death as a stage of growth." Schematically, this concept is represented by five stages through which a dying person (usually an unbeliever) passes. The first stage is the “denial stage” (“no, not me”, “this is not cancer”); the second stage is “protest” (“why me?”); the third stage is "request for a delay" ("not yet", "a little more"), the fourth stage is "depression" ("yes, I'm dying"), and the last stage is "acceptance" ("let it be") .

The stage of "acceptance" attracts attention. According to experts, the emotional and psychological state of the patient at this stage changes fundamentally. The characteristics of this stage include such typical statements of once prosperous people: “In the last three months I have lived (a) more and better than in my entire life.” Surgeon Robert Mack, a patient with inoperable lung cancer, describing his experiences - fear, confusion, despair, finally states: “I am happier than I have ever been before. These days are now truly the best days of my life.” One Protestant priest, describing his terminal illness, calls it "the happiest time of my life." As a result, Dr. E. Kubler-Ross writes that “I would like cancer to be the cause of her death; she does not want to lose the period of personal growth that terminal illness brings with it. This position is the result of understanding the drama of human existence: only in the face of death does a person discover the meaning of life and death.

The results of scientific medical and psychological research coincide with the Christian attitude towards a dying person. Orthodoxy does not accept perjury at the bedside of a hopelessly ill, dying person. “Hiding information about a serious condition from a patient under the pretext of preserving his spiritual comfort often deprives the dying person of the opportunity to consciously prepare for death and spiritual comfort gained through participation in the sacraments of the Church, and also darkens his relationship with relatives and doctors with mistrust.”

Arguing that the attitude of a doctor towards incurable and dying patients cannot be simply scientific, that this attitude always includes compassion, pity, respect for a person, readiness to alleviate his suffering, readiness to prolong his life, Metropolitan Anthony of Surozh draws attention to one "unscientific » approach - on the ability and "willingness to let a person die."

As practice shows, doctors are divided into 2 camps: those who believe that it is not worth telling the truth about a fatal diagnosis, and those who believe that such information will benefit the patient. As a rule, doctors use the following arguments in their judgments:

Arguments for

When there is no need to hide anything from the patient, it is easier for specialists to plan treatment. And the patient has the opportunity to make a conscious choice of clinic and doctor.
If the patient knows his diagnosis, it is easier to convince him of the need for radical treatment.
Fighting a specific enemy is often more effective than fighting against who knows what.
The patient has the opportunity to receive specialized psychological assistance, for example, in support groups for cancer patients.
There is more trust in relationships with relatives who do not have to pretend that everything is in order.
The patient has the ability to manage his life.

Arguments against

Unpredictable consequences of psychological shock.
The negative impact of self-hypnosis on the patient's condition.
The inability to adequately assess the patient's condition (children, the elderly, patients with mental disorders).

Unfortunately, no matter what arguments for and against are given, doctors and relatives need to consider each situation with a potentially sad outcome individually, taking into account the characteristics of the character, condition, desire of a person to know or not to know the truth and prospects for treatment. But at the same time, it is better to leave the decision anyway to those whose life hangs in the balance. Find out whether a person wants to know or not to know the terrible truth can be done in a roundabout way. And if he wants, he must know her. And what to do with this truth is the personal choice of the patient. Will he go for a hopeless operation, refuse to be treated, commit suicide, open a cat shelter with the last money, want to make peace with his enemies, or pretend that nothing happened.

To speak or not to hush up the diagnosis is a problem, in the solution of which it is necessary to proceed from the aspirations of the patient himself, and not from the convenience of those around him. The task of relatives in such a situation is to help and support, and a person is free to end his days as he sees fit.

Patients' reactions to a doctor's report that they have a fatal illness can be varied. It is customary to divide them into a sequence of stages.

Stage one: denial and isolation.

"No, not me, it can't be!" Such initial denial is inherent in both patients who were told the truth at the very beginning of the development of the disease, and those who guessed the sad truth on their own. Denial - at least partial - is inherent in almost all patients, not only in the first stages of the disease, but also later, when it appears from time to time. Denial acts as a buffer against unexpected shock. It allows the patient to collect his thoughts, and later use other, less radical forms of protection. Denial is most often a temporary form of defense and is soon replaced by partial humility.

Stage two: anger.

The first reaction to the terrible news is the thought: “It’s not true, this cannot happen to me.” But later, when a person finally understands: “Yes, there is no mistake, it really is,” he has a different reaction. Fortunately or unfortunately, very few patients are able to cling to the fictitious world in which they remain healthy and happy to the very end.

When the patient is no longer able to deny the obvious, rage, irritation, envy and indignation begin to overwhelm him. The next logical question arises: “Why me?” In contrast to the denial stage, the anger and rage stage is very difficult for the patient's family and hospital staff to deal with. The reason is that the patient's indignation spreads in all directions and at times spills out on others quite unexpectedly. The problem is that few people try to put themselves in the shoes of the patient and imagine what this irritability might mean. If the patient is treated with respect and understanding, given time and attention, his tone of voice will soon become normal, and irritated demands will stop. He will know that he remains a significant person, that they care about him, want to help him live as long as possible. He will understand that in order to be listened to, it is not necessary to resort to outbursts of irritation.

Third stage: trade.

The third stage, when the patient tries to come to terms with the disease, is not so well known, but nevertheless very useful for the patient, although it does not last long. If at the first stage we could not openly admit the sad facts, and at the second stage we felt resentment towards others and God, then perhaps we will be able to come to some agreement that will delay the inevitable. A terminally ill patient resorts to similar techniques. He knows from past experience that there is always a faint hope of rewarding good behavior, the fulfillment of desires for special merit. His desire almost always consists first in prolonging life, and later is replaced by the hope of at least a few days without pain and inconvenience. In essence, such a deal is an attempt to delay the inevitable. It not only determines the reward "for exemplary behavior", but also establishes some kind of "final line" (one more performance, son's wedding, etc.). From a psychological point of view, promises can indicate hidden feelings of guilt. For this reason, it is very important that the hospital staff pay attention to such patient claims.

The sequence of stages of the patient's reaction……………………………... 8 pages
How to and how not to behave with a dying patient………. 10 pages
Conclusion……………………………………………………………………. 12 pages
List of used literature………………………………………… 13 pages

The basis of this feature are quite serious arguments. One of them is the role of the psycho-emotional factor of faith in the possibility of recovery, maintaining the struggle for life, and preventing severe spiritual despair. Since it was believed that the fear of death brings death closer, weakening the body in its fight against the disease, the communication of the true diagnosis of the disease was considered tantamount to a death sentence. However, there are cases when lying did more harm than good. Objective doubts about the well-being of the outcome of the disease cause anxiety in the patient and distrust of the doctor. The attitude and reaction to the disease in patients are different, they depend on the emotional and psychological warehouse and on the value-worldview culture of the person.

Within the framework of the Christian worldview, death is the door to the space of eternity. Deadly illness is an extremely significant event in life, it is preparation for death and reconciliation with death, it is an opportunity to repent, pray to God for the forgiveness of sins, it is a deepening into oneself, intense spiritual and prayerful work, it is the exit of the soul into a certain new qualitative state. Therefore, it is unlikely that an Orthodox person will be surprised by the prayers to God of Elder Porfiry from the monastery in Milesi for sending him a cancerous disease and for his joy in the disease, granted to him at his request.

On this occasion, hegumen Nikon (Vorobiev, † 1963), one of the spiritual elders of our century, once wrote that cancer, from his point of view, is God's mercy to man. A person doomed to death refuses vain and sinful pleasures, his mind is occupied with one thing: he knows that death is already close, already inevitable, and he only cares about preparing for it - by reconciliation with everyone, correcting himself, and most importantly - sincere repentance before God. The disclosure of the content and meaning of the Christian understanding of the perniciousness of perjury, the meaning of illness and death becomes for many Russian doctors the basis for revising the deontological norms of Soviet medical deontology. Metropolitan Anthony of Surozh, himself a former doctor, believes that it is necessary to draw the attention of modern doctors to the fact that during an illness (we are talking about incurable diseases), a person should be prepared for death. At the same time, Vladyka Anthony says: “Prepare the dying not for death, but for eternal life.”

In 1992, the Council of Bishops of the Russian Orthodox Church canonized Grand Duchess Elizabeth Feodorovna (widow of Grand Duke Sergei Alexandrovich, son of Emperor Alexander II, killed by a terrorist in 1905). In 1909, she created the Martha and Mary Convent of Mercy in Moscow, where she was not just an abbess, but participated in all her affairs as an ordinary sister of mercy - she assisted in operations, made dressings, comforted the sick, believing: “It is immoral to comfort the dying with a false hope for recovery, it is better to help them pass in a Christian way into eternity.

Kalinowski P. Transition. // Last illness, death and after. Yekaterinburg, 1994, p. 125.

Fundamentals of the social concept of the Russian Orthodox Church. // Newsletter of the DECR of the Moscow Patriarchate. 2000. No. 8. S. 82.

Monk Agapius. The divine flame kindled in my heart by Elder Porfiry. M .: Publishing House of the Sretensky Monastery, 2000. S. 56.

Metropolitan Anthony of Surozh. Healing of the body and salvation of the soul. // Human. 1995. No. 5. S. 113.

TOPIC 8. MORAL ASPECTS OF DEATH AND DYING (4 hours).

^ Sickness and death are at the core of our lot.

Marcel G.O.

Plan-summary of the seminar:

The problem of human death criteria and moral and ideological understanding of personality. Biological and clinical death. The problem of brain death.
Psychology of terminal patients. The right to the truth about the latest diagnosis.
The concept of euthanasia. Passive and active euthanasia.
Palliative medicine. Hospice care.

Key concepts: terminal states, clinical and biological death, brain death, persistent vegetative states, resuscitation, active and passive euthanasia, neonatal euthanasia, palliative medicine, hospice, personality, individual, body, borderline situation.

^ The problem of human death criteria and moral and ideological understanding of personality. Biological and clinical death. The problem of brain death.

The attitude of a person to the death of a person models the entire system of moral relationships and interdependencies. The problem of death is one of the main topics of philosophical, moral-religious and biomedical reflection.

The difference between clinical death (reversible stage of dying) and biological death (irreversible stage of dying) was decisive for the development of resuscitation, a science that studies the mechanisms of dying and reviving a dying organism.

Death - the termination of the vital activity of the organism and, as a result, the death of the individual as a separate living system.

clinical death - a special kind of existence - terminal state, the border of existence and non-existence of the living; process dying as a transition from one quality to another. A specific feature of clinical death is its fundamental reversibility, since from a biological point of view, it still retains a sufficient number of “elements of life”, many of whose functions have only stopped. Time interval characterizing clinical death - 5-6 minutes (sometimes less) - quantitatively expressed measure still ongoing life. The ethical imperative requires physicians to treat clinical death as a condition in need of urgent care.

Criteria for death - signs that determine the final degree of degradation of the life process and the objective onset of death. Modern concepts suggest that such a criterion for the death of a human individual is the necrosis of the brain, because it is in this case that the autonomy and individuality of the individual is lost.

The formation of resuscitation in the 1960s and 1970s is considered by many to be a sign of revolutionary changes in medicine. This is due to overcoming the traditional criteria of human death - the cessation of breathing and heartbeat - and reaching the level of acceptance of a new criterion - "brain death". The fundamental changes introduced by the achievements of medical science into the temporal space of death turn into an increase in the ethical tension of medical practice. Of course, a set of technical means for maintaining life makes it possible to prevent death for a number of patients, but at the same time, for others, this “maintenance” turns out to be only a way to prolong dying.

Speaking about comatose patients, Professor B. G. Yudin very aptly calls the period between the state of “definitely alive” and “definitely dead” - the “zone of uncertainty”. About this "zone" such judgments of doctors are typical: "The person is still alive, but he is unconscious, it is necessary to wait for his physical death from hunger, infection", or, which is the same thing, "the person is dead, but he is still breathing, it is necessary to stop breath". Within the boundaries of new medical advances, a beating heart and breathing are not signs of life. The statement of “brain death” defines death, within the boundaries of which “vegetative” (at the cellular level) life is acceptable. New medical postulates are adapted with great difficulty in the public mind, for which the judgment that death has been ascertained, but the person is still breathing is very strange. Trying to free from moral and legal responsibility the unwitting executors of the "will of the zone" - doctors, culture turns to the principle of euthanasia - the deliberate, painless killing of hopelessly ill people.

^ Psychology of terminal patients. The right to the truth about the latest diagnosis.

Patients' reactions to a doctor's report that they have a fatal illness can be varied. ^ Elisabeth Kübler-Ross in On Death and Dying describes the patient's response as a sequence of stages.

Stage one: denial and isolation.

^ Stage two: anger.

^ Third stage: trade.

^ Fourth stage: depression.

When a doomed patient can no longer deny his illness, when he has to go to another operation or hospitalization, when new symptoms of the disease appear, and the patient weakens and loses weight, sad thoughts can no longer be discarded with a casual smile. The numbness or stoic attitude, irritability and resentment soon give way to a sense of great loss. Intensive treatment and hospital stays are exacerbated by monetary costs, since not all patients can afford luxurious conditions at the beginning of treatment, and then basic necessities. The causes of depression are well known to anyone who deals with the sick. However, we often forget about the preparatory grief that the terminally ill person experiences when preparing for the final farewell to this world. A sensitive person will easily identify the cause of depression and save the patient from unjustified feelings of guilt, which often accompanies depression.

^ Fifth stage: humility.

If the patient has enough time at his disposal (that is, we are not talking about sudden and unexpected death) and he is helped to overcome the stages described above, he will reach the stage when depression and anger at the "evil fate" recede. He had already thrown out all his former feelings: envy of healthy people and irritation with those whose end would not come soon. He stopped mourning the imminent loss of loved ones and things and now begins to think about the impending death with a certain amount of calm expectation. The patient feels tired and, in most cases, physically weak. Humility should not be considered a stage of joy. It is almost devoid of feeling, as if the pain is gone, the struggle is over, and it is time for "the last respite before a long journey," as one of the patients put it. In addition, at this time, help, understanding and support are needed more by the patient's family than by the patient himself. Most patients died at the stage of humility, without fear and despair.

^ How to and how not to behave with a dying patient:

1. You should not take a rigid position, for example: "In such cases, I always inform the patient." Let the patient be the guide. Many patients want to know the diagnosis, while others do not. Find out what the patient already knows about the prognosis of his disease. Do not deprive the patient of hope and do not reassure him if denial is the main defense mechanism, as long as he can receive and accept the necessary help. If the patient refuses to accept it as a result of the denial of his illness, let him know gently and gradually that help is needed and will be provided to him. Reassure the patient that he will be taken care of regardless of his behavior.

You should stay with the patient after giving him information about his condition or diagnosis. After that, the patient may experience a strong psychological shock. Encourage him to ask questions and give truthful answers. Say that you will be back to answer questions from the patient or family. If possible, return to the patient after a few hours in order to check his condition. If the patient develops significant anxiety, diazepam (Valium) 5 mg may be given, possibly over 24 to 48 hours.

Advice should be given to the patient's family members regarding his illness. Encourage them to communicate with the patient more often and allow him to talk about his fears and worries. Family members will not only have to deal with the tragedy of losing a loved one, but also with the realization of the thought of their own death, which can cause anxiety.

The pain and suffering of the patient should be relieved.

^ The concept of euthanasia. Passive and active euthanasia.

In modern culture and science, special attention is paid to the problem of euthanasia. Term "euthanasia" means a painless voluntary death and reflects a natural desire for a person die calmly, easily and painlessly. In this concept, one can single out such meanings as accelerating the death of those who are experiencing severe suffering, caring for the dying, giving a person the opportunity to die, and ending the life of “extra” people. The question arises how such famous principles as hippocratic oath“I swear not to give lethal medicine, even if I am asked to do so, or advice that can lead to death”, or a principle that prescribes a doctor fight the disease to the end. At the same time, the use of the latest means by modern medicine makes it possible to extend the biological existence of a person for an infinitely long time, sometimes turning unfortunate patients and their loved ones into hostages of superhumanism. All this gives rise to numerous discussions in which some reject euthanasia as an act of murder, others see it as a panacea for all ills.

New technologies and amazing advances in biomedical scientific and methodological research, bordering on a real scientific revolution, today allow to save the lives of such seriously ill and injured people, the treatment of which was not possible yesterday. Modern methods of ensuring the work of the cardiovascular system, cardiac defibrillation, ventricular, respiratory support, monitoring and stimulation of the heart, regulation and alignment of metabolic processes, dialysis and prevention of infectious diseases can support the life of patients who have received serious injuries, patients with profound metabolic disorders and patients with dysfunctions of various organs.

As a result, patients find themselves in new situations where it is possible to artificially maintain life in a seriously injured person, with absolutely no hope of bringing him to consciousness and returning him to normal life. This led to heated discussions about unnecessary resuscitation and the right to die. Some well-known cases of unreasonably prolonged resuscitation also served as the basis for such discussions. So, for example, the case of Carey Quinlan (who went into a coma in 1975, survived, had all hardware support turned off, died but was still in a coma in 1985) or another parallel case (Paul Bailey, who died in 1982, having spent 25 years in a coma). Such prolonged resuscitation of patients in the absence of any hope of recovery has caused euthanasia, as well as the "right to a dignified death", to become increasingly relevant.

Distinguish between passive and active euthanasia. Passive - it is the refusal of life-sustaining treatment when it is either stopped or not prescribed at all. Passive euthanasia simply means not using extraordinary and extraordinary means to save the patient's life if he does not want to use them. It also involves discontinuing any further treatment except for the one that relieves pain. In these cases, at the request of the patient, even intravenous infusions and artificial nutrition should be stopped, while attempts should not be made to resurrect a person if his heart or lungs have stopped working. If a patient can leave the hospital to die at home, then he should not be prevented from doing so. Active euthanasia is called in cases where the patient requires special means to hasten death [P. Kurtz. The Forbidden fruit. Ethics of humanism. M., 2002].

First of all, it should be clarified that euthanasia is understood not just as an easy, painless death, but a death that corresponds to the desire of the dying person himself (or his relatives and friends, if the dying person has irrevocably lost consciousness) and occurs with the assistance (active or passive) physician. This is what determines both the context of medical practice, in which it is possible to meaningfully discuss the problems of euthanasia, and the circle of people directly involved in it. At the same time, both the deep layers of human existence and the fundamental values of society are affected here, which explains the sharpness and complexity of discussions. Conflicting views on euthanasia from a medical and moral and ethical point of view have also given rise to a controversial legal assessment of this phenomenon. Active euthanasia is a deliberate act to end a patient's life. There are such forms of it as mortification out of compassion, when life, which is torment for the patient, is interrupted by the doctor (even without the consent of the patient); voluntary - active euthanasia and death by agreement with the patient with the help of a doctor.

The right of a person to manage his own life and the rejection of inhuman treatment that destroys his dignity is the main argument supporters of active euthanasia. The sanctity of human life, the possibility of medical error with a hopeless diagnosis, the danger of abuse if euthanasia is legalized, etc. are valid counterarguments against active euthanasia. All these problems indicate that euthanasia is an interdisciplinary problem that requires the professional and moral efforts of philosophers, doctors, lawyers, and all interested people for its resolution.

^ Palliative medicine. Hospice care.

Hospice is a medical (medical and social) institution/department where a team of professionals provides comprehensive assistance to a patient who needs to alleviate suffering - physical, psychosocial and spiritual, associated with a disease that cannot be cured, and it must inevitably lead to death in the foreseeable future (3-6 months).

^ Hospice Service - this is a type of palliative care for patients in the terminal stage of any chronic disease (cancer, AIDS, multiple sclerosis, chronic nonspecific diseases of the bronchopulmonary and cardiovascular system, etc.), when treatment no longer gives results, the prognosis is unfavorable in terms of recovery and life.

Hospice is not only an institution, it is a philosophy based on the attitude towards the patient as a person until the very last minute of his life and the desire to alleviate his suffering, taking into account his desires and preferences.

The patient is sent to the hospice not to die, but to carry out activities aimed at relieving pain, reducing shortness of breath or other symptoms that he and his attending physician cannot cope with at home. In addition, patients and their relatives in the hospice are provided with psychological, social and spiritual support.

So, main indications for hospitalization in hospice(medical inpatient institution) are:

the need to select and conduct adequate treatment for pain and other severe symptoms in the absence of the effect of home therapy;
carrying out manipulations that cannot be performed at home;
lack of conditions for providing palliative care at home (single patients, difficult psychological situation in the family);
providing short-term rest for caring for seriously ill relatives.

^ Hospice care – comprehensive, medical and social assistance. This assistance is medical, psychological, social and spiritual. But the main component is still the qualified assistance of a doctor and a nurse with special training and special human qualities. The hospice provides education and research along with care. Today, hospices are an integral part of the healthcare system in all civilized countries.

^ Palliative care - the field of oncology, which is characterized by the absence of a direct impact on a malignant neoplasm and is used in a situation where the possibilities of post-tumor treatment are limited or exhausted. Palliative care is designed to improve the quality of life of cancer patients.

^ Historical reference:

The first hospice of modern history was founded in 1842 in Lyon (France) by the Culver Society. 1879 Mary Akenhead opened in Dublin (Ireland) the Virgin Mary's Asylum for the Dying. In 1905 St. John's Orphanage (London) was founded in England. Cecilia Sanders worked in it, who became the first full-time doctor and organized a hospice for modern-type cancer patients. Hospices were created as a system of care that could be provided in an institution or at home. In Russia, palliative care has been developing over the past two decades. The 1st Hospice (Lakhtinsky) was opened in 1990 in St. Petersburg. About 35,000 cancer patients are registered in Minsk, of which 1,800 have an end-stage disease and need palliative care. In 1994 The first Belarusian children's hospice in the CIS was created. By the decision of the Minsk City Executive Committee dated August 18, 2005 No. 1430, on October 6, 2005, the state institution "Hospital for Palliative Care "Hospice" was established. By order of the Health Committee of the Minsk City Executive Committee No. 147 dated March 14, 2006, the procedure for organizing the work of the first state institution "Hospital for Palliative Care" was determined Hospice".

^ The main tasks of the hospice are:

Elimination or reduction of pain syndrome and fear of death in patients with the maximum possible preservation of their consciousness and intellectual abilities.
Providing medical supervision, conducting symptomatic treatment, which uses special multi-stage protocols for non-narcotic and narcotic pain relief; treatment of adverse and concomitant diseases of patients.
Psychosocial adaptation of patients.
Teaching family members of a hopelessly ill patient how to care for him.
Providing psychological assistance to family members who are hopelessly ill or who have lost a relative.
Creation of a service of voluntary assistants (volunteers) providing free care for patients in hospice and at home.
Studying, summarizing and applying in practice the best practices of hospice work, promotion of the volunteer movement.
Raising professional qualifications, theoretical level, as well as conducting systematic educational and educational work with medical personnel.
Involvement of state, commercial, public and religious organizations in solving the problems of incurable patients.

http://www.mhospice.of.by/

The main provisions of the concept of hospices

1. Hospice provides assistance mainly to cancer patients with severe pain in the terminal stage of the disease, confirmed by medical documents.

2. The primary object of medical, social and psychological assistance in the hospice is the patient and his family. Patient care is provided by specially trained medical and nursing staff, as well as relatives of patients and volunteers who have undergone preliminary training in the hospice.

3. Hospice provides outpatient and inpatient care for patients. Outpatient care is provided at home by hospice outreach teams ("hospice at home"). Inpatient care, depending on the needs of the patient and his family, is provided in a round-the-clock, day or night stay of patients in a hospital.

4. The principle of "diagnosis openness" can be implemented in the hospice. The issue of informing patients of their diagnosis is decided individually and only in cases where the patient insists on this.

5. The whole set of medical, social and psychological assistance to the patient should be aimed at eliminating or reducing the pain syndrome and fear of death while preserving his consciousness and intellectual abilities to the maximum extent possible.

6. Each patient in the hospice should be provided with physical and psychological comfort. Physical comfort is achieved by creating conditions in the hospital that are as close as possible to home. Ensuring psychological comfort is carried out on the basis of the principle of an individual approach to each patient, taking into account his condition, spiritual, religious and social needs.

7. Sources of funding for hospices are budgetary funds, funds from charitable societies and voluntary donations from citizens and organizations.

The experience of practical work of foreign and domestic hospices made it possible to develop a number of rules, regulations, moral prescriptions, for the first time omnipotent and formulated in the form of 10 commandments by A.V. Gnezdilov (St. Petersburg).

Later V.V. Millionshchikova (Moscow), additions are included in the text of the commandments. The amended text of the commandments is as follows:

^ COMMANDMENTS OF HOSPICE

1. Hospice is not a house of death. This is a worthy life to the end. We work with real people. Only they die before us.

2. The main idea of the hospice is to relieve pain and suffering, both physical and mental. We can do little on our own, and only together with the patient and his relatives do we find great strengths and opportunities.

3. Death cannot be hastened and death must not be retarded. Each person lives their own life. Nobody knows her time. We are only companions at this stage of the patient's life.

4. You cannot pay for death, just like for birth.

5. If a patient cannot be cured, this does not mean that nothing can be done for him. What seems like a trifle, a trifle in the life of a healthy person - for the patient has great meaning.

6. The patient and his relatives are one. Be gentle when entering the family. Don't judge, help.

7. The patient is closer to death, therefore he is wise, behold his wisdom.

8. Each person is individual. Do not force your beliefs on the patient. The patient gives us more than we can give him.

9. The reputation of the hospice is your reputation.

10. Take your time when coming to the patient. Don't stand over the patient - sit next to him. No matter how little time there is, it is enough to do everything possible. If you think that you didn’t manage everything, then communication with the relatives of the departed will calm you down.

11. You must accept everything from the patient, up to aggression. Before you do anything - understand the person, before you understand - accept him.

12. Tell the truth if the patient wants it and if he is ready for it. Be always ready for the truth and sincerity, but do not rush.

13. An "unscheduled" visit is no less valuable than a "scheduled" visit. Visit the patient more often. If you can't come in, call you can't call - remember and still ... call.

14. Hospice is a home for patients. We are the owners of this house, therefore: change your shoes and wash your cup after you.

15. Do not leave your kindness, honesty and sincerity with the patient - always carry them with you.

Detailed information about the purpose and philosophy of hospices, the principles and organization of their work is set out in the only Russian-language and unique publication "Hospices", published under the editorship of V.V. Millionshchikova in 2003 (Grant Publishing House).

The full text of the collection can be found on the website of the first Moscow hospice http://www.hospice.ru/lit-med.html

Topics of reports and abstracts:

1. Resuscitation and moral and ethical problems of "dying management".

2. Medical criteria for human death: moral problems.

3. The problem of the equivalence of brain death and human death.

4. Influence of the patient's depressive self-assessment on the doctor's confidence in the hopelessness of the cure.

5. Truths and lies about "easy death" in medicine and the media (media). (How and why does the media create the image of an “easy death”?)

6. The moral responsibility of the doctor "in the face of death."

7. The problem of experiencing death in the work of L. N. Tolstoy "The Death of Ivan Ilyich".

10. "Physics" and "metaphysics" of death.

12. Euthanasia: the history of the problem.

13. The right to the truth about the latest diagnosis.

14. Attitude to the dead body in philosophical anthropology and pathological anatomy.

15. Death and dying as a stage of life.

Questions for self-control:

1. What is the essence of the concept of E. Kübler-Ross “death as a stage of growth”?

2. List the main stages and forms of the patient's reaction to a message about an unfavorable diagnosis (according to E. Kübler-Ross).

4. What are the main arguments of the opponents of euthanasia.

5. What are the criteria currently used to ascertain the death of a person in Belarus?

6. What are hospices and are there any in Belarus?

7. What types of care are provided to patients in the hospice?

8. Is it legal for a doctor to give a terminally ill patient a diagnosis?

9. Name the main arguments of the opponents of perjury in medicine.

10. What are the limits of reliability of an unfavorable medical prognosis and diagnosis considered as grounds for active euthanasia?

^ Texts for discussion.

Ares F.

Man in the face of death

Death upside down

Even at the beginning of the 20th century, say, before the First World War, in the whole West, the death of one person set in motion an entire social group or even an entire society - for example, within a village. Shutters were closed in the room of the deceased, candles were lit, and holy water was brought. The house was filled with neighbors, relatives, friends, all whispering with a serious and solemn air. A mourning notice was attached to the front door, replacing the old custom of displaying the body of the deceased or his coffin at the door. The divine service in the church gathered a lot of people who then stood in line to express their condolences to the family of the deceased. After that, the funeral procession slowly accompanied the coffin to the cemetery. But the matter did not end there either. The period of mourning was filled with visits: the family of the deceased went to the cemetery, relatives and friends visited the family. Only gradually did life return to its usual course, so that only visits to the cemetery by relatives of the deceased remained. The death of an individual affected a whole social group, and it reacted collectively, from the closest relatives to a wider circle of acquaintances and subordinates. Not only did everyone die in public, but the death of everyone became a social event that touched - both figuratively and literally - the whole society.

All the changes in attitudes towards death over the course of a millennium have not violated this fundamental picture. The link between the death of the individual and society remained unbreakable. Death has always been a social fact. It continues to be so today in many cases, and there is no certainty that this traditional model is doomed to disappear. But this model is no longer absolutely universal. During the course of this century, a completely new type of death has developed, especially in the most industrialized and technologically advanced and urbanized regions of the Western world. And of course, we are witnessing today only the first stage in the formation of a new model.

Two of her features are striking to anyone. The first is strikingly new and the opposite of everything we have seen in past centuries: society banishes death, unless it is about prominent statesmen. Nothing notifies passers-by in the city that something has happened. An old black and silver hearse has turned into the most ordinary limousine, imperceptible in the flow of traffic. Death no longer brings a pause to the rhythm of society. The person disappears instantly. In cities, everything now happens as if no one else dies.

Another feature of the new attitude towards death is no less remarkable. Of course, the image of death and the perception of it have changed over the long centuries, but how slowly! Small changes took so long, stretching over entire generations, that contemporaries simply did not notice them. In our time, a complete revolution in morals has taken place - or seems to have taken place - in the course of a single generation. In the days of my youth, women in mourning could not be seen from under black veils and silks. In bourgeois families, children who lost their grandmother wore purple. My mother, after 1945, spent the last twenty years of her life in mourning for her son, who died in the war. Today...

The speed and abruptness of the changes made them noticeable. They are known, discussed, sociologists conduct their research about them, prepare television programs, arrange medical and legal debates. Expelled by society through the door, death re-enters the window, returning as swiftly as it disappeared[…].

^ The triumph of medicalization

So, the romantic model of death, as it existed in the middle of the 19th century, goes through a series of successive stages of decay. First of all, the changes affect the first period of dying at the end of the 19th century: the period of severe illness. This is the case of Tolstoy's Ivan Ilyich: the patient is kept in the dark about his condition and what awaits him. Then, after the First World War showed the world the death of millions of people at the same time, society imposes an unspoken ban on mourning and on everything that in public life reminds of death, in any case, an ordinary, not sensational death. Only the very moment of death remains unchanged, which in the era of Tolstoy and for a long time later continued to retain its traditional character: scrolling in the memory of a life lived, dying in public, the scene of last goodbyes.

After 1945 this vestige of the romantic model of beautiful death disappears. The reason was the complete medicalization of death[...]. The rapid progress of medical technology and methods of inpatient treatment, the training of a sufficient number of competent personnel, the growth of public health expenditures have led to the fact that hospitals have taken a monopoly position in this area. It turned out to be impossible to replace these institutions with complex, rare and expensive equipment, with their highly qualified personnel, many auxiliary laboratories and services.

From the moment when the disease becomes serious and protracted, the doctor is more and more inclined to refer the patient to the hospital. To the successes of diagnostics, observation and treatment in hospitals were added the successes of resuscitation, pain relief, relief of physical suffering. These methods are used not only before, during or after the operation, but during the agony, in order to make the death less painful for the dying person. Gradually dying in the hospital became like a severe postoperative patient, which provided similar care and attention. In cities, people in most cases have ceased to die at home, just as they had ceased to be born at home even earlier. In New York in 1967, 75% of the dead died in a hospital or similar institution (in 1955 - 69%), and in the United States as a whole - 60%. In the future, the percentage of deaths in the hospital continued to grow[...].

The triumph of medicalization had enormous implications for the very understanding of death. In the traditional mentality (in the West until the 17th century), the instantaneousness of death is mitigated by the certainty that man will continue to exist beyond the fatal brink. In the 17th century the idea of the dualism of the soul and the body and their separation at the moment of death eliminated this temporal perception of death: death became an instant, an instant transition from one state to another. Today's death, surrounded by doctors, has regained its extension in time, but not on that, but on this side of the line. Death is shortened or prolonged depending on the actions of the doctor: he cannot prevent it, but he is often able to regulate its duration - from a few hours, as the agony usually lasts, to several weeks, months or even years. It has become possible to delay the fatal moment, and measures designed to alleviate pain have an important side effect, in fact, prolonging the life of the patient.

It happens that delaying the hour of death becomes an end in itself, and medical personnel spare no effort to prolong a person's life by artificial methods. Let us recall, for example, the Shakespearean agony of Generalissimo Francisco Franco in Spain, surrounded by his twenty personal doctors. More sensational cases are also known, especially in America, when doctors do not allow a patient in a coma to die for many months, despite the insistence of the family or even a court decision. At the same time, doctors often refer to the fact that such patients have not yet experienced brain death, which is determined by an electroencephalogram. It is not our task to discuss here the ethical problems of euthanasia, when doctors, in full compliance with the law, turn off the equipment that supports the life of a hopeless patient, or otherwise terminate his existence, often hated by himself. We only repeat that medicine, organized in the form of a hospital, can in principle allow an incurable patient to continue to exist indefinitely[...].

At the same time, death was no longer perceived as a natural and necessary phenomenon. Death is a failure, an accident. This is what the doctor thinks, because this is the justification for his existence. But he expresses here only what society itself feels. Death is a sign of powerlessness, helplessness, error or ineptitude, which should be forgotten as soon as possible. Death in the hospital should not disturb the normal course of things and therefore should be modest, inconspicuous, "on tiptoe"[...].

Consciously or not, doctors and nurses have developed their own understanding of what researchers Glazer and Strauss call the acceptable style of facing death. For the hospital staff, and indeed for society as a whole, the best person to die is the one who does not appear to be dying. It is easier for a person to hide the fact that he is dying, the less he himself suspects about it. His ignorance is even more necessary today than in the time of Ivan Ilyich. Ignorance can even become an important factor in recovery, and for the treating staff, a condition for the effectiveness of their actions.

What today we call a beautiful death - death in ignorance - exactly corresponds to what in the distant past was considered a misfortune and a curse: mors repentina et improvisa - sudden, unforeseen death, for which a person did not have time to prepare. How wild our usual words would have sounded for medieval people: “He died last night in his sleep without waking up. He died the most beautiful death that can be.

However, dying in the hospital often lasts a long time, and an intelligent patient is able to understand from the actions and behavior of doctors and nurses what awaits him. Therefore, the attending staff instinctively, unconsciously forces the patient, who depends on them and wants to please them, to act out ignorance. In some cases, silence turns into silent complicity, in other cases, fear makes it impossible for any communication between the dying person and those who care for him. The passivity of the patient is maintained by sedatives, especially at the end, when the suffering becomes unbearable. Morphine relieves pain, but it also dulls the consciousness, plunging the dying person into the ignorance of his fate that everyone wants.

The opposite of the "acceptable style of dying" is a bad death, ugly, devoid of any kind of elegance and delicacy. In one case, the patient, who knows he is dying, rebels against the inevitable, screams, becomes aggressive. Another case - his attending staff is no less afraid - is when a dying person accepts his death, focuses on it, turns his back to the wall, becomes indifferent to the world around him, stops communicating with people. Doctors and nurses repel this repulsion, as if eliminating them and making their efforts unnecessary [...].

^ Return warning. Death today.

[...] If at the end of the XIX century. death disappears from medical science, then in the latest research it returns as a topic not only of philosophy, but also of medicine. It is about the dignity of the dying, that death should not be ignored and hushed up, but recognized as a real state and, moreover, as a fundamental act. One of the conditions for recognizing death is that the dying person must be informed of his condition. The British and American doctors soon gave in to this pressure, especially because now they could finally share the responsibility, which had become unbearable. Are we not on the verge of a new profound change of mentality in regard to death? Is not the old commandment of silence about death dying? [...].

In the modern drama of ideas about death, society as a whole still repels death as it appears in reality. Everyone agrees that the conditions of dying in hospitals should be improved, but death should not come out. Those who are not satisfied with such a compromise approach, who reject these half-hearted mitigations, in the end, if they take their reasoning to the logical limit, begin to challenge the very idea of the medicalization of death[...]. Increasingly, voices of doubt are heard that the subordination of human life and death to the development of medical technology and clinical methods is such an unconditional blessing[...].

Aries F. Man in the face of death. M., 1992.

Why does F. Aries call the modern model of attitude to death “death inverted”?
What characterizes the process of "medicalization of death"? What contradictions does it contain?

See also texts:

Pershin M.S. Euthanasia: is it easy “to die easy// http://rsmu.ru/335.html

Pavlova Yu.V. Problems of euthanasia in law//Common sense. 2005, no. 3 (36).

Man's attitude to death models the whole system of moral relationships. The problem of death is one of the main topics of philosophical, moral-religious and biomedical reflection.
The difference between clinical death (reversible stage of dying) and biological death (irreversible stage of dying) was decisive for the development of resuscitation, a science that studies the mechanisms of dying and reviving a dying organism.
Death - the termination of the vital activity of the organism and, as a result, the death of the individual as a separate living system.
clinical death – special kind of existence terminal state, the border of existence and non-existence of the living; process dying as a transition from one quality to another. A specific feature of clinical death is its fundamental reversibility, since from a biological point of view, it still retains a sufficient number of “elements of life”, many of whose functions have only stopped. Time interval characterizing clinical death - 5-6 minutes (sometimes less) - quantitatively expressed measure still surviving life. The ethical imperative requires physicians to treat clinical death as a condition in need of urgent care.
Criteria for death - signs that determine the final degree of degradation of the life process and the objective onset of death. Modern concepts suggest that such a criterion is the necrosis of the brain, because it is in this case that the autonomy and individuality of the individual is lost.
The formation of resuscitation in the 1960s and 1970s is considered by many to be a sign of revolutionary changes in medicine. This is due to overcoming the traditional criteria of human death - the cessation of breathing and heartbeat - and reaching the level of acceptance of a new criterion - "brain death". The fundamental changes introduced by the achievements of medical science into the temporal space of death turn into an increase in the ethical tension of medical practice. Of course, a set of technical means for maintaining life makes it possible to prevent death for a number of patients, but at the same time, for others, this “maintenance” turns out to be only a way to prolong dying.

Psychology of terminal patients. The right to the truth about the latest diagnosis.

Patients' reactions to a doctor's report that they have a fatal illness can be varied.
Stage one: denial and isolation. Such initial denial is inherent in both patients who were told the truth at the very beginning of the development of the disease, and those who guessed the sad truth on their own. Denial - even partial - is inherent in almost all patients, not only in the first stages of the disease, but also later, when it appears from time to time. Denial acts as a buffer against unexpected shock.
Stage two: anger. When the patient is no longer able to deny the obvious, rage, irritation, envy and indignation begin to overwhelm him. The next logical question arises: “Why me?” In contrast to the denial stage, the anger and rage stage is very difficult for the patient's family and hospital staff to deal with. The reason is that the patient's indignation spreads in all directions and at times spills out on others quite unexpectedly. But only a few people try to put themselves in the place of the patient and imagine what this irritability can mean.
Third stage: trade. The third stage, when the patient tries to come to terms with the disease, is not so well known, but nevertheless very useful for the patient, although it does not last long. The patient is looking for an agreement that will delay the inevitable. He knows from past experience that there is always a faint hope of rewarding good behavior, the fulfillment of desires for special merit. His desire almost always consists first in prolonging life, and later is replaced by the hope of at least a few days without pain and inconvenience. In essence, such a deal is an attempt to delay the inevitable.
Fourth stage: depression. When a doomed patient can no longer deny his illness, sad thoughts can no longer be discarded. Numbness, irritability and resentment soon give way to a sense of great loss. Intensive treatment and hospital stays are exacerbated by monetary costs. The difficulty lies in identifying the cause of the guilt that often accompanies depression.
Fifth stage: humility. If the patient has enough time at his disposal (that is, we are not talking about sudden and unexpected death) and he is helped to overcome the stages described above, he will reach the stage when depression and anger at the "evil fate" recede. He had already thrown out his former feelings: envy of healthy people and irritation with those whose end would not come soon. Humility should not be considered a stage of joy. It is almost devoid of feelings, as if the pain is gone, the struggle is over and the time comes for "the last respite before a long journey." At this time, help, understanding and support are needed more by the patient's family than by the patient himself.

48. "Death involving a doctor." Euthanasia, its types. Euthanasia and the problem of suffering.

Euthanasia. Bacon 17th century Voluntary painless death.

Types: passive euthanasia (intentional termination by physicians of the patient's maintenance therapy) and active euthanasia (administration of medications to a dying person or other actions that entail a quick and painless death).

Suffering is an emotional state. Man, with a cat. Test. Physical and/or emotional Discomfort.

Suffering might. without pain. The sympathizer can suffer.

2 points of view: 1) Severe pain and suffering deprive of dignity (better death). 2) In suffering manifested. The essence of man (strengthens him).

49. Hospice movement as an alternative to "death with the participation of a doctor."

Hospice is a free public institution that provides care for a seriously ill person, alleviating his physical and mental condition, as well as maintaining his social and spiritual potential.

The ideas of the hospice movement are currently spreading throughout Russia. In total, there are about 45 hospices in our country now, in more than twenty different regions.

Often people associate the word "hospice" with a kind of house of death, where people are placed for a long time to live out their lives in isolation from the world. But this is a delusion. The hospice system is developing, becoming more popular, focused on the person and his needs. The main idea of the hospice is to provide a decent life for a person in a situation of serious illness. Modern Russian hospices work in much the same way as conventional oncology dispensaries, but they specialize in helping patients in especially difficult cases. This idea finds its expression in the concept of palliative care.

Palliative care– care that provides optimal comfort, functionality and social support to patients (and family members) at the stage of the disease, when special, in particular anticancer treatment, is no longer possible. In this situation, the fight against pain and other somatic manifestations, as well as the solution of the psychological, social or spiritual problems of the patient, is of paramount importance. The forms and methods of the palliative care system are used in hospices.

The basis for the success of palliative care is long-term professional continuous monitoring of the patient. The opportunities for improving the quality of life of cancer patients today are quite large. This problem can be solved using the same treatment methods that are used in the implementation of radical antitumor treatment. Palliative care gives a chance to return to interrupted treatment, for example, changes blood counts for the better, providing an opportunity to repeat the course of therapy, etc.

That is, palliative treatment is a branch of oncology, when the ongoing antitumor treatment does not allow the patient to radically get rid of the disease, but only leads to a decrease in tumor lesions or a decrease in the degree of malignancy of tumor cells.

Palliative care is aimed at solving several problems:

provides a reduction in pain and alleviation of other disturbing symptoms of the patient;

· includes psychological and spiritual support of the patient;

offers a system that supports the patient's ability to lead an active life as long as possible;

offers a system of assistance to the family of the patient during his illness.

It is the idea of palliative care that underlies the concept of hospice.

Hospice is an institution, moreover, public and free for patients, which provides a decent life in the severe stage of the disease. It provides outpatient and inpatient care to patients, which, depending on the needs of the patient and his family, can be provided in the form of intermediate forms - a day hospital, an outreach service.

28.03.2023

Literature

The most interesting:

Getting Russia access to the sea under Peter I Peter the Great war with the Swedes

Biography Traveler Chikhachev Petr Alexandrovich brief historical background

Tale The Stolen Sun (Korney Chukovsky) read text online, free download