An edited version of this article appeared in Liberal Conspiracy – the UK’s most popular left-of-centre political blog.
In Russia cancer patients are left to suffer and ultimately die in pain with inadequate access to basic pain control drugs such as morphine. When one doctor defied the state’s overly restrictive laws, she was arrested. It is time for the healthcare community to speak out.
Dr. Khorinyak allegedly wrote out two prescriptions for the pain relief medication tramadol. The prescriptions were for Victor Sechin, a terminally-ill cancer patient. In the eyes of the Russian state, the medical practitioner of more than 50 years broke the law.
In 2011, it is thought that the Russian Federal Drug Control Service discovered the prescriptions at the local pharmacy, and referred the case to the prosecutor and the court. Dr. Khorinyak was then charged under:
- Article 234 of the Criminal Code: “Trafficking potent substances in large quantities by prior agreement with the intent to sell, an organized group”;
- Article 327 of the Criminal Code, “Forgery of documents in order to facilitate the commission of another crime.”
The online palliative care news service, ehospice, spoke out about Dr. Khorinyak’s case. Quoting Trustees of the Worldwide Palliative Care Alliance (WPCA), the ehospice article said:
“The Worldwide Palliative Care Alliance is seriously concerned to hear about the prosecution of Dr Alevtina Petrovna Khorinyak…We fully support Dr Khorinyak in attempting to provide pain relief for patients coming to her for help. We stand in defence of her professional practice and her humane response to patients in pain.”
The article finished by urging readers to sign a petition calling for the charges against Dr. Khorinyak to be reversed. The editor of the international edition of ehospice, Kate Jackson, explained her decision to run the story saying:
“Dr Khorinyak performed her professional duty and acted with compassion towards a patient in pain. If it is outside of the laws of a country for a doctor to treat a patient to the best of their ability, then there is a need for a serious and urgent re-examination of those laws.”
Indeed, Russia’s overly restrictive laws regulating access to morphine have been the focus of on-going criticism for a number of years.
In its 2012 annual report, Human Rights Watch commented on Russia’s health policy saying:
“Although over 300,000 Russians die of cancer each year, with many facing severe pain, available palliative care services remained limited. As a result, hundreds of thousands of patients die in avoidable agony each year. In much of the country, the government does not make oral morphine available through the public healthcare system, or adequately train healthcare workers on modern pain treatment methods. Existing drug regulations are excessively restrictive and limit appropriate morphine use for pain relief.”
Indeed, the UN Special Rapporteurs on the Highest Attainable Standard of Health and on Torture, Cruel, Inhuman and Degrading Treatment have said:
“The failure to ensure access to controlled medicines for the relief of pain and suffering threatens fundamental rights to health and to protection against cruel, inhuman and degrading treatment.”
Indeed, Article 21 of the Russian constitution states that:
“The dignity of the person shall be protected by the state. No circumstance may be used as a pretext for belittling it.”
Simply put, palliative care is a human right.
In Russia though, 450,000 people are diagnosed with cancer every year resulting in more than 2.5 million people suffering from the disease. Russia not only has a clear moral obligation to support these patients but also a legal human rights responsibility as well – one that it is currently neglecting.
With the noble exception of ehospice and a handful of other professionals, few have spoken out. The Russian government is standing by while thousands needlessly suffer. When one person does speak out, she is prosecuted as a criminal.
It is time for health care professionals from around the world to stand up for Dr. Khorinyak and speak out, not only against her prosecution but also against Russia’s wider neglect of patients in need of pain relief.