Euthanasia which the doctor prescribes independently. In Switzerland, for four thousand euros, anyone can be sent to the next world. Euthanasia on a “working” heart

Illustration copyright istock Image caption The list of countries where assisted dying is allowed is very small

British parliamentarians have overwhelmingly rejected a bill to make it easier to obtain drugs that can help terminally ill people die.

The bill proposed that doctors would prescribe a lethal dose of medication, which the patient would then take himself.

Each such case would have to be approved by two doctors and a member of the Supreme Court.

As a result, England and Wales were never included in the list of countries that guarantee the “right to die.”

This list, by the way, is quite short: in five countries it is allowed to provide a patient with drugs with which he can die, and in several more euthanasia is completely legalized and doctors are allowed, in certain circumstances, to administer a lethal cocktail to the patient themselves.

Netherlands

Illustration copyright istock Image caption In the Netherlands, assisted suicide has strict conditions

In 2002, the Netherlands became the first country to legalize euthanasia. In addition, assistance in committing suicide is no longer prosecuted by law.

In this case, euthanasia is subject to a strict set of conditions: the patient must suffer from an incurable disease, suffer from “unbearable” pain and not have the slightest chance of recovery. He or she must express his or her desire to die while being of complete sound mind and continue to insist on this for a certain period of time

The End of Life on Demand and Assisted Suicide Act came into force in April 2002.

Doctors from the Christian Medical Association claim that since the passage of this law, the number of voluntary deaths has "gotten out of control." By 2015, the increase was about 15%, amounting to almost 5,000 cases.

However, this statement is contradicted by a scientific study, the results of which were published in the British medical journal Lancet in 2012. It claims that the number of people who voluntarily died after the new law was adopted remained the same as before its introduction.

Illustration copyright Istock Image caption Not all doctors, even in countries where euthanasia is legal, approve of this practice

The most controversial aspect of the Dutch law is the age limit: it applies to patients from 12 years of age (however, terminally ill children aged 12 to 16 years require parental consent).

Switzerland

Switzerland is perhaps the most famous country in which the right to die is enshrined in law.

Illustration copyright istock Image caption The Dignitas Clinic claims to help people die without pain and with dignity

This is partly due to the Dignitas clinic, which, for a fee, helps terminally ill people end their lives. It has become the last refuge of many foreigners who want to die without pain and with dignity.

Swiss law allows “assisted suicide” in cases where “those who help do not have selfish motives.”

Criminal law, in force since 1942, punishes assisted suicide only in cases where the patient is persuaded to take his own life in order, for example, to get rid of the burden of caring for him, not to pay for care and treatment, or to quickly receive an inheritance. If none of the above can be proven, then no criminal case will be initiated.

In order to avoid criminal liability, a person helping a patient die must prove that the patient knew what he was doing and expressed this desire several times over a certain period of time.

At the same time, euthanasia as such, that is, when the patient does not take the lethal cocktail himself, but is given an injection or medicine by a doctor or relative, is illegal.

Belgium

Illustration copyright istock Image caption In Belgium, euthanasia is allowed without age restrictions

In 2002, Belgium followed the Netherlands in passing a law legalizing euthanasia.

According to the Euthanasia Law, doctors can help patients die only if they have been observing them for a long time. Patients must be Belgian citizens and permanently resident in the country.

Patients must be in “a hopeless medical condition and in constant intolerable physical or mental suffering that cannot be relieved.” Also, a patient who knows that he will soon fall into a vegetative state may express a desire not to be artificially kept alive in this state. The doctor must be present at the hospital bed until the “very last breath.”

In February 2012, Belgium became the first country to legalize euthanasia for children: unlike the Netherlands, the law does not define a minimum age after which patients can request death.

United States

In the United States, the question of whether or not to allow assisted suicide is left to the discretion of individual states. As a result, it has been legalized in four states, but remains illegal nationwide.

Illustration copyright istock Image caption In the US, euthanasia is legal in only four states. Patients must express their desire to die twice

Oregon doctors have been able to prescribe drugs to help terminally ill patients die since 1997. Oregon became the first state to allow assisted suicide, passing a law called Death with Dignity.

Patients must be of sound mind and memory and over 18 years of age. Doctors must conclude that the person has no more than six months to live. Patients must express their wish to die twice in the presence of an independent witness.

In 2014, Oregon made news after a 29-year-old woman named Brittany Maynard, who was suffering from terminal brain cancer, moved to the state to die.

Assisted suicide was later legalized in the states of Washington, Vermont and Montana.

New Mexico legislators have overturned the state's supreme court decision to allow assisted suicide, and the bill is now undergoing legal review.

And other countries

Illustration copyright istock Image caption Germany and the Canadian province of Quebec may soon allow assisted suicide

In Luxembourg, euthanasia and assisted suicide have been legal since 2009. The legislation is similar to that adopted in Belgium. It emphasizes “the right of doctors to freedom of conscience.”

In Colombia, the first case of assisted suicide was resolved in July this year. The Ministry of Health decided to support the request of 79-year-old Ovid Gonzales, who was suffering from a fatal form of cancer.

In Germany, doctors currently do not have the right to prescribe medications to help people die. However, this issue is currently undergoing legal review. It is expected that the new law could be adopted by the Bundestag as early as November.

A similar situation has developed in the French-speaking Canadian province of Quebec. The National Assembly has already passed a law allowing the use of sedatives and medical aid in dying. It is due to come into force in December this year.

What would happen in England and Wales if the new law were passed?

The law proposed prescribing a lethal dose of drugs to those patients who had no more than six months to live.

Two doctors and a Supreme Court judge would have to formally agree to help a patient die.

They would have to ensure that the patient is of sound mind and memory, that he actually has no more than six months to live, and that he is well aware of the options for palliative treatment. Thus, assisted suicide would be illegal for people not suffering from terminal illnesses or the mentally ill.

The patient would have to take the lethal dose of medication on his own. Doctors would not have the right to administer it themselves - in this case, their actions from a legal point of view would already be qualified as euthanasia, and not as assisted suicide, which the proposed and now rejected bill did not allow.

Some call euthanasia the right to a dignified death, others call it legalized murder and a terrible sin. And find out what it really is. God forbid anyone.

Officially, euthanasia and assisted suicide are allowed in only a few countries - Belgium (since 2002), the Netherlands, Switzerland (since 1942), five US states, Luxembourg (since 2009), Canada (since 2016).

There are also countries where euthanasia is seemingly not allowed, but not prohibited either - Germany, France, Spain, Albania, Israel... Every year the list of states that side with the right to die grows.

In Russia, all types of assisted dying are strictly illegal. Although thousands of seriously ill people are literally begging for it. People suffering from terminal cancer, immobilized disabled people, victims of car accidents who find themselves forever bedridden.

When there is no longer any means to help them, a person with hellish pain is simply sent home to die. And all that remains for relatives and friends is to go through all the circles of hell in attempts to get painkillers or somehow make the life of the dying person easier.

At such moments, people begin to look for another way out.

Several stories from crime reports over recent years.

“Strangled his own mother”

56-year-old Moscow university teacher Vladimir Olkhovsky strangled his own mother. A 78-year-old pensioner suffered from terminal liver cancer.

“She screamed so much and asked to kill her so much that I couldn’t stand it and agreed,” Vladimir said in court. Doctors confirmed that his mother had literally a few days to live. The professor was given 9 years.

Pavel Kovalenko from the Saratov region shot and killed his sick wife Elena (esophageal cancer). The woman was discharged from the hospital to die. She could neither eat nor drink and suffered from terrible pain.

After drinking vodka for courage, Pavel took a sawed-off shotgun and pointed the barrel at his wife’s chest. Then he tried to commit suicide, but failed. Sentenced to 6 years.

Muscovite Yuri Kiseletsky killed his 93-year-old mother with a hammer blow to the head. The woman was a bedridden patient. She begged all her friends and family to give her a lethal dose of pills. But in the end it was her own son who decided to kill. Yuri did not live to see the trial - he committed suicide in a temporary detention center.

Due to the lack of accessible palliative care, Russians are trying in wild ways to fulfill the last wishes of their dying relatives. According to official statistics from the Russian Ministry of Health, today about 600,000 people are waiting for a place in hospices. And although the number of hospices is constantly growing, there are still not enough places.

"We bought her heroin"

We communicated with Svetlana (name changed) on VKontakte in a thematic group under the self-explanatory name “Euthanasia”. I vowed not to give out her address and delete all letters immediately after reading them.

We are from a small provincial town. The hospital is in the regional center 60 kilometers from us. Of course, they triggered my mother’s illness. It took us six months just to examine and make an accurate diagnosis. We went to Moscow to the Herzen Institute.

All the money was collected from friends, acquaintances, and some things were sold. But they didn’t take my mother to treatment. It was too late. Rectal cancer, inoperable stage. You can’t imagine how she suffered. I still cry remembering this hell. The older sister dropped everything and came from St. Petersburg to help us.

The doctors said: “Make her feel warm and calm. That's all that's possible. She has three months left.”

It’s very scary to realize that nothing can be done. You just watch a loved one die slowly and painfully.

Prescribing strong painkillers with drugs back then was akin to a feat (the story with Svetlana’s mother happened before 2015, after 2015, when the number of suicides in cancer patients began to gain massive momentum, writing prescriptions for drugs became much easier. - Ed.).

My sister and I were on duty. Otherwise I would have gone crazy. My sister gets medicine, I’m at home with my mother. Then vice versa. And you also have to support your family and children.

If the pills ran out, my mother screamed so loudly that I was ready to jump out of the window myself. She asked us to kill her, to give her sleeping pills so she could fall asleep and not wake up. And the cousin already got a real drug - heroin. Just in case.

Was it useful?

Yes. I never thought that I would be brewing a dose in my kitchen. But I had to, more than once. And then I saw a story on TV about euthanasia. I went online and read it. I sent my sister a link to a website about euthanasia in a private message. I couldn't say that out loud. Tanya didn't talk to me for three days. And then we sat down and began to think about what to do. Sending my mother to Switzerland for 8,000 euros was unaffordable for us, of course.

Immediately on the Internet, “knowledgeable people” explained to the sisters: an analogue of the very drug that is prescribed to those who come to Switzerland to commit suicide can be bought in China through the website.

Mom immediately agreed. Now I understand how terrible it all sounds, but at the time we were all relieved. She even somehow became more cheerful, and it was as if the pain was not so strong. It was a quiet week, we joked and watched movies. But then the pain returned. We had everything ready. We just diluted the mixture and mom drank it.

The police didn't suspect anything?

No. The three months prescribed for her by doctors have long passed. The death certificate states that she died from an underlying disease. Only my sister and I know about what really happened.

Do you regret what you did?

No. If this happens to me, I will order the powder myself.

“I’ll leave the apartment to someone who will send me to Switzerland”

I have been disabled since childhood - cerebral palsy. Now the mother is caring, but when she dies, then what? She is 65, I am 40. All I can do on my own is see, hear, breathe and speak. There is no pill for my illness. So I'm ready to die.

I know all the ways to die painlessly and quickly. But who will assist me? I can’t leave the house on my own; I can’t get to the front door. I really hope that somehow I can save up. I will leave the apartment to someone who will help me get to Switzerland.

Several members of a group of “good death” supporters suggested contacts for a person who would be willing to advise me on how to die painlessly. I contacted him. And although I had a legend prepared, he instantly figured out that I was a journalist and collecting information.

Revelations from the “Suicide Consultant”

People come to us differently: some are terminally ill, others are tired of living.

“Don’t ask for any details about me,” the interlocutor immediately warned (we communicated on the social network). - Let's just call me Mr. G. The fact is that, according to our legislation, all this advice is illegal. And if the authorities are interested, then you can fall under the criminal article of “assisting suicide.”

Even in a virtual conversation, it was clear that the person was educated. Knows several languages ​​and understands complex terms. Euthanasia is his hobby, and he promotes this idea to the masses. For example, he runs a YouTube channel in two languages, translates thematic books, films and lectures.

A suicide trip to Switzerland is a dream for many. But it is expensive and not so easy. In the same Swiss clinic Dignitas, only two Russians visited the same Swiss clinic in 20 years. So I can’t help you go to the West. The only thing is to suggest a way to pass away painlessly at home.

The drug, which is given to take in a Swiss clinic, could previously be illegally ordered in China for $300. The contacts of suppliers whose products have been tested in laboratories are known to all those interested thanks to the Australian doctor Philip Nitschke and his book.

This is the same Doctor Death who presented the suicide capsule at the exhibition that year. In his native Australia, Dr. Nitschke's books are banned. In addition, he was deprived of his medical license. But this did not stop him from conducting seminars throughout the country.

He is the owner of an online store that sells devices for assisted suicide and just suicide. But you won’t be able to order anything to Russia.

By the way, the last reliable supplier of prohibited substances from China stopped communicating, as indicated in the book. It still trades, but there are a lot of scammers there.

There is also an option to order the drug from Mexico: veterinary solution - $400 for a 100 ml bottle or $600 for 2. But, unlike powder from China, which goes through customs, the bottles can easily be detected on an X-ray, and then a criminal offense. I do not recommend and warn of the risks. Moreover, there is another, cheap and legal way to commit suicide.

The “doctor” told me all the ways, where, how and what to take. We have no right to publish this. Let me just say that I was very shocked by the availability of the instruments of death.

This is roughly how my consultation goes.

What's the price?

For sick people it’s usually free, but otherwise it’s $50. But they rarely seek advice. In total, over the course of a couple of years, I advised more than 10 people, and more than 10 actually committed suicide. I learned about the deaths of two from the news. These were young guys, and we wrote off literally the day before what happened.

Who are these people and why do they want to die? These guys, for example, what was their reason?

There were different people: some were terminally ill, others were tired of living. I don't require a "good" reason for consultation, but that's what they usually say. One had bipolar affective disorder, the other had a physical illness that also caused psychological suffering.

By the way, people without a “good” reason usually either consult for the future, or, even having bought the drug, postpone it. The instinct of self-preservation is a strong thing. About a year ago I advised a businessman - the man had everything except the desire to live. I’m still alive, happily or not, I don’t know.

How do the police record such deaths?

How else can they record if a person killed himself. Although, sometimes the media write that there is a version of murder - this happened to one of those guys.

Tell me, what is your philosophy? Why did you even do this?

- “This way” has a negative connotation. Death is the same right of every person as life. I know how to die painlessly - if someone also wants to know, why not. Another option is sublimation.

Perhaps subconsciously I want to kill people, and this is the socially acceptable way to do it. As for discussions about euthanasia itself, well, yes, the potential for abuse is the main counter-argument, besides the fact that it is an ungodly act.

In Russia, issues of legalizing euthanasia were voiced a couple of times in the State Duma, and the idea itself was subject to severe criticism. After all, the right to commit death can be used by dishonest individuals.

What about them?One way tour

Switzerland stands a little apart from all death-tolerant countries.

Surprisingly, it was thanks to this rich and civilized country that such a terrible word as “suicide” took root next to the cheerful and carefree word “tourism”. The fact is that in Switzerland the law allows assisting suicide if there are no selfish motives. And this applies to everyone, including foreigners.

The concept of “suicide tourism” has been around for more than 20 years, ever since the Dignitas organization appeared in Zurich in 1998, thereby acting as a suicide assistant not only for local residents, but also for foreigners.

By the way, the name of the clinic is translated from Latin as “Dignity”. “Live with dignity, die with dignity” says the slogan of this death factory.

According to Dignitas rules, preparing for suicide is quite a troublesome matter. A person must confirm his illness with papers and undergo consultations with at least two clinic doctors. And confirm your intention twice with a time difference. Only after this is day X assigned.

Employees record everything that happens on video and provide it to the police as evidence. Some Dignitas clients don't mind the death video being seen by the general public.

Short videos are now actively circulating in thematic public pages. The spectacle is not for the faint of heart. I watched one where millionaire Simon Bynner dies.

Do you understand that after you open the IV channel, poison will enter your body and you will die? - asks the voice-over.

The man nods heavily; he cannot speak because of his illness. Then he turns on the audio recording on his phone, listens to the latest declarations of love from his loved ones and opens the deadly tap of the IV.

At the same time, the man smiles happily... The next shots show a coffin being loaded into a hearse. Over the years, Dignitas has lost about 2,500 lives.

There are now several similar organizations operating in Zurich. The one-way tour is, I must say, not cheap.

Here is a detailed price list of one of the clinics (all prices in euros):

3500 is an advance payment, but the doctor’s positive decision is not guaranteed and the payment is not refundable.

870 - for two consultations with a doctor.

2200 - payment if the doctor authorized assisted suicide (AS) and wrote a prescription.

440 - paperwork.

2200 - cremation.

Total: 6570 just for AS, 9210 - AS + cremation + paperwork.

The doctor must fight for the patient's life to the end

Founder and director of the St. Petersburg Children's Hospice, Archpriest Alexander Tkachenko:

In most cases, if a person receives timely and high-quality palliative care, the question of euthanasia does not arise. If there is no pain, a psychologist works, medicine and normal care are provided, a person appreciates the time that he can spend with his family.

I'm not even talking about the scope for crime in this topic and the possibility of resolving inheritance issues. In my opinion, we need to think not about euthanasia, but about how to provide every person with quality care, affordable medicine, quality medications and the opportunity to live as long as they are allotted without suffering.

It seems to me that by raising the issue of euthanasia now, we are “putting the cart before the horse.” We need to first accept the concept of a dignified death in society, agree that this is a natural part of life and we need to be prepared for death.

And society must agree that the right to a dignified death is the same inalienable human right as the right to life. Only after this will it be possible to begin discussing the topic of euthanasia. In the meantime, it’s too early, neither society, nor legislation, nor specialists, nor the people themselves are ready.

As is known, euthanasia- the practice of ending the life of a person suffering from an incurable disease, experiencing unbearable suffering. Currently, euthanasia is allowed in the Netherlands, Switzerland, and Belgium. In the United States, only 4 states allow euthanasia. There is also a single case of euthanasia in Colombia.

This article will review Holland's practical guide: Organ donation after euthanasia.

Introduction.

In September 2013, the Dutch Medical Journal published an article on organ donation after active euthanasia. A patient suffering from a progressive neurodegenerative disease was able to donate his liver and both kidneys. The transplant result is described as excellent.

Until December 2015, organ transplantation after euthanasia was performed 15 times in the Netherlands. During the work, eight pairs of lungs, 13, 13 pancreas transplants, and 29 kidneys were transplanted.

The very fact of organ transplantation from donors after euthanasia required the creation of practical guidelines for euthanasia followed by organ donation due to the unique and complex legal and ethical aspects, as well as the peculiarities of both procedures from the point of view of providing medical benefits.

This guide covers the basic principles of euthanasia followed by organ donation, developed jointly by the Maastricht University Medical Center and the Erasmus University Medical Center Rotterdam.

Although the manual covers euthanasia and organ donation in the Netherlands, many of the issues discussed may be similar or comparable to those in any country that is planning or is currently performing organ transplants from euthanasia donors. Discussion of ethical considerations is not included in this document, however, this does not preclude necessary ethical discussions related to this topic.

Legal issues relating to euthanasia and organ donation.

Current status of euthanasia worldwide: Blue – Euthanasia is allowed. Blue – passive euthanasia is allowed. Black – Euthanasia laws vary across administrative units. Red – euthanasia is prohibited.

Euthanasia is legally possible in the Netherlands, Belgium, Luxembourg and Colombia, as well as in 4 US states. Several other countries have legalized assisted suicide.

Euthanasia involves the intravenous administration of coma inducers and muscle relaxants, which leads to rapid death of patients without causing severe ischemia of internal organs.

If a patient requests to undergo euthanasia and subsequently donate their organs for donation, the physician must determine whether all legal requirements for euthanasia under the Euthanasia Act have been met before beginning the process of preparing the patient for organ donation. First, the patient must be an adult. Secondly, the patient must independently and voluntarily request euthanasia. Thirdly, his request must be carefully considered: the patient must have objective reasons for carrying out euthanasia, such as unbearable suffering from an irreversible disease, which will ultimately lead him to natural death from the progression of the latter. At the same time, if it is possible to stop the underlying disease and/or suffering of the patient, then euthanasia cannot be performed. In addition, the patient must be additionally consulted by doctors, and, if necessary, by a council of specialists about the need/possibility of undergoing euthanasia. Euthanasia itself must be carried out in accordance with national standards (Netherlands).

After a patient has died, the Dutch law on burial and cremation requires that the municipal coroner (the person who specifically investigates deaths that have unusual circumstances or occurred suddenly and directly determines the cause of death) is notified, since in legal terms euthanasia results in " unnatural" death.

Since the euthanasia procedure results in the death of the patient from cardiac arrest, organ explantation is permissible according to the Maastricst classification. This type of donor belongs to the type III category - expected cardiac arrest (see table).

In type III donors, according to this classification, all organs except the heart are allowed to be explanted for transplantation.

Ethical issues regarding euthanasia and organ donation.

There are many ethical issues surrounding organ donation after euthanasia that differ from those of organ donation after a person has died for other reasons. In particular, these ethical issues relate to the decision to authorize euthanasia in circumstances where the patient's organs will be used for transplantation.

Although a program for organ donation after euthanasia already exists and is producing results, the practice remains ethically questionable. However, relatively recently, one patient was refused organ donation after euthanasia. In this case, the patient was not undergoing hospital treatment, but simply expressed a desire to undergo euthanasia followed by donation. There was an outcry in society about the fact that the patient himself has the right to express his will in this matter. The issue was subsequently brought up for discussion in the Dutch Parliament, and parliamentarians asked the Minister of Health to facilitate the process of organ donation after euthanasia of the patient. This case is still being discussed.

What is the patient's motivation for organ donation after euthanasia?

The attending physician should find out whether third parties, such as patients on the waiting list for organs from a postmortem donor, are interested in organ donation after euthanasia. However, it is important not to interfere with the patient's altruistic intentions. If a patient meets the criteria for euthanasia, it is important to respect the patient's wishes to donate organs.

It can be assumed that in the presence of matching HLA typing and a negative cross-match blood test to match the donor and recipient, some patients are motivated or convinced to undergo euthanasia in order to donate organs to a specific recipient. It is worth considering that in the Netherlands, organ distribution is carried out by coordinators of the Eurotransplant organization, which does not allow the donor to choose recipients. However, in the USA, for example, this possibility is practiced.

Living organ donation before euthanasia is a theoretical alternative even in seriously ill patients. However, it seems irrational that the only option for a patient to choose a recipient is to undergo surgery before undergoing euthanasia.

Euthanasia on a “working” heart.

Some organ donors have expressed a desire to donate all of their organs, including the heart, which is currently a very unusual practice. Theoretically, it is possible to perform euthanasia by removing the heart under general anesthesia. However, the “dead donor” rule, as well as the current Dutch law on euthanasia, does not allow such a procedure.

However, one may wonder whether donation should be used in this way. Thus, in the procedure of living organ donation (without euthanasia), the task is to protect the interests of the donor by avoiding the removal of vital organs, while the desire to euthanize a patient is a strong desire of the patient to die, regardless of whether he will organs are used for transplantation or not.

In addition to the above, it is worth adding: practice has shown that sometimes relatives insist that the patient die before he is transferred to the operating room.

Should a doctor force patients to become organ donors after euthanasia?

What to do if a doctor encounters a patient who meets the criteria for euthanasia, and also has no contraindications to organ donation, if the patient does not raise the issue of possible organ donation?

By pointing out the possibility of organ donation after euthanasia, the doctor refers to the patient's right to self-determination and informs the patient about this possibility if he did not know about it before. The patient may find comfort in the idea that he or she can help people survive and improve their quality of life.

However, there are times when a patient suffers so much that they request urgent euthanasia, in which case it may simply be inappropriate to discuss organ donation.

The attending physician, who often has a trusted relationship with the patient, is usually the preferred person to raise the issue of organ donation after euthanasia. If the patient agrees, he is entered into the donor register.

Informing the donor and recipient.

Donors often ask who will receive their organs. It is not legally permitted to share this information for privacy reasons. This is done because this information may influence the patient's decision about organ donation. It may also create additional stress for the patient if, for example, he is told that there are no suitable recipients for his organs.

According to Eurotransplant rules, recipients and their doctors have the opportunity to refuse certain types of donor organs when the recipient is on the waiting list. These criteria include the age and type of donor, as well as information about whether the donor is participating in a donation program after euthanasia.

Contents of the practical guide.

What practical steps should a general practitioner or medical specialist take when a patient requests euthanasia and also expresses a desire to donate organs if there are no contraindications to donation?

Euthanasia.

If a patient requests euthanasia, his request is always carefully considered. The physician should discuss with the patient various treatment options, including psychological treatment, to avoid euthanasia (various options such as sedation, pain management, and hospice care will be discussed).

It happens that the question of organ donation is raised by the patient even before the issue of euthanasia is discussed. In this case, the doctor must indicate that euthanasia must be carried out in a special way so that the patient can become an organ donor. As a rule, a consultation is held on this issue. After the consultation, the attending physician may agree to the request for euthanasia, and then he becomes the “executive physician,” which is a key role in the euthanasia procedure.

Organ donation.

If a patient wants to become an organ donor, the performing physician checks whether the patient is registered as an organ donor. If the patient is not registered, he signs the appropriate consent.

Transplant coordinator.

The doctor contacts the transplant coordinator, who studies the patient’s medical history to determine contraindications for organ donation. If the patient is a suitable potential donor, a meeting will be arranged between the patient and the provider during which the practicalities of euthanasia and organ donation will be explained. Also at this meeting, at least two important issues are raised: the need for additional diagnostic examination of the patient and the need for hospital euthanasia (that is, the fact that the patient will not be able to carry out the euthanasia procedure at home).

Additional diagnostics.

Although Dutch law states that diagnostic testing can only be carried out when it benefits the patient, the Dutch Organ Donation Act allows the transplant coordinator to perform various tests when it is clear that the patient will die within a limited period of time. Depending on the results of the examination, the transplant coordinator, together with transplant surgeons, decides which organs can be used for transplantation.

As a rule, blood and urine tests are taken, and if necessary, additional diagnostic studies may be required to establish contraindications to the donation of certain organs. These examinations may be performed in the hospital prior to admission or on the day of euthanasia, depending on the patient's wishes. Based on the results, Eurotransplant is looking for suitable recipients. However, it happens that during the operation contraindications to organ donation may be discovered.

Hospital stage.

After the euthanasia procedure, the deceased donor is transferred to the operating room as soon as possible. This must be clearly explained to relatives: they will not be able to say goodbye to the deceased donor, because the period of time between death and organ removal should be as short as possible. Every minute of delay leads to a decrease in organ quality, which may even lead to the inability to donate due to ischemia. Relatives are widely informed that they need to say goodbye before the euthanasia drug is administered. To date, this approach has not resulted in any problems.

It is critical to discuss what to do if the patient's condition worsens and the patient remains unconscious in the days leading up to the day of euthanasia. If necessary, a new medical evaluation will be performed to determine the appropriateness of donation in this case.

Preparatory activities.

After additional examinations, a combined procedure of euthanasia and organ donation is organized. The patient, executive physician and transplant coordinator, in close contact with the operating room medical coordinator, decide on the appropriate date for the procedure.

If the executing physician is not an employee of the hospital (for example, a GP or medical specialist from another institution), he will be required to sign a statement stating that euthanasia will be carried out in accordance with the latest standards; the hospital is also officially responsible for this procedure.

After death, the transplant coordinator transmits the information to the municipal coroner (forensic physician), who, after reviewing the patient's medical record, informs the prosecutor about euthanasia and planned organ donation. The prosecutor can then grant permission to use the body for organ donation, so as not to waste time after the patient's death. This approach optimizes the organ donation process while respecting the patient's ultimate wishes for organ donation, reducing the time period between death and organ retrieval.

Removal of organs from patients after euthanasia.

The time the patient arrives at the hospital depends on which organs are planned for removal, as well as on what additional diagnostic procedures are planned.

At the hospital, euthanasia will be carried out in a patient room adjacent to the operating room, large enough to allow relatives to be present.

Once all interested parties have arrived, the nurse establishes peripheral venous access. Dutch guidelines for euthanasia require the doctor to administer a sedative (thiopental or propofol) followed by muscle relaxants. Thiopental is potentially cardiotoxic; propofol is commonly used for general anesthesia and thus does not harm donor organs. In Belgium, doctors sometimes administer heparin immediately after injecting euthanasia drugs to improve organ perfusion. In the Netherlands this is not done because it is generally believed that donation should not interfere with the euthanasia procedure itself.

After administration of the drugs, there is a period of insensitivity for five minutes. After this time, an irreversible stoppage of blood circulation and breathing occurs, and the patient’s death is declared

Once death is determined, the doctor informs the municipal coroner. The patient is transported to the operating room, where the surgical team is on standby. After collection, the organs are transported for transplantation to various recipients.

After the procedure.

A nurse and a second transplant coordinator assist relatives. Relatives are allowed to stay in a special room where they can wait until the procedure is completed. The deceased donor will be delivered to the hospital mortuary, but may also be delivered to another mortuary or to their home.

Psychological work is carried out for 2 weeks after the procedure to discuss any moral issues that may arise among any medical personnel involved and to review all legal, ethical and practical aspects. The regional euthanasia oversight committee is informed by the municipal coroner and checks whether the performing physician has fulfilled all the requirements when performing euthanasia. If this committee is convinced that not all requirements have been met, it is obliged to inform the Dutch Health Inspectorate. This inspection can inform the prosecutor, after which the court can convict the doctor. In the donation procedures carried out so far after euthanasia, the Dutch Health Inspectorate has determined that all requirements have been met. If this were not the case, it would not necessarily imply that the organ donation procedure was also illegal.

Conclusions.

Dutch laws on euthanasia and organ donation provide sufficient opportunities for patients to donate their organs after euthanasia. Given the right to self-determination, such a combined procedure may be ethically justifiable, although it must be recognized that many ethical issues remain open and actively debated. A physician who is faced with a patient who requests euthanasia may consider organ donation if no contraindications are identified.

As of December 2015, the procedure for organ donation after euthanasia has been used 15 times.

The original article was published in the American Journal of Transplantation and is available at the link: https://www.ncbi.nlm.nih.gov/pubmed/26842128 Konstantin Olesievich Syomash https://site/wp-content/uploads/2017/04/logosmdd.png Konstantin Olesievich Syomash 2017-11-14 08:03:29 2018-11-01 09:53:15 Organ donation after euthanasia

A 14-year-old Chilean girl suffering from incurable cystic fibrosis has asked her country's president for euthanasia.

Valentina Moreira, who was diagnosed with cystic fibrosis, recently posted a video message on her Facebook page pleading for a meeting with Chilean President Michelle Bachelet.

“My name is Valentina Moreira. I am 14 years old and I suffer from cystic fibrosis. I urgently need to talk to the President because I am tired of living with this disease. She can authorize injections that will allow me to sleep forever,” the girl said in a video she filmed in her hospital room, posted in February 2015.

A representative of the Chilean government said that euthanasia is prohibited by law in the country and therefore the girl was refused. The girl's video message sparked widespread debate about whether euthanasia should be legalized in the predominantly Catholic country.

President Michelle Bachelet, who has a degree in pediatrics, visited the sick girl in the hospital.

Cystic fibrosis is a genetic disease that is inherited and seriously weakens patients as a result of clogging and blockage of the bronchi with viscous pulmonary secretions. Valentina weighs only 35 kilograms, breathes with the help of a breathing apparatus and is fed through a tube.

2The Terminally Ill 29-Year-Old Woman Who Moved to Oregon to Die

On November 1, 2014, Brittany Maynard, a terminally ill woman, died in her home from a massive dose of barbiturate. She was 29 years old. On her Facebook page, she wrote a farewell letter.

Maynard and her husband Dan Diaz drew attention a month ago when the couple announced their intention to use euthanasia in Oregon, whose law allows people with terminal illnesses to end their lives with lethal drugs provided by a doctor. The couple moved to Oregon from California in June because of the state's euthanasia law, which was passed in 1994.

Maynard was diagnosed with stage 4 brain cancer (glioblastoma) in January 2014. She was told that she only had 6 months to live.

3. A healthy woman who wanted to die with her sick husband

George and Betty Cumbias from Canada, who had been married for 50 years, wanted to die together and so traveled to Switzerland, where voluntary euthanasia is allowed as part of “suicide tourism.”

The couple's request was unusual in that George Cumbias suffers from a heart condition, while Betty Cumbias is in excellent health. In the end they were refused.

In 2009, the previously healthy Betty Cumbias was diagnosed with cancer and died, although her ill husband lives on.

4. Blind twins asked for euthanasia

In 2012, a pair of twins, Marc and Eddie Verbessem, who were born deaf, asked Belgian doctors for euthanasia after they learned they would soon go blind.

45-year-old brothers from Antwerp chose death because they could not come to terms with the idea that they would never see each other. On December 14, they were killed by lethal injection at the Brussels hospital in Jetta.

Their case was highly controversial because the twins did not suffer from an incurable disease. The doctor who attended the euthanasia claimed that the twins made this decision in a “conscious state.”

5. Murderer and rapist who was granted the right to euthanasia

In September 2014, a convicted rapist and murderer who spoke of unbearable psychological suffering in prison was granted euthanasia rights in Belgium. This was followed by 15 more similar requests from other prisoners. He was supposed to die in January 2015, but euthanasia was suddenly canceled due to the fact that the victim's family strongly condemned the easy death of the criminal.

6The Newly Married Paralyzed Man Who Decided To Euthanasia Before His Child Was Born

Tim Bowers, 32, was hunting deer when he fell from a huge tree and suffered a spinal injury.

After the accident, the man was paralyzed. Bowers was motionless and dependent on a ventilator because he could not breathe on his own.

The Bowers family turned to doctors and asked to remove the patient's breathing tube, because even after having surgery on his spine, he would never be able to walk or live outside the hospital.

His sister Jenny Schultz said that when Tim was asked if he wanted to die, he shook his head emphatically. Also, doctors repeatedly asked him about euthanasia and received the same answer. Then they removed the breathing tube and 5 hours later he died.

Bowers got married 3 months ago, he left his pregnant wife because he did not want to live in a wheelchair.

7. Belgian man asked for euthanasia after unsuccessful gender reassignment surgery

In 2013, transsexual Nathan Verhelst asked doctors for euthanasia after unsuccessful gender reassignment surgery. The forty-four-year-old man was born female and named Nancy. He was allowed euthanasia by lethal injection due to "unbearable psychological suffering."

Verhelst was prescribed hormone therapy in 2009, followed by a mastectomy and gender reassignment surgery in 2012.

Euthanasia is carried out by doctors solely at the request of the patient and is allowed only in three European countries: the Netherlands, Belgium and Luxembourg.

8. A woman with a tumor on her face committed suicide with the help of drugs.

In 2000, French teacher Chantal Sebier was diagnosed with esthesioneuroepithelioma, an extremely rare type of cancer. Over the past 20 years, only 200 people have been diagnosed with this type of cancer. Sebir refused treatment and surgery and asked to be given the right to die through euthanasia.

In March 2008, a French court rejected the request of a 52-year-old teacher. A few days later, the woman was found dead in her home. An autopsy revealed that she died of unnatural causes. Subsequent tests showed the presence in the blood of the drug Phenobarbital, which is not sold in French pharmacies, but is used by doctors in other countries where euthanasia is allowed.

About a million Russians suffer from fatal diseases. A third of them are thinking about voluntary death, experts say. At the same time, euthanasia is prohibited in Russia, and a trip to Europe for the procedure costs several thousand euros.

How terminally ill Russians live, why euthanasia is prohibited in Russia, and who helps terminally ill people die - “ Paper"found out whether the inhabitants of Russia have the right to die.

Tatyana from Moscow is 55 years old. She loves Gaidai's comedies and knows Bulgakov practically by heart, is fond of rare perfumes and often remembers her students - there have been many of them in her 25 years of work as a physics teacher.

Now Tatyana is no longer teaching. She is retired and is trying to save up for euthanasia, a procedure in which the doctor himself administers a lethal drug to the patient.

In March 2015, the woman found out that she had cancer. Later - that her disease does not respond to treatment and is only progressing. And recently doctors discovered a new tumor in Tatiana’s lung.

My stage [of the disease] is late. The situation is not particularly critical yet, but I know what will happen next. Terrible pain, helplessness, uselessness to anyone - I have no relatives or loved ones. There is no one to run around to fetch medications and provide basic care. There are only a couple of friends left,” says Tatyana.

Against this background, a Muscovite thought about voluntary death: “Every person has the right to decent care. It’s better to leave in a civilized manner, rather than getting smeared on the asphalt by going out onto the street through the balcony. And only if you can crawl to it.”

Euthanasia is prohibited in Russia. The only way out for a woman is to travel abroad for the procedure. But it costs several thousand euros. “I’m trying to save up for euthanasia, but my retirement isn’t working out very well. Oncology is very expensive. Free healthcare has faded into the background. You have to pay for everything. If you are seriously ill, the state stands aside. It’s simply impossible to accumulate,” Tatiana emphasizes.

Where is euthanasia allowed and what does its legalization lead to?

Euthanasia is prohibited in most countries of the world. Russia is no exception: patients only have the right to refuse medical intervention, including artificial life support.

However, some countries have legalized euthanasia or assisted suicide (AS) for their citizens - a procedure in which a doctor prescribes a lethal drug to a patient, but the patient takes it himself.

Since 2002, euthanasia has been legal in the Netherlands and Belgium. Since 2009, assisted suicide has been allowed in Luxembourg, and in 2015 - in Colombia, Germany and Canada. In addition, assisted suicide is legal in six US states: Oregon, Washington, Colorado, Vermont and California got it through changes in legislation, and Montana got it through a court decision. In these states, patients over 18 years of age who have no more than six months to live have the right to end of life with the help of doctors. A fatal diagnosis must be confirmed by two independent doctors, and the patient must express his desire to die three times.

In Switzerland, assisted suicide is also legalized at the state level, and the procedure can also be applied to foreign citizens. Back in 1942, they passed a law allowing “assistance in committing suicide” if the “assistant” - most often a doctor - does not have selfish motives. There are several non-profit organizations operating in the country that, for a fee, help foreigners commit assisted suicide.

The most famous of them - Dignitas - offers to organize assisted suicide for people suffering from incurable diseases, “unbearable pain” or “intolerable disability”. Such services cost 8–12 thousand dollars. In total, according to official data, over 18 years the non-profit organization has helped 2,328 people die, almost half of whom are Germans. During all this time, there were only two Russians among Dignitas clients. Both committed assisted suicide in 2014. Tell about them " paper"Dignitas refused.

Dignitas movie trailer

However, the number of people choosing euthanasia or assisted suicide varies greatly from country to country. Thus, in Switzerland there are about 700 cases of voluntary death with the help of doctors per year, in the Netherlands - 5 thousand, and in Oregon, America - a little hundreds. At the same time, the number of lethal procedures in such countries is increasing from year to year. For example, in Switzerland in 2014, 26% more euthanasia was carried out than in the previous year.

Statistics show that cancer patients choose euthanasia more often than others. In 2015 in the Netherlands, more than 70% of the 5,500 people who chose euthanasia (which accounted for about 4% of all deaths in the country) had cancer.

At the same time, according to polls, physical suffering is not the main factor in favor of euthanasia for such patients. People who decide on it most often indicate that they made such a choice primarily because of depression and a feeling of “hopelessness.”

What is an alternative to euthanasia and AS

Palliative care for patients is considered an alternative in Russia. Palliative medicine physicians are responsible for using methods and procedures that can provide relief to a terminally ill patient, such as pain relief and severe symptoms.

Palliative medical care is developing by leaps and bounds in Russia today. However, if we compare our level of development with other countries, then, of course, we are far behind and will continue to catch up for some time,” says Evgeniy Glagolev, executive director of the Russian Hospice Care Association.

In Russia, palliative care is represented primarily by hospices: there are about a hundred of them in the country. Hospices are free medical institutions for patients in the terminal stage of the disease. The environment in a good hospice is reminiscent of scenes from Hollywood films where they show homes for the elderly. Such institutions have a small number of patients (about 30–50 people), caring nurses, psychological assistance and an individual approach to patients. In addition, hospices have outreach services that serve and assist patients who remain at home: there are usually more of them than those who are hospitalized.

According to the latest data from the Ministry of Health, which keeps records only of terminally ill patients, there are now up to 600 thousand in Russia in need of palliative care, including 36 thousand children. In fact, there are most likely even more people who need help, says Glagolev. It is difficult to give exact figures: there are different assessment methods. According to one of them, at least 260 thousand cancer patients and 520 thousand patients with other diseases, as well as about 200 thousand minors, need such help. According to Glagolev, less than half of those in need receive palliative care.

Hospices are very expensive to run. Naturally, there is not enough government funding, as everywhere else,” says Glagolev. “However, the Ministry of Health has a clear plan for the development of palliative care, according to which by 2020 the country will have a sufficient number of palliative beds per capita. The plan is being carried out successfully. It’s easy to open beds; it doesn’t even require a lot of money, especially taking into account the ongoing modernization of the healthcare system, when many departments are closing. But it is very difficult to ensure that high-quality palliative care with all the components is actually provided on allocated beds - and I see this as a big problem.

Glagolev gives the following example: the state allocates about 1,800 rubles per bed-day for a hospice patient, while in reality, for quality care, a patient needs about 10 thousand rubles daily.

The specialist admits that patients with incurable diseases often have thoughts about euthanasia. “The objectives of palliative care are neither to hasten nor to delay the onset of death. However, all the research on this topic says that people are afraid not of the fact of death itself, but of the suffering associated with dying. Not only yours, but also your loved ones. Nobody wants to be a burden to relatives. I know for sure that if you stop painful symptoms, remove pain, alleviate the painful condition, then very often the question of euthanasia goes away by itself,” says Glagolev.

With him Agree and pediatrician Anna Sonkina, who studied the experience of euthanasia in the Netherlands: “We can only think about legalizing euthanasia in Russia after the development of palliative care.”

The head of the department of suicidology at the Moscow Research Institute of Psychiatry, Evgeniy Lyubov, in a conversation with “ Paper“explained that at least a third of all seriously ill patients are prone to suicide, but only a small part decides to do so. Lyubov emphasizes that there are no accurate statistics on such suicides in Russia: they are “masked” by accidental overdoses, falls, and so on. However, according to his estimates, only about 5% of suicides in Russia occur due to incurable diseases; psychological problems are much more dangerous. “Most death callers are depressed, feel burdened, lonely and physically suffering. And they need help,” the specialist explained.

Indeed, not all Russians can receive the necessary palliative care. Thus, even in Moscow, according to the Vera Foundation, no more than a quarter of terminally ill patients received quality care and pain relief in 2015. Sometimes this situation leads to a wave of suicides. This was the case, for example, in February 2015, when in one month in Moscow, eleven people who suffered from cancer and did not receive the necessary medical care committed suicide. After one of these cases - the suicide of Rear Admiral Vyacheslav Apanasenko - Russia nevertheless significantly facilitated the prescription of narcotic painkillers for cancer patients.

However, it is not only cancer patients who face similar problems. Moreover, most free hospices only accept them, refusing patients with other diagnoses.

Why is the Russian Orthodox Church against euthanasia and what do patients think about it?

Anastasia started getting sick from birth. In infancy, she suffered blood poisoning twice, after which the girl was vaccinated against tuberculosis, and then Nastya became paralyzed. At 3.5 years old she was diagnosed with cerebral palsy.

Now Anastasia is 40 years old. She has the 1st group of disability - the woman cannot walk and take care of herself. Her elderly mother takes care of her. “I know that with a 2nd or 3rd group of disability, people with a similar diagnosis can often study and socialize somewhere, sometimes even start a family and give birth to healthy children. But I can only talk, see and hear,” says Anastasia. - My intellect is normal, but this makes it psychologically, oddly enough, only more difficult. Do you understand what it’s like to realize that you are 40 years old and, due to current circumstances, will not have an independent life, personal life, or family? You are dependent on others to get dressed, undressed, bathe or go to the toilet.”

The woman sees no way out of this situation; new methods of treating Anastasia have not been offered for a long time. “My mother won’t send me to a boarding school. She is a categorical person: she decided that she would look after me for the rest of my life, as long as she could. But I think that they are doing the wrong thing by leaving severely disabled people with elderly parents for the rest of their lives. You may live less in a boarding school, but in some cases this is for the better. After all, no one thinks about the fact that problems only get worse with age - this is how Anastasia explains why she is thinking about assisted suicide. - Of course, if there was such an opportunity, I would not refuse, but I don’t know how to implement this technically in my case. Most often I can’t travel further than my own street in a stroller, let alone fly abroad.”

The woman admits that in Russia it is difficult to talk about the legalization of euthanasia: “Now for many, the opinion of the church is important, and believers are sharply opposed to such methods. But not everyone should be believers. I believe that for those who do not consider themselves believers, there should be some kind of alternative and the right to choose how a person should behave in the event of a serious illness. Personally, for example, I am an atheist, although I was baptized in infancy in the Orthodox Church. I don't know what the parents hoped for. Perhaps they thought I would recover, but nothing happened.”

All major world religions oppose euthanasia, declaring that only God can give and take life. Thus, at the end of 2016, the head of the Russian Orthodox Church, Patriarch Kirill, and Pope Francis made a joint statement in which they condemned the procedure. They said that the spread of euthanasia leads to the fact that elderly and sick people begin to feel like an excessive burden on loved ones and society as a whole.

“Manipulation of human life is an attack on the foundations of human existence, created in the image of God,” the hierarchs explained in a statement.

Patriarch Kirill spoke more than once about his negative attitude towards euthanasia. Among other things, he stated that euthanasia is “a path to the de-Christianization of Europe” and “a disgrace to modern civilization.”

The Russian Orthodox Church often pointed out that in countries that first legalized euthanasia for terminally ill patients, the circle of people who can use this procedure is constantly increasing. According to church representatives, this trend could end in “forced euthanasia” and the legalization of murder.

Indeed, in Belgium over time allowed euthanasia for minors and depressed people, in the Netherlands they carry out euthanasia for the “tired of life” elderly people and the mentally ill, and are also discussing the legalization of euthanasia for completely healthy people. At the same time, in more religious countries, for example, in the United States, the circle of people who have the right to euthanasia is not expanding.

Even less systematic Orthodox priests agree with the decisive role of religion in the issue of the “right to death.” For example, Bishop Grigory Mikhnov-Vaitenko, who left the Russian Orthodox Church after he publicly criticized the war in Donbass, in a conversation with “ Paper“stressed that Christianity will always be on the side of palliative care and not euthanasia.

“Now the Russian Orthodox Church is part of the state apparatus”: the priest on why he is against the transfer of Isaac and the law on insulting the feelings of believers

Do clergy really earn a lot and why do they take out loans, why does a priest oppose the law on insulting the feelings of believers, and does the church pay attention to the protests against the transfer of St. Isaac’s?

Christianity will always be for life and, accordingly, for the development of hospices, says the priest. “But you need to understand that this is not a matter of legislation or a ban on mentioning suicide in the media. It’s just that a person should always have an alternative to dying - this is quality care and medical assistance. Because if we talk about seriously ill people who experience terrible pain, we should not demand that they continue to live, smile and rejoice. This is strange to say the least. And if they still choose to leave this life, then it is not him who needs to be condemned, but us, those around us, those who did not give them this alternative.

36-year-old Anna from St. Petersburg also agrees with the importance of the church’s opinion on euthanasia. She, like Anastasia, suffers from a serious illness and advocates the legalization of euthanasia in Russia.

Anna always loved to sing. A few years ago, she could play the guitar for hours and sing her favorite rock hits - the St. Petersburg woman loves Tsoi and “Spleen,” “Aria” and DDT. Singing was Anna’s whole life, she admits in a conversation with “ Paper«.

Now, due to health problems, the woman can no longer sing. She has bronchial asthma, chronic obstructive pulmonary disease (one of the deadliest diseases on Earth) and chronic gastroduodenitis. A month ago, a St. Petersburg woman had to leave her job at the studio due to another exacerbation of the disease. “I get severe shortness of breath even if I just sit without moving. And constant abdominal pain. For weeks. Sometimes I feel like I’m going to die,” Anna explained.

The thought of euthanasia first occurred to a woman 15 years ago. In 2002, Anna was once again admitted to the hospital, but after a month of treatment, the doctors were unable to help or relieve the pain. After leaving the hospital in a state of depression, Anna found information on the Internet about assisted suicide for foreigners in Switzerland and decided to save up for it, but was unable to. And later she drove away this thought for the sake of the children: now Anna and her husband Dmitry are raising a 10-year-old son, Timofey, and a 5-year-old daughter, Alisa.

In addition to her family, the St. Petersburg resident also has favorite hobbies - studying the culture and languages ​​of Asia, painting and popular science books. Despite this, Anna admits that she will probably return to the idea of ​​euthanasia: “During exacerbations, I always think about death. The thought that you will have to suffer like this for several more decades does not allow you to approach life wisely. I already almost constantly feel the symptoms of my illness. But when they are unbearable, you want to die.”

The woman no longer counts on the legalization of euthanasia in Russia. “In Russia, euthanasia is viewed very critically. I came across this when asking my online friends to sign a petition for euthanasia in Russia. I know almost all of them personally, but only a few of them signed. Almost everyone answered that it was a sin and no one had the right to take someone else’s life. Many people refer to God. But no one in veterinary medicine refers to it. And they euthanize the animal without asking. A person can say for himself why he wants to die,” she explained.

Why Russian officials oppose euthanasia

Russian authorities hold extremely conservative views on euthanasia and have not even begun to develop a bill to legalize it. Only in 2007 did the media report on the possible adoption of euthanasia in Russia, but even then everything was limited to rumors and requests from deputies to medical institutions. After this, euthanasia was discussed in the State Duma exclusively in a condemning tone, judging by the transcripts of the meetings on the parliament website.

The Russian authorities explain their point of view not only by religious dogma, but also by the unpreparedness of society. Thus, former Deputy Speaker of the State Duma Vladimir Katrenko, when the legalization of euthanasia was last seriously discussed in parliament, said that, in fact, this is a permission for suicide and murder.

We are told that the quality level of medical care in Russia is very low, but this only proves the need to increase this level, and not try to solve the problem by allowing desperate patients to commit suicide. By allowing euthanasia, we are legalizing the right to a death sentence imposed by medicine on a person and a person on himself,” he explained.

Deputy Chairman of the State Duma Committee on Health Protection Nikolai Gerasimenko then stated that euthanasia would become “a weapon in the hands of unscrupulous doctors, lawyers and black realtors” who would “ruin thousands of people for the sake of apartments.” “What the hell is euthanasia? Pensioners are dying of hunger. In our country, the state carries out euthanasia, but no one talks about it,” added Natalya Markova, an expert at the Coordination Council for Social Strategy under the Chairman of the Federation Council.

At the same time, officials emphasized: the idea of ​​legalizing euthanasia will not find widespread support in Russian society. Their opinion is partially confirmed by the fact that the fight for the legalization of euthanasia in Russia is now limited to posts in specialized communities for terminally ill patients on social networks and the creation of petitions on the website Change.org. They don’t get more than 200–300 signatures.

« Paper» talked to the creator of one of these petitions. He turned out to be a 37-year-old unemployed man who is not sick with any fatal diseases, and advocates the legalization of euthanasia, as he considers “life is too expensive, dangerous and immoral to seriously live and leave offspring.”

However, it recently became clear that such ways may appear, because among the Russian authorities there are also open supporters of euthanasia. For example, the new Commissioner for Human Rights, Tatyana Moskalkova, announced her position. “It seems to me that this is very humane if a person himself wants to die and his life has no chance of living, if he suffers, and if his loved ones and relatives in one harmony came to end this suffering,” the ombudsman said . The matter has not yet progressed beyond this statement.

At the same time, not only terminally ill people dream of introducing euthanasia in Russia, but also those who suffer from mental illness.

Why are not only terminally ill people in favor of euthanasia?

27-year-old Ruslan from Simferopol does not like to talk about the present and lives only in the past. Five years ago, everything “was perfect” for him. Then Ruslan worked as a stationery seller and worked part-time at a construction site, jumped with a parachute and practiced martial arts, loved nature and dated girls. But when the young man turned 22, everything changed: Ruslan began to suffer from social phobia - a mental disorder characterized by a fear of being in society.

Due to social anxiety, Ruslan developed severe insomnia. He took handfuls of antipsychotics and sleeping pills to help him sleep and contemplated suicide. “I remember the horror when you think that the day will soon come when the sleeping pills will stop working, and you will die terribly painfully for a week with a complete lack of sleep,” he explained. Paper".

Over two years of treatment, Ruslan managed to overcome insomnia, but social phobia became increasingly stronger. Now the man lives on antidepressants, which are helping less and less. “I was quite a cheerful person, but now I am psychologically broken. I have no more hope. You can’t call this life - I just exist,” he explained, emphasizing that in the future he will most likely commit suicide if social phobia does not recede and euthanasia is not legalized in Russia.

However, not all patients are able to die without outside help. They are often helped in this by relatives, neighbors and even Internet activists.

Why is euthanasia done illegally in Russia and how is it punished?

The first high-profile trial on unofficial euthanasia in Russia took place 13 years ago. In February 2004, 32-year-old Natalya Barannikova from the Rostov region was in a car accident and was left paralyzed. Her husband looked after the bedridden woman, but then he asked a neighbor girl, 14-year-old Marta Shkermanova, to become a nurse for Natalya. She agreed.

Aunt Natasha suffered greatly due to her illness. She constantly complained that she didn’t want to live. She said that she wanted to die, not wanting to be a burden to the family. She asked me several times to find out who could kill her in order to end her suffering,” Marta later said. It turned out to be difficult to find those willing to kill Natalya, and Barannikova asked her nurse to help her die, promising her about 5 thousand rubles.

Marta told her 17-year-old friend Christina Patrina about the proposal. The schoolgirls decided to help the woman. “Euthanasia” was scheduled for August 22.

Aunt Natasha was lying on the bed, as usual. She had no clothes on, only a robe covered her on top. Then she began to cry, asking to be killed as soon as possible. We got scared and refused. But she continued to beg, Marta said during the investigation.

In the end, the schoolgirls made up their mind: Marta tied the woman’s arm with a belt, and Christina gave an injection, injecting ten cc of air into a vein. The woman did not die and asked the girls to strangle her. The friends took the rope and killed the paralyzed Natalya.

After making sure that the neighbor was dead, the girls took Natalya’s jewelry, promised for “euthanasia”: a wedding ring, earrings, crosses and other small jewelry. Their friends took them to a pawnshop and received 4,575 rubles, which they spent on ice cream and chewing gum. Two days later the girls were detained.

Illustration: Ekaterina Kasyanova

Despite the words of her friends, the court found that the girl was killed only for profit. “In my opinion, there is no smell of euthanasia here. This is evidenced by the further behavior of the girls, when they began to hastily spend the “earned” money,” said the head of the department of the prosecutor’s office of the Rostov region, Sergei Ushakov. At the end of December 2004, Kristina received five years in prison for murder, Shkermanova - four years.

Similar stories have happened more than once in Russian regions. They invariably resulted in a conviction for murder, but not always with an actual sentence. For example, former police sergeant Vladimir Korsakov received only four years probation for strangling his mother, who suffered from cancer and asked her son to kill her.

At the same time, “euthanasia” in Russia is performed not only by neighbors or relatives, but also by doctors: Russian doctors themselves have anonymously spoken about such an unofficial practice more than once. For example, one of the former heads of the Sklifosovsky Research Institute of Emergency Medicine told Kommersant that the legalization of euthanasia “will legitimize an actually existing phenomenon: there are cases of euthanasia in Russia, but no one will officially talk about it, because it is a crime.”

Countries that have officially allowed euthanasia also often point out that this happens all over the world. “The law on euthanasia appeared in our country in 2002 to protect doctors so that they could perform euthanasia without fear of criminal prosecution. And in Russia they do this too, and in Kyrgyzstan, and in Chile, and in London, and in Washington. The practice of [unofficial] euthanasia occurs everywhere. But in Holland we decided to no longer do this secretly behind a curtain, but with dignity and openly,” explained Dutch doctor Bert Kaiser, who performed euthanasia more than 30 times. However, there are no known cases of any high-profile trials of Russian doctors who killed patients at their request.

In addition, in thematic groups on social networks dedicated to euthanasia, you can also find activists who promote the “right to die” and are ready to help the terminally ill with advice. One of them said " paper”, which has been trying to spread ideas about the “right to die” on the Russian Internet for several years: it orders translations and dubbing of films about euthanasia, uploads videos and books about ways to die to hosting sites, and also provides personal consultations.

According to him, in total several dozen Russians approached him who wanted to commit suicide (screenshots of correspondence are available “ Papers"). “There were different people: some were terminally ill, some were terminally ill, some were tired of living. Why was I the last to help? I believe that everyone has the right to die,” he explains.

An activist who spoke with “ Paper" on condition of anonymity, wrote to those interested in his consultation that they have several humane options. This is either an expensive trip to Switzerland, or a purchase in China of a chemical drug used in euthanasia, or a completely legal purchase of a cylinder of inert gas.

I don't sell anything myself. I only give consultations,” he emphasized. - I do all this because of the philosophy of the right to die. I'm not talking about an affective, impulsive decision, but about a balanced decision. It seems to me that there is nothing special to promote here, everyone has this right. What’s more interesting to me is that when people exercise this right, they do it in ways that are far from humane and other people have to clean up after them,” the activist explained “ paper", noting that, in his opinion, it is impossible to bring him to trial for incitement to suicide, since he allegedly does not wish anything bad to those whom he gives consultations, but, on the contrary, helps them.

However, he notes that even in countries where euthanasia is allowed, there are public organizations that help people die. Indeed, there are dozens of organizations abroad, for example, the World Federation of Right to Die Societies, which unites activists and social activists from 26 countries from Zimbabwe to New Zealand. However, the most famous organization is Exit International, with more than 20,000 members, and its founder Philip Nitschke. Nitschke and his colleagues provide consultations to terminally ill patients, fight for the legalization of euthanasia in different countries of the world, publish books, make films and even advertise euthanasia on TV.

Companion " Papers“admitted that, unlike the West, the topic of euthanasia in Russia “is of no use to anyone” and even terminally ill people are of little interest in it. “I think this is a question of mentality and social structure. It is easier for a terminally ill person to jump out of a window than to at least try to defend his rights, which he probably never even thought about. About the right to a dignified end to life. This is just a slave mentality,” he emphasized.

In the West there are not only well-known activists, but also their own “stars” among people who have decided on euthanasia. For example, American Brittany Maynard, who suffered from brain cancer. After a relapse, the 29-year-old moved from California to Oregon, where assisted suicide was already legal, posted a video message on YouTube that was viewed more than 3 million times, and sent a letter to CNN entitled “My Right to Die with Dignity at 29.” .

In the last months of her life, she promoted the right to die, and also fulfilled all the wishes on her list, which she compiled after learning about the fatal disease. Brittany spent months teaching orphans in Nepal, climbed Kilimanjaro, rock climbed in Ecuador, visited Yellowstone National Park, and traveled to Alaska. In October 2014, she said that she had crossed off the last item on her list of places to visit before she died: the Grand Canyon.

On November 1, 2014, Brittany passed away with the help of doctors and became an American symbol of the fight for the right to die. After her death, assisted suicide was legalized in two more states. Including in California, the girl’s home state.