Nothing to Stop the Pain

A few days ago, retired Rear Admiral Vyacheslav Apanasenko put an end to his own life. He earlier helped develop the Bulava missile but later struggled with terminal cancer. Although he had little hope of surviving, he could have spent his remaining days in the company of friends and relatives. Former Apple CEO Steve Jobs died from a similar illness, and he managed to continue working almost right up until the end. Apanasenko preferred shooting himself. In his case, euthanasia was preferable to the treatment provided by the medical system.

Euthanasia is illegal in Russia, but it remains common practice. Relatives kill their loved ones rather than watch them suffer in agony without painkillers. Patients commit suicide, and one patient even killed his doctor who was prolonging his torment before taking his own life.

News reports have been rather vague in explaining Apanasenko's cause of death. The newspaper Rossiiskaya Gazeta reported only that he had a "serious case of cancer" and experienced difficulty obtaining painkillers. But his daughter gave a more dramatic description of the situation in a Facebook post:

"Papa had late-stage pancreatic cancer," she wrote. "He courageously endured the pain. Mama tried to obtain the morphine he had been prescribed. To get a five-day supply of vials, for several days she had to run from office to office in the medical center for hours at a time. On the final day, she was short of one signature when the medical center closed. She came home completely burned out and without the anesthetics. Papa was outraged. This was the last straw. That night he got everything ready and left a note clearly stating his reasons. 'I ask that you not blame anyone except the Health Ministry and the government. I am prepared to suffer, but it is intolerable to see my loved ones suffer.' He wrote the time and date and signed it. Then he took his prized pistol. … I think that with this act he wanted to draw attention to how cancer patients are treated in Russia."

The Federal Drug Control Service headed by Viktor Ivanov, a longtime associate of President Vladimir Putin, created this inhumane system for controlling the issuance of painkillers.

Terminally ill patients and those in severe pain must navigate a hellish bureaucracy to obtain even five vials of potent painkillers. Then, they must return the unused vials and bottle labels after the patient has died. Not only is it difficult and frustrating to get the clinic staff to sign off on the returned items, but the relatives are held criminally responsible for failing to do so — even if they have accidentally lost them. Cancer patients are assigned to a single pharmacy that works with the medical center or cancer clinic in question. If that pharmacy does not have the medicines for whatever reason, the patient is left to scream in pain or die of shock. In some cases, individuals with late-stage cancer must personally appear to receive a prescription for the medicines that can relieve their suffering. Long weekends or holidays become a living nightmare for patients and their relatives because each prescription covers only a short period and regulations make it impossible to stock up in advance.

The incidence of cancer has doubled in Russia in the past 20 years, and although the U.S. has 1.5 times the number of cancer patients than Russia, the death rate from cancer is 1.5 times lower there. Of Russia's 3 million cancer patients, about 750,000 currently have late-stage cancer. These people are dying in agony, although the West has long made it possible for such patients to die with dignity by giving them up to 10 times the quantity of powerful painkillers than such patients receive in Russia. Some patients in the West are even prescribed marijuana to ease their suffering. In this respect, Russia's laws resemble those in backward countries of Africa and Asia, where it is also prohibited to give cancer patients powerful opiates or where access to them is cruelly limited. All of those countries effectively violate World Health Organization requirements that such patients have access to those medicines. And according to WHO research, Russian cancer patients have access to only five or six of the 20 to 25 effective painkilling medicines that exist — and only if their relatives are prepared to spend hours collecting signatures from an army of doctors. That is on a par with Ghana, where cancer patients are also tied to a single pharmacy and are forced to gather multiple signatures to receive needed medications.

The West now uses 40 times the number of strong painkillers — primarily opiates — than it did in the 1980s. In Russia, despite a significant increase in cancer rates, the use of such medicines remains unchanged. What's more, limiting access to those drugs has reached inhumane levels.

Doctors are themselves victimized by threats of criminal prosecution and avoid trouble by prescribing such patients ordinary, weaker medications. In such cases, the best medicine patients can hope to receive is the weak Tramadol — and even then, only if the pharmacy happens to carry it. Ambulances often refuse to visit cancer patients, considering intense pain and even pain-induced shock insufficient grounds for treatment.

Russian doctors, who have taken the Hippocratic Oath, are not called to account for leaving patients to die an agonizing death. They carry no responsibility for failing to provide painkillers, but if they commit even the slightest error in filling out a prescription for powerful narcotics or happens to lose a vial of the medicine, they can be subjected to a criminal investigation.

Despite these draconian measures, drug addiction continues to rise in Russia as addicts easily find substitute drugs for those that have been banned or heavily regulated in recent years. Maybe it is time for Russia to consider legalizing euthanasia. That would be a more humane — and more honest — option for terminally ill people in agonizing pain.