To the content
1 . 2023

The patient's right to voluntary choose euthanasia and assisted suicide: why palliative care should be equated with obstetric care in terms of funding priority

Abstract

The relevance of the study is due to the growing number of elderly and hopelessly ill patients, the population's demand for practices that, in the event of a severe incurable health disorder, do not become a hostage to the process of dying, painful for the patient and ruinous for his family, artificially prolonged by the healthcare system, as well as the high price of life-supporting medical technologies: up to 20% of national health spending in developed countries goes to pay for medical services to citizens during the last 3 years of their lives. The authors review the economic and ethical aspects of the practices of continuous deep sedation, euthanasia, and assisted suicide permitted in a number of countries. A conclusion is made about the economic feasibility and ethical acceptability of these practices, provided that the voluntariness and freedom of their choice by the patient is ensured by the availability of guaranteed palliative care. It is proposed to equalize the priority of financing palliative care with obstetric care for ensure such guarantees.

Keywords:terminally ill; healthcare costs; palliative care; euthanasia; assisted suicide; continuous deep sedation

Funding. The article was prepared based on the results of research carried out at the expense of budgetary funds under the state assignment of the Financial University under the Government of the Russian Federation.

Conflict of interest. The authors declare no conflict of interest.

For citation: Ragozin A.V., Grishin V.V., Sivodedov A.A. The patient's right to voluntary choose euthanasia and assisted suicide: why palliative care should be equated with obstetric care in terms of funding priority. ORGZDRAV: novosti, mneniya, obuchenie. Vestnik VSHOUZ [HEALTHCARE MANAGEMENT: News, Views, Education. Bulletin of VSHOUZ]. 2023; 9 (1): 26-40. DOI: https://doi.org/10.33029/2411-8621-2023-9-1-26-40 (in Russian)

References

1. Population Division. World Population Prospects: The 2015 Revision. United Nations, Department of Economic and Social Affairs. 2015. URL: https://www.un.org/en/development/desa/publications/world-population-prospects-2015-revision.html (date of access September 15, 2022).

2. World Health Organization. World Report on Ageing and Health. 2015. URL: https://apps.who.int/iris/handle/10665/186463 (date of access September 15, 2022).

3. Basta L., Tauth J. High technology near the end of life: Setting limits. J Am Coll Cardiol. 1996; 28 (6): 1623-30. URL: https://doi.org/10.1016/S0735-1097(96)00341-5

4. Ragozin A.V., Itselev A.A., Glazunova S.A. Mobilization readiness for respiratory catastrophes: How to increase the financial and economic availability of medical equipment for artificial lung ventilation. Natsional’haya bezopasnost’/Nota Bene [National Security/ Nota Bene]. 2021; (4): 14-26. DOI: https://doi.org/10.7256/2454-0668.2021.4.35906 URL: https://nbpublish.com/library_read_ar-ticle.php?id=35906 (in Russian)

5. Jordan P., van Rooyen D., Strnmpher J. The lived experience of patients on mechanical ventilation. Health SA Gesondheid. 2002; 7 (4): 24-37. DOI: https://doi.org/10.4102/hsag.v7i4.101

6. Lynn J. Learning to care for people with chronic illness facing the end of life. JAMA. 2000; 284 (19): 2508-11. DOI: https://doi.org/10.1001/jama.284.19.2508

7. Hogan C., Lynn J., Gable J., et al. Medicare Beneficiaries’ Costs and Use of Care in the Last Year of Life: Final Report to the Medicare Payment Advisory Commission. Washington, 2000.

8. Saphir A. The third way: Palliative care gives providers a chance to treat chronic conditions better while lowering costs. Mod Healthc. 1999; 29 (15): 30-3.

9. WHO. Universal Health Coverage. 2019. URL: https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc) (date of access October 01, 2022).

10. French E.B., McCauley J., Aragon M. End-of-life medical spending in last twelve months of life is lower than previously reported. Health Aff (Millwood). 2017; 36 (7): 1211-7. DOI: https://doi.org/10.1377/hlthaff.2017.0174

11. World Health Organization. Assessing National Capacity for the Prevention and Control of Noncommunicable Diseases: Report of the 2019 Global Survey. Geneva, 2020.

12. International Narcotics Control Board. Report. 2019. URL: https://www.incb.org/documents/Publications/AnnualReports/AR2019/Annual_Report_Chapters/English_ebook_AR2019.pdf (date of access September 10, 2022).

13. WHO. Palliative care. 2020. URL: https://www.who.int/ru/news-room/fact-sheets/detail/palliative-care (in Russian)

14. Shukshentseva T.A. Ways of development of palliative care in the Russian Federation. In: Management in Healthcare: Challenges and Risks of the XXI Century: Collection of materials of the II All-Russian scientific and practical conference. Volgograd: Volgogradskiy go-sudarstvenniy meditsinskiy universitet, 2018: 519-22. (in Russian)

15. Dubgorin A.A., Kovalenko E.V., et al. Problems and prospects of organizing palliative care in Russia (review of regulations). Saratovskiy nauchno-meditsinskiy zhurnal [Saratov Journal of Medical Scientific Research]. 2021; 17 (2): 214-20. (in Russian)

16. Bondarenko K. 400 thousand people in Russia need palliative care. Plus one. 2019. URL: https://plus-one.ru/society/2019/02/14/chislo-hospisov-v-rossii-utroilos-za-god (date of access August 14, 2022). (in Russian)

17. World Health Organization. Atlas of the World on Palliative Care at the End of Life. Worldwide Palliative Care Alliance. London. 2017. URL: https://www.hospicefund.ru/wp-content/up-loads/2017/09/GlobalAtlas-Russian-version_small.pdf (date of access June 24, 2022).

18. Batesetal M.J. Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: A prospective cohort study. Lancet Glob Health. 2021; 9 (12): e1750-7. DOI: https://doi.org/10.1016/S2214-109X(21)00408-3

19. Metropolitan Life Insurance Company Report. The Met Life Juggling Act Study: Balancing Care Giving with Work and the Costs Involved. Westport, CN: MetLife Mature Market Institute, 2011.

20. Gardiner C., Robinson J., Connolly M., et al. Equity and the financial costs of informal caregiving in palliative care: A critical debate. BMC Palliat Care. 2020; 19: 71. DOI: https://doi.org/10.1186/s12904-020-00577-2

21. Emanuel E.J., Fairclough D.L., et al. Understanding economic and other burdens of terminal illness: The experience of patients and their caregivers. Ann Intern Med. 2000; 132 (6): 451-9. DOI: https://doi.org/10.7326/0003-4819-132-6-200003210-00005

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

CHIEF EDITOR
CHIEF EDITOR
Guzel E. Ulumbekova
MD, MBA from Harvard University (Boston, USA), Head of the Graduate School of Healthcare Organization and Management (VSHOUZ)

Journals of «GEOTAR-Media»