What Are The Symptoms Of A UTI? 6 Surprising Signs You Have One But Don’t Know It

Being sick is never enjoyable, but some illnesses tend to be worse than others. One that can be particularly nasty is a urinary tract infection (more commonly called a UTI). Few things are more frustrating than constantly feeling like you have to pee… but not really being able to. The symptoms of UTIs are usually painful, aggravating, and they can really mess up any plans you might have. More importantly, UTIs can be dangerous, and if left untreated, can lead to some serious issues. On top of that, there’s one thing you didn’t know about UTIs — and that’s that they can come with silent symptoms, making them even more dangerous.

A UTI is exactly what it sounds like: an infection in the urinary tract system, including the kidneys, bladder, and urethra. Most of the time, UTIs occur in the lower urinary tract. They are caused by bacteria that gets into the urethra, usually from the rectal area, but this can vary. You’re probably already aware of the usual symptoms that come along with a UTI: these can include a burning sensation when you urinate, feeling like you have to urinate immediately even if nothing or just a little comes out, pain or pressure in your lower back or stomach, bloody or strong-smelling urine, feeling tired or shaky, and in some cases, even a fever. If you feel any of these things, you would hopefully know that you probably have a UTI, then head to a doctor for medication to get better. Problem (probably) solved!

But what if you don’t feel any of those things? It is totally possible to have a UTI without feeling the usual symptoms, especially if you’re an older woman. UTIs can and often do have really subtle symptoms that don’t include the burning and pain often associated with the infection. According to Harvard Medical School’s Harvard Health Publishing, this is common in older women — “some experts think that is because the symptoms of a UTI are actually caused by the immune system’s fight against the infection, and the immune systems of older people may not fight as fiercely,” — but, theoretically, an asymptomatic UTI could affect anyone who is immunocompromised. Seemingly unrelated symptoms, the journal reported, range from the following:

• confusion
• fatigue
• nausea
• vomiting
• agitation
• loss of appetite

Of course, these are all symptoms of many other conditions and infections — so without the classic urinary tract symptoms like burning or pain, it’s easy to overlook a UTI as the culprit. This is known as a silent UTI, and it’s where things can get dangerous; after all, if a UTI isn’t caught early, the infection won’t be treated accordingly. According to Harvard Health Publishing, “A lack of symptoms may result in a UTI going untreated and then spreading to the kidneys, and then the bloodstream — a potentially fatal condition.”

Of course, you can’t always assume exhaustion means you have a silent UTI, or you’d be spending all of your time at the doctor. Instead, if you feel any of the aforementioned symptoms and other test results aren’t coming up with any reason for them, ask your doctor to check you for a UTI.

You can also work at preventing UTIs to begin with. According to Harvard Health Publishing, both Dr. George Flesh, director of urogynecology and pelvic reconstructive surgery for Harvard Vanguard Medical Associates, and Dr. Suzanne Salamon, a geriatrician and instructor at Harvard Medical School, recommend drinking more fluids throughout each day to flush out urine and bacteria. You should always make sure you pee after having intercourse — right away, not an hour later. If you know you’re prone to UTIs, Dr. Flesh says to try vaginal estrogen cream, saying, “It is the most effective preventive treatment, resulting in 70 percent to 90 percent fewer infections.”

Remember: UTIs aren’t just annoying, they can also be very dangerous. Don’t let a silent UTI lead to a serious kidney infection or worse. Stay on top of your health!

Oh My Aching Bladder: Is It A UTI or IC?

One in five women will have at least one urinary tract infection (UTI) in her lifetime, according to the National Kidney Foundation. And, if you’ve ever had a urinary tract infection, you are all too familiar with the burning urination and constant feeling of needing to go to the bathroom. But, did you know that some of the symptoms of a UTI are similar or the same as symptoms women experience when they have interstitial cystitis or painful bladder syndrome? How is a woman to know if it’s a UTI or painful bladder syndrome?

What is a Urinary Tract Infection (UT)?

A UTI is an infection of the urinary tract, most commonly affecting the bladder and the urethra (the tube that carries urine from the bladder to the outside of the body). When bacteria gets into the urethra and travels to the bladder, a UTI is often the result.  With a UTI, the bladder lining also becomes red, swollen and inflamed.

Common symptoms of a UTI include:

• Urinary urgency or the feeling that you need to urinate often. You may have to run to the bathroom several times per hour only to find you urinate only a few drops.
• A burning sensation when urinating.
• Abdominal pain, pelvic pressure and/or lower back pain. You may experience lower abdominal discomfort, bloating and/or feel pressure in the lower pelvic area, especially when urinating.
• Blood in the urine. Urine can appear to have a reddish or dark orange tiny, which signifies blood in the urine from the infection.
• Cloudy urine that has an odor
• Fever and/or chills

What is Interstitial Cystitis (IC)?

Interstitial cystitis (IC), also known as painful bladder syndrome, is another type of pelvic health condition that affects approximately eight million young and middle-aged women in the U.S. IC is a chronic inflammatory condition of the bladder lining that causes pain and pressure in the pelvic area around the bladder.

Symptoms of IC can be similar to the symptoms of a UTI:

• Pain in the bladder and in the pelvic region surrounding the bladder.
• Painful urination without the presence of bacteria or infection.
• Urgent and frequent need to urinate, even if the bladder is not full.

The Difference Between a UTI and IC

According to Lisa Hawes, M.D., female urology specialist at Chesapeake Urology:

“In women who have interstitial cystitis, urine culture results will be negative,  meaning that no bacteria are found in the urine as with a urinary tract infection.”

With IC, women may also experience pain during sexual intercourse, another symptom not commonly associated with a UTI.

Diagnosing & Treating a UTI Vs. Interstitial Cystitis

Typically, treatment for a UTI is a course of antibiotics, the use of over-the-counter medications to help relieve burning and/or bladder pain and increasing the intake of water.

Some women, however, experience frequent UTIs that require more investigation. If recurrent UTIs are a problem, your doctor will perform a thorough pelvic exam to ensure nothing in the vagina or bladder is causing infection, and may also order diagnostic tests such as an ultrasound, CT scan, cystoscopy or urine culture.

• Learn about other treatments for chronic UTIs here.

Diagnosing IC is often more difficult. What women often find frustrating about this condition is that no exact cause has been pinpointed; however many IC patients may also have other health conditions such as fibromyalgia, irritable bowel syndrome, endometriosis, and pelvic floor dysfunction. Your doctor will begin testing for other conditions that cause the same symptoms and come to a diagnosis of IC once other causes are ruled out.

Treating IC

While there is no cure for IC, treatments can provide relief from painful symptoms. Your doctor may provide several different therapies that have been shown to alleviate and/or diminish many of the symptoms of IC including:

• Physical therapy provided by a specialized pelvic health physical therapist with training in IC has been shown to be successful at improving symptoms in many women.
• Dietary changes such as avoiding bladder irritants or foods that may cause the bladder to flare or trigger symptoms, as well as adequate hydration.
• Bladder instillations
• Medications to relieve symptoms of IC
• Bladder distention

Learn more about treatment options for interstitial cystitis here.

Find a Urologist or Call 866-953-3111.

Kidney infection – NHS

A kidney infection is a painful and unpleasant illness usually caused by cystitis, a common infection of the bladder.

Most people with cystitis will not get a kidney infection, but occasionally the bacteria can travel up from the bladder into one or both kidneys.

If treated with antibiotics straight away a kidney infection does not cause serious harm, although you’ll feel very unwell.

If a kidney infection is not treated, it can get worse and sometimes cause permanent kidney damage.

Symptoms of kidney infection

Symptoms of a kidney infection often come on within a few hours.

You can feel feverish, shivery, sick and have a pain in your back or side.

In addition to feeling unwell like this, you may also have symptoms of a urinary tract infection (UTI) such as cystitis.

These include:

• needing to pee suddenly or more often than usual
• pain or a burning sensation when peeing
• smelly or cloudy pee
• blood in your pee

When to see a GP

See a GP if you feel feverish and have pain that will not go away in your tummy, lower back or genitals.

You should also see a GP if you have symptoms of a UTI that have not improved after a few days, or if you have blood in your pee.

Contact a GP immediately if you think your child may have a kidney infection.

If you cannot get a GP appointment and need urgent medical attention, go to your nearest urgent care centre (UCC).

If you do not have a local UCC, go to your nearest A&E.

Diagnosing kidney infection

To work out if you have a kidney infection, your doctor will ask about your symptoms and recent medical history.

They’ll carry out a urine test to see if you have a UTI.

If you’re a male with a confirmed UTI, a GP will refer you straight to a specialist (a urologist) for further investigation.

Treatment of kidney infection

Most kidney infections need prompt treatment with antibiotics to stop the infection damaging the kidneys or spreading to the bloodstream.

You may also need painkillers.

If you’re especially vulnerable to the effects of an infection (for example, if you have a long-term health condition or are pregnant), you may be admitted to hospital and treated with antibiotics through a drip.

Most people who are diagnosed and treated promptly with antibiotics feel completely better after about 2 weeks.

People who are older or have underlying conditions may take longer to recover.

Causes of kidney infection

A kidney infection usually happens when bacteria, often a type called E. coli, get into the tube that carries urine out of your body (urethra).

The bacteria travel up to your bladder, causing cystitis, and then up into your kidneys.

E. coli bacteria normally live in your bowel, where they cause no harm.

They can be transferred from your bottom to your genitals during sex or if you’re not careful when wiping your bottom after going to the loo.

A kidney infection can sometimes develop without a bladder infection. For example, if you have a problem with your kidney, such as kidney stones, or if you have diabetes or a weakened immune system.

Who’s at risk

Kidney infections can happen at any age and are much more common in women.

This is because a woman’s urethra is shorter, making it easier for bacteria to reach the kidneys.

Younger women are most at risk because they tend to be more sexually active, and having frequent sex increases the chances of getting a kidney infection.

Preventing kidney infection

The best way to prevent a kidney infection is to keep your bladder and urethra free from bacteria by:

• drinking plenty of fluids (plain water is best)
• going to the loo as soon as you feel the need to, rather than holding it in
• going to the loo after sex
• wiping from front to back after going to the loo
• washing your genitals every day, and before having sex if possible
• treating any constipation – being constipated can increase your chance of developing a UTI
• not using a diaphragm or condoms coated in spermicide if you’re prone to getting UTIs – it’s thought spermicide can increase your risk of getting a UTI

If you keep getting urine infections, a GP may prescribe you a low dose of antibiotics to take regularly.

This may help to prevent the infection returning or any infection spreading to the kidneys.

Page last reviewed: 06 January 2021
Next review due: 06 January 2024

Urinary Tract Infections: Causes, Symptoms & Treatment

Overview

What is a urinary tract infection (UTI)?

A urinary tract infection (UTI) is an infection of the urinary system. This type of infection can involve your urethra (a condition called urethritis), kidneys (a condition called pyelonephritis) or bladder, (a condition called cystitis).

Your urine typically doesn’t contain bacteria (germs). Urine is a byproduct of our filtration system—the kidneys. When waste products and excess water is removed from your blood by the kidneys, urine is created. Normally, urine moves through your urinary system without any contamination. However, bacteria can get into the urinary system from outside of the body, causing problems like infection and inflammation. This is a urinary tract infection (UTI).

What is the urinary tract?

The urinary tract makes and stores urine, one of the body’s liquid waste products. The urinary tract includes the following parts:

• Kidneys: These small organs are located on back of your body, just above the hips. They are the filters of your body — removing waste and water from your blood. This waste becomes urine.
• Ureters: The ureters are thin tubes that carry urine from the kidneys to your bladder.
• Bladder: A sac-like container, the bladder stores your urine before it leaves the body.
• Urethra: This tube carries the urine from your bladder to the outside of the body.

How common are urinary tract infections (UTIs)?

Urinary tract infections are very common, occurring in 1 out of 5 women sometime in their lifetime. Though UTIs are common in women, they can also happen to men, older adults and children. One to 2% of children develop urinary tract infections. Each year, 8 million to 10 million visits to doctors are for urinary tract infections.

Who gets urinary tract infections (UTIs)?

Anyone can get a urinary tract infection, but they are more common in women. This is because the urethra (tube the carries urine out of the body) in females is shorter and closer to the anus, where E. coli bacteria are common. Older adults also are at higher risk for developing cystitis. This increased risk may be due to incomplete emptying of the bladder. There are several medical conditions that can be related to this, including an enlarged prostate or a bladder prolapse (a condition where the bladder falls or slips out of its usual position).

If you get frequent urinary tract infections, your healthcare provider may do tests to check for other health problems — such as diabetes or an abnormal urinary system—that may be contributing to your infections. People with frequent UTIs are occasionally given low-dose antibiotics for a period of time to prevent the infection from coming back. This cautious approach to treating frequent UTIs is because your body can develop a resistance to the antibiotic and you can get other types of infections, such as C. diff colitis. This practice is used very infrequently.

What’s the difference between a urinary tract infection (UTI) and bladder infection (cystitis)?

A urinary tract infection is a more general type of infection. There are many parts of your urinary tract. A UTI is a term for an infection that takes place throughout the urinary tract. A bladder infection, also called cystitis, is a specific infection. In this infection, bacteria makes its way into the bladder and causes inflammation.

Not all urinary tract infections become bladder infections. Preventing the spread of the infection is one of the most important reasons to treat a UTI quickly when you have symptoms. The infection can spread not only to the bladder, but also into your kidneys, which is a more complicated type of infection than a UTI.

Symptoms and Causes

What causes a urinary tract infection (UTI)?

Urinary tract infections are caused by microorganisms — usually bacteria — that enter the urethra and bladder, causing inflammation and infection. Though a UTI most commonly happens in the urethra and bladder, bacteria can also travel up the ureters and infect your kidneys.

More than 90% of bladder infection (cystitis) cases are caused by E. coli, a bacterium normally found in the intestines.

What are the symptoms of a urinary tract infection (UTI)?

A urinary tract infection causes the lining of the urinary tract to become red and irritated (inflammation), which may produce some of the following symptoms:

Other symptoms that may be associated with a urinary tract infection include:

• Pain during sex.
• Penis pain.
• Flank (side of the body) pain or lower back pain.
• Fatigue.
• Fever (temperature above 100 degrees Fahrenheit) and chills.
• Vomiting.
• Mental changes or confusion.

Diagnosis and Tests

How are urinary tract infections (UTIs) diagnosed?

Your doctor will use the following tests to diagnose a urinary tract infection:

• Urinalysis: This test will examine the urine for red blood cells, white blood cells and bacteria. The number of white and red blood cells found in your urine can actually indicate an infection.
• Urine culture: A urine culture is used to determine the type of bacteria in your urine. This is an important test because it helps determine the appropriate treatment.

If your infection does not respond to treatment or if you keep getting infections over and over again, your doctor may use the following tests to examine your urinary tract for disease or injury:

• Ultrasound: In this test, sound waves create an image of the internal organs. This test is done on top of your skin, is painless and doesn’t typically need any preparation.
• Cystoscopy: This test uses a special instrument fitted with a lens and a light source (cystoscope) to see inside the bladder from the urethra.
• CT scan: Another imaging test, a CT scan is a type of X-ray that takes cross sections of the body (like slices). This test is much more precise than typical X-rays.

Management and Treatment

How are urinary tract infections (UTI) treated?

You will need to treat a urinary tract infection. Antibiotics are medicines that kill bacteria and fight an infection. Antibiotics are typically used to treat urinary tract infections. Your healthcare provider will pick a drug that best treats the particular bacteria that’s causing your infection. Some commonly used antibiotics can include:

• Nitrofurantoin.
• Sulfonamides (sulfa drugs).
• Amoxicillin.
• Cephalosporins.
• Trimethoprim/sulfamethoxazole (Bactrim®).
• Doxycycline.
• Quinolones (such as ciprofloxacin [Cipro®]).

It’s very important that you follow your healthcare provider’s directions for taking the medicine. Don’t stop taking the antibiotic because your symptoms go away and you start feeling better. If the infection is not treated completely with the full course of antibiotics, it can return.

If you have a history of frequent urinary tract infections, you may be given a prescription for antibiotics that you would take at the first onset of symptoms. Other patients may be given antibiotics to take every day, every other day, or after sexual intercourse to prevent the infection. Talk to your healthcare provider about the best treatment option for you if you have a history of frequent UTIs.

What are the complications of a urinary tract infection (UTI)?

A urinary tract infection can be easily treated with antibiotics. However, if it isn’t treated or if you stop the medication early, this type of infection can lead to a more serious infection, like a kidney infection.

Can I become immune to the antibiotics used to treat a UTI?

Your body can actually get used to the antibiotics typically used to treat a urinary tract infection (UTI). This happens in people who have very frequent infections. With each UTI and use of antibiotics to treat it, the infection adapts and becomes harder to fight. This is called an antibiotic-resistant infection. Because of this, your healthcare provider may suggest alternative treatments if you have frequent UTIs. These could include:

• Waiting: Your provider may suggest that you watch your symptoms and wait. During this time, you may be encouraged to drink plenty of fluids (especially water) in an effort to “flush out” your system.
• Intravenous treatment: In some very complicated cases, where the UTI is resistant to antibiotics or the infection has moved to your kidneys, you may need to be treated in the hospital. The medicine will be given to you directly in your vein (intravenously). Once you’re home, you will be prescribed antibiotics for a period of time to fully get rid of the infection.

Does cranberry juice prevent a urinary tract infection (UTI)?

Many people say that cranberry juice can help treat, or even prevent, a UTI. Researchers are currently looking into the topic, but haven’t found a definitive answer yet. Healthcare providers recommend drinking lots of fluids if you have, or have a history of getting, a UTI. Adding a glass of unsweetened cranberry juice to your diet isn’t a proven way to prevent a UTI, but it typically won’t hurt you either.

Prevention

Can I prevent a urinary tract infection (UTI)?

You can usually prevent a urinary tract infection (UTI) with lifestyle changes. These tips can include:

• Practicing good hygiene: You can often prevent UTIs by practicing good personal hygiene. This is especially important for women. Because the urethra in women is much shorter than it is in men, it’s easier for E. coli bacteria to move from the rectum back into the body. To avoid this, it’s recommended that you always wipe from front to back after a bowel movement. Women should also use good hygiene practices during their menstrual cycle avoid infections. Changing pads and tampons frequently, as well as not using feminine deodorants can also help prevent UTIs.
• Drinking plenty of fluids: Adding extra fluids, especially water, to your daily routine can help remove extra bacteria from your urinary tract. Drinking six to eight glasses of water per day is recommended.
• Changing your urination habits: Urination can play a big role in getting rid of bacteria from the body. Your urine is a waste product and each time you empty your bladder, you’re removing that waste from your body. Urinating frequently can reduce your risk of developing an infection, especially if you have a history of frequent UTIs. Drinking plenty of fluids will encourage this, but makes sure to avoid fluids and foods that could irritate your bladder. These can include alcohol, citrus juices, caffeinated drinks and spicy foods. You should also try to urinate immediately before and after sex. This could help flush out any bacteria that may have been introduced during intercourse. You can also wash the genital area with warm water before having sex. Don’t douche. This practice isn’t recommended by healthcare providers.
• Changing your birth control: Some women have an increased risk of developing a UTI if they use a diaphragm for birth control. Talk to your healthcare provider about other options for birth control.
• Using a water-based lubricant during sex: If you experience vaginal dryness and use a lubricant during sex, use one that is water-based. You may also need to avoid spermicide if you have frequent UTIs.
• Changing your clothing: Avoiding tight-fitting clothing can actually help keep you dry, preventing bacteria from growing in the urinary tract. You can also switch to cotton underwear. This will prevent extra moisture from getting trapped around your urethra.

In some post-menopausal women, a healthcare provider may suggest an estrogen-containing vaginal cream. This may reduce the risk of developing a UTI by changing the pH of the vagina. Talk to your healthcare provider if you have recurrent UTIs and have already gone through menopause.

Over-the-counter supplements are also available for UTIs. These are sometimes recommended for people who have frequent UTIs as another way to prevent them. Talk to your healthcare provider before starting any supplements and ask if these could be a good choice for you.

Outlook / Prognosis

What is the prognosis (outlook) for a person with a urinary tract infection?

Urinary tract infections (UTIs) typically respond very well to treatment. A UTI can be uncomfortable before you start treatment, but once your healthcare provider identifies the type of bacteria and prescribes the right antibiotic medication, your symptoms should improve quickly. It’s important to keep taking your medication for the entire amount of time your healthcare provider prescribed. If you have frequent UTIs or if your symptoms aren’t improving, your provider may test to see if it’s an antibiotic-resistant infection. These are more complicated infections to treat and may require intravenous antibiotics (through an IV) or alternative treatments.

Living With

When should I call my healthcare provider?

Call your healthcare provider if you have symptoms of a urinary tract infection. If you have been diagnosed with a UTI and your symptoms are getting worse, call your healthcare provider. You may need a different treatment. Watch out for these symptoms in particular:

• Fever.
• Back pain.
• Vomiting.

If you have any of these symptoms, or your other symptoms continue after treatment, call your healthcare provider. A UTI can spread throughout your urinary tract and into other parts of your body. However, treatment is very effective and can quickly relieve your symptoms.

Kids Health Information : Urinary tract infection (UTI)

A urinary tract infection (UTI) is an infection anywhere in the urinary tract. The urinary tract includes the kidneys, bladder and urethra (the tube from which urine passes out of the bladder).

UTIs are common in children of all ages, but are especially common in children who are still in nappies.

Signs and symptoms of UTI

If your child has a UTI, they may:

• have pain or burning when passing urine (doing a wee)
• have pain in the lower part of the abdomen (under the belly button)
• need to go to the toilet frequently to urinate
• pass some urine before getting to the toilet (wetting or incontinence)
• have smelly or discoloured urine
• have a fever or vomiting.

Young children with a UTI may not show any of these symptoms, but they are just generally unwell.

What causes a UTI?

A UTI is usually caused by bacteria (germs) getting into the bladder or urethra. The germs most often come from the bowels (gut), or from faeces (poo) that is on the skin and then gets into the urethra.

When to see a doctor

Testing your child’s urine is the only way to know for sure if they have a UTI. UTIs should not go untreated, as the infection can cause further problems with the kidneys. You should take your child to a doctor if they:

• develop any of the signs and symptoms of UTI 
• are unwell with a fever without other obvious causes.

The doctor may want to do a urine test. See our fact sheet Urine samples for information on how to collect a urine sample.

A urine sample is usually tested first with a dipstick testing strip, which can help show if there is any sign of infection. If the dipstick test shows that there might be a UTI, then treatment may be started. The final urine test results can take up to 48 hours to be sent back to your doctor.

Treatment for a UTI

The main way of treating a UTI is with antibiotics, which can usually be taken by mouth as a tablet or syrup. Children who are very unwell may be admitted to hospital for antibiotics given directly into a vein through a drip (intravenous or IV therapy).

Some children with a UTI may need an ultrasound to look for a problem with the bladder or kidneys. Your doctor will discuss this with you if required.

Care at home

If your child has been diagnosed with a UTI, you can care for them while they are recovering by:

• following the doctor’s instructions for giving the antibiotics – it is very important to complete the whole course of antibiotics, even if your child seems better
• keeping them at home and allowing them to get extra rest
• giving them plenty of fluids to drink.

Most children who are treated for a UTI make a full recovery and have no future problems.

Key points to remember

• UTIs are a common infection, especially in children who wear nappies.
• A doctor needs to do a urine test to diagnose a UTI.
• The main treatment for UTIs is antibiotics.

For more information

Common questions our doctors are asked

How can I prevent my child getting a UTI?

Good hygiene can help prevent the spread of bacteria from the gut. When girls are wiping their bottom after a poo, they should always wipe front to back (vagina to bottom). Also, being constipated can increase the chance of a child getting a UTI. See your doctor if you think your child is constipated.

Can I give my child cranberry juice to treat a UTI?

Children with UTIs need to be treated by a doctor who will prescribe antibiotics. Cranberry juice is not recommended as a treatment option for children.

Developed by The Royal Children’s Hospital General Medicine department. We acknowledge the input of RCH consumers and carers.

Reviewed March 2018.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.

Symptoms & Causes of Bladder Infection in Children

What are the symptoms of a bladder infection?

Don’t assume that you’ll know when your child has a bladder infection, even if you’ve had one yourself. Symptoms can be very different in children than in adults, especially for infants and preschoolers. If your child is not well, contact your child’s pediatrician or health clinic.

Fussiness or a general ill feeling can be symptoms of a bladder or kidney infection in a child younger than age 2.

Young children

It’s not always obvious when an infant or child younger than age 2 has a bladder infection. Sometimes there are no symptoms. Or, your child may be too young to be able to explain what feels wrong. A urine test is the only way to know for certain whether your child has a bladder or kidney infection.

When a young child has symptoms of a UTI, they may include

• fever, which may be the only sign
• vomiting or diarrhea
• irritability or fussiness
• poor feeding or appetite; poor weight gain

Older children

Symptoms of a bladder or kidney infection in a child ages 2 and older can include

• pain or burning when urinating
• cloudy, dark, bloody, or foul-smelling urine
• frequent or intense urges to urinate
• pain in the lower belly area or back
• fever
• wetting after a child has been toilet trained

Seek care right away

If you think your child has a bladder infection, take him or her to a health care professional within 24 hours. A child who has a high fever and is sick for more than a day without a runny nose, earache, or other obvious cause should also be checked for a bladder infection. Quick treatment is important to prevent the infection from getting more dangerous.

What causes a bladder infection?

Most often a bladder infection is caused by bacteria that are normally found in the bowel. The bladder has several systems to prevent infection. For example, urinating most often flushes out bacteria before it reaches the bladder. Sometimes, your child’s body can’t fight the bacteria and the bacteria cause an infection. Certain health conditions can put children at risk for bladder infections.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Saul P. Greenfield, MD, FAAP, FACS, State University of New York at Buffalo School of Medicine; Jeffrey M. Saland, MD, MSCR, Icahn School of Medicine at Mt. Sinai

Sudden Change in Behavior? Urinary Tract Infection Could Be the Cause

This post was updated in March 2020.

UTIs, or urinary tract infections, can cause changes in people living with Alzheimer’s disease and other dementia. As a care consultant with the Alzheimer’s Association’s 24/7 Helpline, I often speak to people about possible urinary tract infections (UTIs). UTIs are common among people diagnosed with Alzheimer’s and other dementia. This is attributed to age and partly due to increasing difficulty with hygiene and personal care.

Since the launch of ALZConnected, more than 98,000 individuals have registered for this free, online community for people living with Alzheimer’s and other dementias and their caregivers.

If you search the Caregivers Forum on ALZConnected and type in “UTI”, you will pull more than 8,000 posts on our message boards.

Here is a sampling of some of the posts on the topic:

• “For me, falling and hallucinations always mean check for UTI.”
• “Our compromised elders, especially females often develop, “silent” urinary tract infections. These UTIs are called “silent” because they usually have no symptoms of pain, no burning, no odor, no frequency, etc. BUT there will often be profound changes in behaviors.”
• “UTI, UTI, UTI, UTI, UTI! When my mother has a UTI she sleeps all day. We can’t get her out of bed, she will also stop eating. Have the doctor check her for a UTI.”
• “UTI and dehydration!!!!! I’ve never been so happy to get that kind of diagnosis. They have her on IV antibiotics. The interesting thing was that her urine was clear and they were pretty sure she didn’t have a UTI. Luckily the testing came back positive. ”
• “With my aunt, I could always diagnose the UTI because she started acting crazier than her current norm. (When she picked up a glass of water and threw the water over her shoulder, I called it right away — UTI.)”

Signs of a UTI
There are various signs and symptoms of a UTI, which can occur in women and in men. People with a UTI may experience burning when they urinate as well as a frequent intense urge to urinate. They may also have back or abdominal pain. 

The Alzheimer’s Association free 24/7 Helpline (800.272.3900) is available around the clock, 365 days a year.

Learn more

Family members and caregivers may notice difficulty urinating, change in urine smell, darkening urine color, and fever. However, some UTIs present without clear symptoms. 

Detecting UTIs can be difficult, particularly with someone whose communication may be impaired due to dementia. Sudden changes in behaviors and an increase in symptoms may indicate that your loved one has a UTI. Behavior changes and causes that seem to affect one’s personality may include sleeping issues, anxiety, depression, confusion, aggression, delusions, hallucinations and paranoia.

 
Getting Help

When UTIs wreak havoc, we sometimes see message threads in which caregivers are in a state of panic about the symptoms. And for good reason — the symptoms are powerful and can actually mimic the end of life for some people. Getting a urine test may not be the first thing you think of when your loved one starts behaving so differently, but these changes often occur with a UTI due to fever and increased pain. When you see sudden behavioral changes, it is important to rule a UTI out and consult with a doctor. 

Typically the natural progression of Alzheimer’s and other dementia diseases is gradual. Generally, once the UTI has been treated with antibiotics, the person returns to their baseline and no lasting harm is done. 

If you have questions or concerns about changes you are observing in your loved one, don’t hesitate to reach out to us at the Alzheimer’s Association 24/7 Helpline: 800. 272.3900. 

 

This post was provided by R. Clinton, a care consultant with the national office of the Alzheimer’s Association.

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Alzheimer’s and Aggression
Incontinence

Help Die: Where Euthanasia Is Legal

• Valeria Perasso
• BBC World Service

September 11, 2015

Photo Author, istock

Photo Caption,

List of Countries Allowed to Help Leave life, very small

British parliamentarians overwhelmingly rejected a bill to facilitate the procedure for obtaining drugs with which terminally ill people can die.

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

Every such case would have to get the approval of two doctors and a member of the Supreme Court.

As a result, England and Wales were not included in the list of countries that guarantee the “right to death”.

This list, by the way, is rather short: in five countries it is allowed to provide the patient with drugs with which he can die, and in several other countries euthanasia is fully legalized and doctors are allowed, in certain circumstances, to inject the patient with a lethal cocktail.

Netherlands

Photo author, istock

Photo caption,

In the Netherlands, assistance in committing suicide is subject to strict conditions

In 2002, the Netherlands became the first country to legalize euthanasia. In addition, assistance in committing suicide is now also not prosecuted.

At the same time, euthanasia is hedged with a strict set of conditions: the patient must suffer from an incurable disease, suffer from “intolerable” pain and not have the slightest chance of recovery. He or she must express his or her desire to die in complete sane mind and continue to insist on this for a specified period of time

The Demand-Based Termination and Assisted Suicide Act came into effect in April 2002.

Doctors from the Christian Medical Association say voluntary deaths “got out of control” after the law was passed. By 2015, the increase was about 15%, which is almost 5,000 cases.

However, this claim is contradicted by a scientific study published in the British medical journal Lancet in 2012. It argues that the number of people who voluntarily passed away after the adoption of the new law remained the same as before its introduction.

Photo author, Istock

Photo caption,

Not all doctors, even in those countries where euthanasia is allowed, approve this practice

The most controversial in the Dutch law is the age range: it is applicable to patients from 12 years old (but deadly sick children between the ages of 12 and 16 require parental consent).

Switzerland

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

Photo author, istock

Photo caption,

The Dignitas Clinic claims to help people leave life without pain and with dignity

This is partly due to the Dignitas Clinic, where terminally ill people are helped to leave for a fee from life. She became the last refuge of many foreigners who want to die without pain and with dignity.

Swiss law permits “assistance in committing suicide” in cases where “the helpers have no selfish motive”.

Criminal legislation in force since 1942 punishes assisted suicide only if the patient is persuaded to die, for example, to get rid of the burden of caring for him, not to pay for care and treatment, or to get an inheritance as soon as possible. If none of the above can be proved, then a criminal case is not initiated.

In order to avoid criminal liability, a person helping a patient to 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 deadly cocktail himself, but he is given an injection or is given medicine by a doctor or relative, is illegal.

Belgium

Photo author, istock

Photo caption,

In Belgium, euthanasia is allowed without age restrictions

In 2002, Belgium, following the Netherlands, adopted a law legalizing euthanasia.

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

Patients must be in “a hopeless medical condition and experience constant unbearable physical or mental suffering that cannot be alleviated.” Also, a patient who knows that he will soon fall into a vegetative state may express a desire that his life in such a state is not artificially supported. 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 specify a minimum age after which patients can request death.

United States

In the United States, whether or not assisted suicide is permitted is up to the discretion of individual states. As a result, it was allowed in four states, but it remains illegal throughout the country.

Photo author, istock

Photo caption,

In the United States, euthanasia is permitted in only four states. Sick patients must express their wish to die twice

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

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

Oregon made headlines in 2014 after a 29-year-old woman named Brittany Maynard, who suffered from terminal brain cancer, moved to the state to die.

Assisted suicide was later legislated in Washington, Vermont, and Montana.

New Mexico lawmakers overturned a state suicide ruling authorizing assisted suicide, and the bill is now under legal review.

And other countries

Photo author, istock

Photo caption,

Germany and the Canadian province of Quebec may soon approve suicide assistance

In Luxembourg, euthanasia and assisted suicide have been permitted 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 authorized in July this year. The Ministry of Health decided to support the request of 79-year-old Ovid Gonzales, who suffered from a fatal form of cancer.

In Germany, at the moment, doctors are not allowed to prescribe drugs that help to die. However, this issue is now undergoing legal expertise. The new law is expected to be passed by the Bundestag in November.

A similar situation exists in the French-speaking province of Canada, Quebec. The National Assembly has already passed legislation allowing the use of sedatives and medical treatment for dying.It should come into force in December this year.

What would have happened in England and Wales if the new law had been passed?

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

Two doctors and a Supreme Court judge would have to give their formal consent to help the patient die.

They would have to make sure that the patient is of sound mind and memory, that he really has no more than six months to live, and that he is well aware of the possibilities of palliative care. Thus, assisting suicide would be illegal for people who are not suffering from terminal illnesses or who are mentally ill.

The patient would have to take the lethal dose of medication on their own. Doctors would not have the right to introduce it themselves – in this case, their actions from a legal point of view would already be qualified as euthanasia, and not as assistance in committing suicide, which was not allowed even by the proposed and now rejected bill.

Two deaths without pain.How palliative care works in Sweden and Russia

“It didn’t hurt, you are great”

When Vera and Johan met, her father and his mother already had cancer, but were in remission. It took them a long time to decide where to gather: at his place in Stockholm or at her place in Moscow. Both had a good job, both did not want to leave their family. “In the end, we just threw a rock – scissors – paper, and I lost,” Vera laughs. In 2019, she received a residence permit and moved in with her husband. And then their parents simultaneously became worse.“All this time I was, as it were, in two realities,” Vera recalls.

Gunilla and Heinz have lived together for over half a century. Vera says they were “happy European retirees”: travel, bridge on Thursdays, book club on Fridays, always together. They accepted the choice of their son automatically and immediately fell in love with their daughter-in-law – the children lived in another city, but often visited their parents.

First, Gunilla stopped seeing one eye – she was given a special bandage, like a pirate.Then it became difficult to walk – they brought her a rollator (something like a walker), and then a stroller. And to make it more convenient, the doorways in the toilet were widened “under the stroller” and the dining table “fitted” under it. “All this was done quickly and without a single piece of paper,” says Vera. “There were no“ acts of accepted work. ”When Gunilla became weak and could no longer wash herself, women from the special services began to help her.

All these seemingly little things reflect the principles of palliative care. First, if possible, it is better to leave the patient at home for as long as possible.Secondly, you need to do your best to keep his life comfortable. Thirdly, this is help not only to the patient, but also to his relatives: you cannot complicate everything with bureaucracy. And if an elderly person finds it difficult to look after his wife, that’s okay. Vera says that they did not have a solution like “from today we need a palliative.” All this was simply automatically integrated into life – from less to more, depending on the state of the mother-in-law. “Doctors kept asking Heinz:“ Are you coping? ”Gradually they began to come, put her on a chair in the morning, put her in bed in the evening, and so on.

In the summer of 2019, Gunilla could still walk with a rollator. But already in September, at some point, she began to choke and could not swallow food. She was taken to a hospital – not a hospice, not even a palliative department, an ordinary hospital. But in Sweden even there you can be with loved ones around the clock, and the husband spent the night in her ward. “We were sure that she would be discharged and she would still live,” Vera says. “A couple of days later, they took Heinz to the forest for mushrooms to somehow distract him. The next day I baked a pie, and Gunilla had time to eat it.She died a few hours later. “

© Alexey Durasov / TASS

Vera says that after a loved one leaves, doctors say important words: “We did our best, she did not hurt, you were together until the last minute, you are great.” And this supports and “closes the main gestalts”: people do not think that a person could have been saved, that they did not have time to say something important and that they are to blame for something. And one more important thing: the next morning, a stroller and a rollator were taken from their house, “so that Heinz would not have this in front of his eyes.”

Now Heinz has already come to life a little. Two months ago, Vera gave birth to a daughter – she and her husband hope that the granddaughter will help her father-in-law to recover. “It was the first death I saw,” Vera says. “But it was the best option possible. Gunilla left in peace, in a clean, beautiful room, without pain. And we were there.”

“Hospice is like a recognition that a loved one will die”

Vera’s parents lived a couple of hours drive from Moscow. When Alexander Ivanovich got worse, he was registered in the capital: here the help for cancer patients is still better.But there were difficulties – from problems with buying medicines to having to go to the oncology clinic every morning. “Dad was such a man-man. Who doesn’t hurt, who will do everything himself,” says Vera.

Alexander Ivanovich was a physicist, scientist and teacher, as she says – “a crazy professor” who most of all liked to draw something and derive some formulas.He could fix absolutely everything, solve any problem. “And we are three blondes around him,” says Vera. “Mom is a musician, my sister is an artist, and I’m a manager…” He was ashamed of his illness, considered it a weakness, something “unmanly”. And he went to work as long as he could walk at all.

After his death, we came to his institute and saw that he had planned lectures for December-January. Glasses lay on the open notebook …

Therefore, he categorically refused to go to the hospital: it was important for him to think that he would “get sick and go to work.”But at some point, because of the pain, it became impossible to sleep and even roll over from one side to the other. Prescribed painkillers did not help. And the family decided to try palliative care.

© Alexey Durasov / TASS

Vera, a charity fund for hospices, always says: “Hospice is life for the rest of your life.” Vera’s family knew this, the director of the Moscow Multidisciplinary Center for Palliative Care of the Moscow Department of Healthcare Nyuta Federmesser had read Facebook for a long time and seemed to understand that hospice is not a “dying hut” as many think.And yet they were afraid to even pronounce the word.

This sounds like an admission that your loved one is going to die. When you discuss hospice with your dad or husband, you kind of start to say goodbye to him

This fear was a little “removed” by the visit of a physician of the mobile palliative service. He immediately injected the patient with morphine, and Alexander Ivanovich felt better. “It is difficult to say why morphine was not prescribed at the oncological dispensary,” says Vasily Shutov, a doctor at the Center for Problems of Treatment.It also happens that relatives come to get drugs, but doctors do not come to the patient’s house and simply do not see him. “

And for the first 20 minutes, the doctor talked to his father about his work, “brought him back to normal life.” Even the best doctors often simply do not have time to psychologically support the patient. In less successful cases, things are even worse – Vera says that often her father was “treated like a petitioner with a coupon.” In palliative medicine, the dignity of the patient, in whatever condition he is, is the main thing. The next day, the family went to the hospice.

“As if suffering before death is a mandatory checkmark”

“We drove and said: Dad, you’ll just look. We were even afraid to call this place a hospice, they said“ palliative care, ”says Vera. But the place with a frightening name turned out to be“ an island of Sweden in Russian medicine. ”

Hospice patients should feel at home. Not like a hospital. Therefore, there are flowers everywhere. And the parrots are talking.And in the hospice, where Vera’s family came, lived two cats. “We are also cat lovers,” she says. “At home, the cat called daddy to sleep in the evenings. Daddy watches TV late at night, she comes and meows in his face. He says:“ What, sleep? ”And she leads him into the bedroom. In the hospice, it was a cool psychological fad for us: the kitty came, she was asleep. Cozy. ”

Special project on the topic

At the same time, the home environment is accompanied by professional care. Here, patients have special beds – such that they can easily raise their heads or take a person for a walk right in bed. Here pain relievers are given on time. Here they take care of themselves – and the family may not think about changing diapers, but about holding their hand in the end. “Someone from our acquaintances told us:“ Why, you yourself cannot take care of your dad? ”In Russia, this attitude is very strong: how can I give up my loved one? I have to take care of myself and suffer!” Vera says. these inconveniences and suffering before death – this is some kind of obligatory checkmark. But by doing this we only make the departing one worse. ”

In September this year, Moscow Mayor Sergei Sobyanin decided to provide palliative patients with free medical products at home.Starting next year, if necessary, Muscovites will be able to get beds, strollers, special mattresses and other things that will help take care of bedridden patients if it is important for them to stay at home (regardless of whether the person has a disabled status). Even last year, for this it was necessary to register a disability, which Alexander Ivanovich categorically did not want.

© Alexey Durasov / TASS

Vera’s father died on the fifth day in the hospice. All this time the family was with him in the same ward.“Dad always liked to drink at the table and have fun,” Vera says. “Finally, he ate two pancakes and drank two glasses of Cahors, the doctor allowed.” Then he developed a fever and gradually stopped breathing. All this time, the doctors smeared his lips and hands with cream so that they would not dry out.

“It’s great that when dad died … Sounds strange, doesn’t it?” Vera interrupts herself. “But yes, it’s great that we got rid of the bureaucracy. We only signed a refusal to autopsy – it took a couple of minutes. There were no more papers.” …Vera confesses that the hospice surprised her by the fact that “everything is as it should be.” Unfortunately, this is not always expected in Russia.

But even today, death in our country can be like that – where “it is not painful, not ashamed, not scared, not lonely,” as Nyuta Federmesser says.

“When our loved ones leave, we often ask – why are they? And we blame ourselves for everything,” says Vera. “There is no sense or logic in death. But this is part of life. And when you understand that death is near, you learn to value life.And you just know that you need to give a person warmth and have time to get warmth from him. It is possible in a hospice. “

• There are now a Palliative Care Center and eight hospice branches for terminally ill adults in the capital, as well as 13 mobile palliative services. If you need help, you can call the toll-free 24/7 number: +7 (499) 940-19-48.
• For children there is the First Moscow Children’s Hospice and the House with a Lighthouse.
• The Pro Palliative portal (a project of the Vera Foundation) provides expert information on how to care for terminally ill people, on the treatment of pain, pressure sores, nutrition and hygiene, psychological support, communication – both for doctors and for relatives of patients.
• The Vera Hospice Charitable Foundation has created a hotline to help terminally ill people, it works around the clock and free of charge. Her number is 8-800-700-84-36. Patients, their friends or relatives, specialists caring for incurable patients, health workers and employees of specialized non-profit organizations can call here.
• The project of Nyuta Federmesser and the All-Russian Popular Front “Region of Care” is involved in the creation and development of palliative care in the regions.

Continuation

Bella Volkova

90,000 “I want to die on my own terms” The story of an American woman who tried all methods of treatment and decided to euthanize: Books: Culture: Lenta.Common crawl en

Death accompanies life since the beginning of time, but this does not mean that in the process of dying there are no changes. Modern Death: How Medicine Changed Leaving Life is a book by a young American physician, Haider Warrich, about how all aspects of the end of human life have changed as a result of advances in modern medicine: from what we die, when we die, where we die and how we die. The book was published as part of the publishing program of the Polytechnic Museum and is part of the “Polytechnic Books” series.With the permission of the publishing house Alpina Non-Fiction, Lenta.ru publishes a fragment of the text devoted to the debate around the law on euthanasia.

Brittany Maynard, who lived in the suburbs of San Francisco, had headaches shortly after the wedding. Headache is an extremely common symptom: we rarely manage to live without it for any length of time, sometimes even a day without access to coffee. Many of us have never had a heart attack, stroke, or even a urinary tract infection (especially men) in our long lives, but almost everyone has a headache at one point or another.Of the nearly 40 million American patients who complain of recurrent headaches over the course of a year, only a few are associated with life-threatening cancer. After a thorough examination, which included an MRI of the brain, it turned out that Brittany was one of them.

She did what any other patient with a potentially curable form of cancer would do in her place – she underwent neurosurgery, which involved removing part of the bones of her skull. Nevertheless, the woman had a relapse, and this time she was already in the incurable fourth stage. With or without treatment, patients with this diagnosis live for less than a year. “After months of searching for a solution, my family and I came to a difficult conclusion,” she wrote. “There is no cure that can keep me alive, and the recommended methods will make the months I have left unbearable.” She considered traditional hospice palliative care, but felt that she “could develop morphine-resistant pain, as well as personality changes, verbal, cognitive and motor impairments of almost any kind.”As a result, she decided not to cede control of her death to either the disease or the doctors. Brittany and her family packed their bags and headed to Oregon.

– I want to die on my own terms.

Oregon’s journey to becoming the first American state to legalize physician assisted suicide began in the 1990s, when the struggle for the right to die was at its most active and difficult phase. Beginning with the publication of “It’s Over, Debbie” in 1988 and the first suicide orchestrated by Jack Kevorkian in 1990, physician assisted euthanasia and suicide have been hotly debated in medical conferences, legislatures, courts, and in American society itself.In 1994, by a small margin of 2.6 percent, Oregon’s voters made it the first state to allow terminally ill patients to commit suicide with the assistance of a doctor.

California Senate meeting discussing euthanasia law. The senator holds a portrait of Brittany Maynard

Photo: Rich Pedroncelli / AP

Almost immediately, even before anyone could exercise this right, a federal judge imposed an injunction on this, citing his decision by the fact that the adopted law did not provide those wishing to use them on an equal basis with the rest of the population “protection from suicide.”However, this ban was lifted in 1997, and lawful suicide with the help of a doctor finally appeared in the United States.

Oregon’s regulations were very similar to those applied in other parts of the world. Applicant may be an adult over 18 years of age who can make medical decisions, resides in Oregon and has a terminal illness with a life expectancy of less than six months. A patient who meets all of these criteria is required to make one written request for a lethal dose of the drug, certified by two witnesses, and make two verbal requests to the prescribing physician.

This doctor must make sure that there is an incurable disease and that the patient has less than six months to live. Another colleague should give a similar conclusion. If any of them suspects that the patient is incapacitated or has some kind of psychiatric illness, they are referred to a psychiatrist. After informing the patient of other possible alternatives, doctors are also required to inquire if the patient would like to notify any of his immediate family members.

In a debate where almost no one ever agreed to a compromise, Oregon’s Death with Dignity Act had the effect of a bomb.Polls conducted in the 1990s showed that the vast majority of medical professionals opposed physician assisted suicide and euthanasia. Physicians of some religious beliefs (Jews and those who do not associate themselves with any religion) were more open to the idea of ​​euthanasia, but still most of them were still opposed. While Oregon doctors were more likely to support the law, medical professionals in other states were much more skeptical.

However, surveys have shown that American doctors are constantly receiving requests for euthanasia from their patients and that a small percentage of them agree to this, despite the illegality of such actions.A nationwide study found that about 5 percent of American doctors injected patients with lethal doses of drugs, compared with 7 percent in Oregon. A survey of ICU nurses also showed that one in five of them injected a patient with a lethal dose of medication at his request, with the express intent of ending his life.

Since euthanasia and its variations remained banned and their perpetrators could be charged with unlawful deprivation of life, it is highly likely that these polls underestimated the prevalence of this practice – but most observers were still very surprised.

On the other hand, the general public, although more sympathetic, still seemed to be divided into two equal camps. The category that most decisively stands for the legalization of euthanasia or suicide with the assistance of a doctor has always been and will be the few to whom these issues are most directly related – patients with incurable diseases.

For me this is the most important group of the population in this discussion, but it is she who often fails to participate in the discussion.Patients with terminal illnesses are outnumbered by both the general public and the medical community. In addition, due to their diagnosis, they are often unable to operate outside the hospital, nursing home or hospice, where they spend most of their time.

When physician assisted suicide finally became legal in Oregon, many believed that the state would become a true final resting place for patients flocking there from all over the country in an attempt to take control of the end of their lives.

Photo: BAXTER / BSIP / Legion-media.ru

Another concern, perhaps more justified, was that the main victims of this initiative would be economically disadvantaged patients – representatives of national minorities and patients without insurance, who cannot afford full treatment and will be forced to choose this path. Unlike the Netherlands, where everyone has health insurance, in Oregon at the time the law was passed, there were about half a million non-residents.

Extensive data gathered in the sixteen years since the law came into force in 1997 allows much to allay these concerns. During this period, 1,173 patients applied for a lethal dose of drugs, and two thirds of them (752 people) used this prescription.

We are talking about a few cases for every 10 thousand deaths. The average age of these patients is 71 years, and 77 percent of them were in the range from 55 to 85 years. Only six, like Brittany Maynard, were under 35.The vast majority of patients who took advantage of the law are white (97.3 percent), had health insurance (98.3 percent), died at home (95.3 percent), received palliative care (90.1 percent), had completed secondary education ( 94.1 percent) and had cancer (79.8 percent).

About half of them were men (52.7 percent), were married (46.2 percent), had a university degree (45.6 percent) and died without a doctor (44.7 percent). It is noteworthy that since 1997, only one such patient has died in hospital.Despite fears that vulnerable populations would be more likely to commit suicide with the assistance of a doctor, only 12 uninsured people and one African American have committed euthanasia in Oregon.

What motivates terminally ill Oregonians to make this decision? The top three reasons cited by patients are: loss of independence (91.4 percent), lack of opportunities to do things that bring joy (88.9 percent), and loss of self-esteem (80.9 percent).Inadequate medication for pain relief was cited as a cause by only 23.7 percent of those surveyed. Quite an unexpected result considering that 65 to 85 percent of patients with advanced cancer experience severe pain. This is important because many critics of physician assisted suicide consider any such decision to be a reflection of deficiencies in palliative care and pain management. However, as the Dutch experience has shown, the legalization of euthanasia has only underlined the importance of palliative care, which has made physicians more aware of their duty to dying patients.

It has been suggested that most requests for euthanasia are driven by depression. But research in Oregon shows that depression is one of the least important factors that lead patients to make this decision. Sometimes it’s just about getting the prescribed drugs. “Once the drugs were in my possession,” Brittany wrote, “I was incredibly relieved.” A third of patients do not even use the drugs they receive, and the rest do it sometimes quite a long time later (from 15 to 1009 days) after submitting a request for a lethal dose.

Photo: Philippe Wojazer / Reuters

When Oregon first permitted suicide with the assistance of a doctor, opponents of this decision very often drew parallels with Nazi experiments. Now we can confidently assert that there are few places in the world where death is better than in Oregon, and this applies not only to those who decide to commit suicide. Rather than being a warning against the slippery slope of eugenics, Oregon has served as a model for several other states.In 2008, Washington State voters passed a law similar to Oregon, also legalizing physician-assisted suicide.

Montana was next, where the Supreme Court ruled in 2009 that there was no law prohibiting doctors from helping patients to hasten their own deaths. In 2013, the Vermont State Congress passed the Patient Choice and End-of-Life Control Act, which is similar to those mentioned above. More recently, in 2016, California did the same, and outside the US, Canada passed a death assistance law.

Brittany Maynard’s mother speaks to the media after the adoption of the euthanasia law, September 2015

Photo: Carl Costas / AP

A few days before Brittany Maynard’s death, it seemed to many that she had changed her mind. In a video posted on October 29, 2014, she says, “I laugh and smile so much with my family and friends that now seems like the wrong time.” After hearing this, I wrote her an email asking her to describe her psychological state.I received no answer, and on November 2 there was news that Brittany had committed suicide, as she intended.

“Bye, world. Share good energy. If you were helped, help someone else, ”she posted this latest status on her Facebook page. Five states have already legalized physician assisted suicide, but there are 45 others where it is illegal, and even in these five, it is still used by only an absolute minority of patients. Nevertheless, there are completely legal and much more common practices that can significantly accelerate the onset of patient death, and they are extremely similar to active euthanasia.I remember many nights when I heard – and followed – requests to double the dose of the drug given through the IV until the line on the heart monitor turned into a straight line.

Translated by Maria Smirnova

Why is medical suicide normal in Switzerland?

Foreigners often come to Switzerland not to live, but to die by means of “euthanasia”, that is, active suicide by the administration of medications, which entails a quick and painless death of a hopelessly ill and suffering person.In Switzerland, suicide assistance is considered an acceptable measure, it happens under the auspices of specialized structures.

This content was published on 12 March 2020 – 11:28
12 March 2020 – 11:28

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In 2014, This Jenny, a famous Swiss politician who had inoperable end-stage stomach cancer, committed suicide with the help of doctors from Exit, which deals with escorted suicide.Swiss public television accompanied him throughout the last weeks of his life, in some sense breaking a taboo, for the first time so openly concentrating on the topic of voluntary suicide.

After the death of the politician, however, no mass public outrage followed, the country, on the contrary, sympathized and even admired. Among the Swiss, assisted suicide is recognized as a legitimate palliative care measure that is not life-saving, but life-saving, last but not least, saving the patient from unnecessary pain and suffering.

Now in the country more and more people are thinking about their future and become members of relevant organizations to help organize voluntary suicide. “In Switzerland, we know that we have the opportunity if something happens,” says Samia Hurst-Majno, a professor at the University of Geneva. “It should be noted that cases of assisted suicide are still quite rare even in Switzerland. But many people are happy to know that they have the potential to legally end their excessive suffering, ”she notes.

Polls and the results of many referendums show that the majority of the country’s population is against the ban on assisted suicide. For example, in 2011, citizens of the canton of Zurich unequivocally opposed restrictions on the practice of assisted suicide, and therefore the Swiss federal government decided to abandon plans to regulate this area at the national level, even if the European Court of Human Rights later reprimanded Switzerland for its alleged , insufficiently clear legal position on this issue.

Professor Samia Hurst-Maino explains this fact by the fact that Swiss legislation governing the organization of assistance in suicide has been in effect for a long time, which helped to strengthen public confidence in this practice and to exclude any cases of very flagrant abuse.

“We proceed from the premise that the need for such suicide does not arise due to a fleeting whim of the patient. Mentally ill people are immediately referred to the appropriate preventive services.In other cases, we study all the alternatives, so assisted suicide is available in Switzerland only as a last resort for those who have a stable and clearly formed completely rational desire to voluntarily die, ”says Samia Hurst-Maino.

Switzerland decriminalized voluntary suicide in the early 20th century. “If suicide is a crime, suicide assistance is complicity,” explains S. Hurst-Maino. “But if suicide is a non-crime, then helping outside is also not complicity in a crime.”At the same time, it was decided in Switzerland to integrate several important fuses into this system.

“A person providing assistance in organizing voluntary and deliberate suicide should not have any reason to be interested in the death of a patient, otherwise such a doctor may be held accountable. However, if such material benefit is obvious and provable, it is not a crime to help suicide, ”explains S. Hurst-Maino.

Active euthanasia or assisted suicide is now prohibited in most countries. Switzerland is one of the few countries in the world where foreigners can benefit from suicide assistance. This theme even found its reflection in the novel by the famous writer Michel Houellebecq “Map and Territory”. The book is just about the so-called “suicidal tourism”, when foreigners come to Switzerland to die in protected and dignified conditions.

According to the voluntary suicide organization Dignitas, perhaps the most famous organization in the world that provides assisted suicide services not only to Swiss, but also to foreigners, in 2018 more than 90% of its members were citizens of other countries.Among them, by the way, is the famous singer Tina Turner, who, however, has long since received a Swiss passport.

Even so, criticism of this practice is expressed regularly – especially in cases when people who want to die are not terminally ill and do not suffer from unbearable pain syndromes, apoputically “tired of life” or even suffer from mental illnesses.

Swiss euthanasia organizations are working to ensure that elderly people with terminal illnesses and weary people also have easier access to drugs to help them complete their journey on land, subject to all criteria for admission to such a suicide.Recently, the Swiss experience has been studied with curiosity in foreign countries.

Many Swiss structures in the field of organizing voluntary suicides are actively promoting the idea of ​​legalizing assisted suicide by various methods – presentations, providing advice, lobbying, advertising and public work. Their goal: to make euthanasia legal all over the world someday so that no one can travel to Switzerland.

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Federal Law “On the Rights of Patients”

Section I. General

This Federal Law establishes the rights of patients as a specific group of rights derived from general human rights, and defines guarantees for ensuring these rights in the field of healthcare, based on the fundamental value of human life, safety, and the close relationship of physical and mental health.

Article 1. Basic concepts

Patient – a person in need of and / or seeking medical care, receiving medical care, or participating as a subject in biomedical research, under medical supervision, as well as acting as a consumer of medical and related services, regardless of whether he is healthy or sick.
Medical information – information about the patient’s state of health and the medical care provided to him, including data on the presence of a disease, its diagnosis, prognosis, methods of diagnosis, treatment and prevention, the risk associated with medical intervention, and other medical information.
Patient rights are rights exercised at the individual, collective and group levels in the field of health care, including in connection with any medical intervention.
Patient Rights Guarantee – a system of obligations established by a legal act or contract, ensuring the implementation of the patient’s rights.
Standards of medical care are norms, rules and recommendations approved at the level of the federal executive body and determining the procedure for the provision of medical care.
Medical care – treatment, prophylactic and rehabilitation measures carried out during pregnancy, childbirth, diseases, injuries.
Necessary Medical Assistance – Medical assistance provided in accordance with approved standards.
Participants in the provision of medical care – medical institutions, private practitioners, pharmacies, federal executive authorities and executive authorities of the constituent entities of the Russian Federation, medical insurance organizations, compulsory medical insurance funds and other individuals or legal entities licensed to engage in a certain type of activity, providing patient care in an inpatient facility or at home, as well as persons and organizations involved in the financing and use of funds allocated for the resource and organizational provision of the necessary medical care.
Medical intervention – any examination, treatment and other action having a preventive, diagnostic, therapeutic, rehabilitative or research orientation, performed by a doctor or other medical professional in relation to a specific patient.
Medical service is the direct implementation of examinations, consultations, operations, manipulations, procedures, research and patient care.
Service service – providing additional comfort conditions for the patient’s stay in a medical institution.
Informed voluntary consent is a voluntary consent of a patient or his legal representative to a medical intervention, given by him on the basis of complete and comprehensive information received from the attending physician or a physician conducting biomedical research in a form available to the patient about the purpose, nature, methods of this intervention, associated probable risk and possible medico-social, psychological, economic and other consequences, as well as possible alternative types of medical care and associated consequences and risks.
Biomedical research is a scientific research aimed at studying specific physiological, psychological and other states of the human body under the influence of factors, as well as approbation of new diagnostic, therapeutic and prophylactic, rehabilitation methods, medicines and other means, carried out in the form of a clinical trial with the participation of a person in as a test subject.
Alternative hospitalization conditions for the provision of medical care – the organization of medical care for the population without interruption from the usual social environment, including assistance at home, in an outpatient clinic or in a semi-stationary department (institution).
Professional medical secret – information not subject to disclosure about a patient, the fact of seeking medical help, diagnosis and other information about the state of health and private life obtained as a result of treatment and examination.

Article 2. Legislation of the Russian Federation on the rights of the patient

The legislation of the Russian Federation on the rights of the patient consists of the relevant provisions of the Constitution of the Russian Federation, the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens, this Federal Law, other legislative and other regulatory legal acts of the Russian Federation, legislative and other regulatory legal acts of the constituent entities of the Russian Federation regulating relations in the field of ensuring and protecting the rights of the patient.
The right of patients to social services is implemented in accordance with the legislation of the Russian Federation on social protection of the population, including the Federal Law on Social Services for Elderly and Disabled Citizens.
Laws and other regulatory legal acts adopted in the Russian Federation and the constituent entities of the Russian Federation cannot restrict the patient’s rights provided for by this Federal Law.
If an international treaty of the Russian Federation establishes rules other than those provided for by this Federal Law, then the rules of the international treaty shall apply.

Article 3. Tasks and scope of application of this law

This Federal Law establishes the legal framework for state policy and regulates relations in the field of ensuring and protecting the rights of the patient.
The main objectives of this law are:
securing the rights and obligations of the patient;
establishment of basic guarantees for ensuring the rights of the patient;
determination of the grounds for responsibility for violation of the patient’s rights and methods of their protection;
establishing the procedure for limiting the rights of the patient;
determination of responsibility for violation of the requirements of this law.
This Federal Law applies to citizens of the Russian Federation, state authorities, local governments, organizations of state, municipal and private health systems, foreign citizens temporarily or permanently residing in the Russian Federation, unless otherwise provided by international treaties, stateless persons, temporarily or permanently residing in the Russian Federation, refugees and displaced persons.

Article 4.Principles for approaching and exercising patients’ rights

The fundamental value of life.
Close relationship between physical and mental health.
Ensuring the safety of life and health.
Mental and physical integrity of a person.
Respect for dignity.
Inviolability of a person and his personal life.
Individuality and choice.
Recognition of the patient as an equal participant in the decision about medical intervention.
Regulation of the rights and obligations of the patient, the conditions for limiting his rights for the purposes of the health and interests of the patient himself and others.
Regulation of patient rights by mechanisms of their provision and protection.
Approval of the principle of mutual trust in the relationship between the patient and the medical professional.
Prompt and objective consideration of the facts of violation of patients’ rights and responsibility for violation of rights.
Control and independent examination of the quality of medical and pharmaceutical care.

Article 5. Conditions for the implementation of patients’ rights.

The rights of patients enshrined in this federal law are exercised by the patients themselves, and in relation to persons under 15 years of age or persons recognized as legally incompetent, by their parents or other legal representatives.
The patient can entrust any competent person with the exercise of his rights in connection with a medical intervention. In this case, the representation of the patient’s interests is confirmed by a power of attorney drawn up in accordance with the legislation of the Russian Federation.
In urgent cases, when the patient’s state of health does not allow him to exercise his rights and requires urgent medical intervention, as well as in the absence of the persons specified in parts one and two of this article, and (or) if it is impossible to establish contact with them, responsibility for organizing the provision of the necessary medical care and the life of the patient is undertaken by a commission of doctors, and if it is impossible to assemble a commission, the attending (duty) doctor who is obliged to notify the administration of the health care institution about the measures taken at the earliest opportunity.
The administration during the first day of the patient’s stay in a medical and diagnostic institution is obliged to notify the patient’s relatives or his legal representatives about the case, and if it is impossible, to notify the territorial bodies of internal affairs.
Responsibility for the realization of the rights of patients under the age of 15 or recognized as legally incompetent and without legal representatives lies with the administration of the health care or social service institution where they are located, or which provides them with home-based services and assistance.
If the legal representatives of the patients referred to in the first part of this Article refuse to exercise the rights provided for the patients, and this refusal creates a danger to their life and health or runs counter to the interests of the patients, the administration of the health care institution providing them with medical care shall assume responsibility for the exercise of these rights. … Refusal in these cases is made in writing, confirmed by the signature of the patient or his legal representative and attached to the patient’s medical records.

Section II. Realization of the rights to life, security and freedom of choice

Article 6. Patients’ right to life

The right to life is a fundamental right and is realized through granting patients the right to safely carry a pregnancy, natural childbirth, health protection, including the right to necessary medical and drug assistance and nutritional therapy.
No one can be subjected to forced sterilization without a court decision, except in cases of vital evidence.
Patients cannot be arbitrarily deprived of their lives. Medical professionals do not have the right to satisfy the request of the patient, his relatives or persons representing his interests to accelerate his death.
A child has the right to health care from the moment of conception.
When the fact of brain death is ascertained, the decision to disconnect the patient’s life support is made in writing by a commission of medical specialists in accordance with the regulations of the health authority of the Russian Federation.
The participation of transplantologists and members of the teams that provide the work of the donor service and are paid by it is not allowed to make a decision to turn off the means of life support in order to remove organs and (or) tissues for transplantation.
It is not allowed to establish additional allowances for the salaries of medical personnel and administration for donor training.
Information from the medical institution to the centers for transplantation or organ donation about the presence of a possible donor is transmitted only after the informed consent of direct relatives about the possible removal of organs and tissues from the patient.

Article 7. Patients’ right to freedom from discrimination

Any refusal, without legal grounds, provided for by the legal acts of the Russian Federation, to provide persons with disabilities, physical disabilities or mental disorders in providing the necessary medical care in full or in insufficient amount, preserving their workplace for the period of treatment, as well as when prescribing social benefits, the establishment of benefits, should be considered a discriminatory act.
Patients are guaranteed equal accessibility to all types of necessary medical care and related services.
The influence of discriminatory factors is not allowed in cases where medical care must be provided simultaneously to several patients. When determining the sequence of its provision, a medical worker must be guided solely by medical indications.

Article 8. Patients’ right to freedom of choice

The right to freedom of choice implies the right to consent to hospitalization and the right to refuse it, as well as to receive medical care outside the hospital, in the patient’s area of ​​residence in his usual social environment, unless otherwise required by the patient’s health condition.
The right to receive medical care outside the hospital provides for freedom from the use of physical restraints on patients in isolation, except in cases where patients may harm their health or the health of others, and when out-of-hospital care is ineffective. The conditions and procedure for applying physical restraint and isolation devices to patients are determined by the health authorities of the Russian Federation. Violation of these conditions and procedures entails liability in accordance with the legislation of the Russian Federation.
Hospitalization is carried out only on the basis of the patient’s voluntary consent, except for the cases provided for in Articles 27? 31 of this Federal Law and in other circumstances established by the legislation of the Russian Federation.
Does the patient have the right to refuse hospitalization or interrupt his / her stay in an inpatient healthcare institution, except as provided in Articles 27? 31 of this federal law and in other circumstances established by the legislation of the Russian Federation.In case of refusal of hospitalization or discharge on the initiative of the patient, the consequences of the decision should be explained to him. In special cases associated with the threat of a serious deterioration in the patient’s health, his refusal to hospitalize is made in writing, confirmed by the patient’s signature and included in his medical documentation.
In the absence of medical contraindications, the patient has the right to interrupt inpatient treatment in order to resolve personal issues. Days free from hospital stay are provided to the patient in the manner prescribed by the regulatory legal acts of the health authorities, without issuing an discharge from the hospital.

Article 9. Patient’s right to health safety

Patients have the right to safety, excluding the possibility of risk to life or harm to their health during medical intervention.
The use of methods of prevention, diagnosis, treatment, rehabilitation, as well as medicines, medical devices, medical equipment and software is allowed only with a permit issued after registration by the federal health authority in the manner prescribed by the legislation of the Russian Federation.
In order to ensure the safety of life and health of patients, any medical intervention, production, purchase or sale of medical products is carried out in accordance with the established federal standards in compliance with sanitary norms and rules.
It is not allowed to use methods of influence on the human body that are not amenable to standardization, qualitative assessment and, as a result, subsequent control of the application.
Responsibility for ensuring the safety of patients in health care institutions, regardless of ownership, lies with the administration of this institution, or a doctor who provides paid services or private practice.Ionizing and radioactive exposure is used in the provision of medical care to patients within the limits excluding the possibility of exceeding the permissible radiation doses, only for diagnostic and therapeutic purposes and taking into account the patient’s state of health. Allowable levels of such exposure and the procedure for performing the appropriate medical procedures are established by the federal health authority.

Article 10. The right to maintain mental and physical integrity during medical intervention

Respect for the right to preserve the mental and physical integrity of the patient’s body is a prerequisite for providing him with medical care.This right is not subject to any restrictions other than those provided for by the legislation of the Russian Federation and are necessary to save the patient’s life. Medical intervention capable of impairing the physical or mental state of the patient’s health is permitted only in the interests of treating the patient. The decision on such intervention is made by a council of doctors, and in emergency cases, if it is impossible to collect a council, by the attending (duty) doctor, about which an entry is made in the patient’s medical records.
In order to control the validity and feasibility of medical intervention, the surgical material removed from the patient as a result of the operation is subject to mandatory pathological examination.
The removal of any prostheses, organs, tissues and environments of the body, including abortive material, tissues and environments rejected during childbirth, for any other purpose other than the interests of the patient himself, is not allowed. These restrictions also apply to the body of the deceased. In the absence of relatives, other representatives of the deceased, it is allowed to use the organs and tissues of the body of the deceased for educational and scientific purposes, subject to the observance of the right to respect for the body of the deceased and in the manner prescribed by the legislation of the Russian Federation.
The export of corpses and cadaveric material on a commercial or other basis, except for cases with subsequent burial, is not allowed.

Article 11. Patients’ right to freedom of religion in healthcare institutions

The patient has the right to perform religious rituals and invite a clergyman in a specially designated place.
Proselytism is prohibited in health care facilities. The admission of a clergyman to health care institutions is carried out only at the invitation of the patient or his representative at any daytime with the consent of all patients in this room.In the event of a threat of death of the patient, the admission of a clergyman is allowed at night in a separate room.

Section III. Respect for honor and dignity

Article 12. Right to Pain Relief

The patient is entitled to pain relief.
Treatment of terminally ill patients with chronic pain should be directed towards alleviating their suffering. Treatment for severe chronic pain should be individualized and tailored to the needs of the patient.
Patients suffering from acute pain, as well as terminally ill patients suffering from chronic pain, are guaranteed the availability of analgesic drugs that provide quantitative and qualitative pain management.

Article 13. Prohibition of any measures of influence on the patient for behavioral reasons

The use of drugs, physical restraints and isolation in relation to the patient is not allowed in order to punish or ensure the convenience of personnel in health care facilities.

Article 14. Right to participate in planning and conducting treatment

The patient, with the assistance of a doctor, has the right to participate in the planning and implementation of the treatment of his disease.
If a patient has a chronic illness, the doctor must teach the patient self-help methods, including prevention and pre-medical diagnostics and ways to overcome the painful symptoms that arise, in order to preserve the independence of patients and maximize the ability to function both at home and in the community.
A patient’s request for the provision of additional medical and service services that are not included in the compulsory treatment plan provided by the doctor can be satisfied taking into account the patient’s health condition and for an additional fee paid by him in the manner prescribed by the legislation of the Russian Federation, constituent entities of the Russian Federation.
A doctor has the right to refuse a patient’s request to provide additional medical services that do not correspond to the treatment plan at this stage and time of medical care.

Section IV. Patient health information and privacy

Article 15. Right to receive medical information

The patient has the right to receive information about his health status, diagnosis, prognosis, treatment of his disease, methods of prevention, possible risk associated with medical intervention. The patient is also given the right to receive information about the advantages of the proposed and alternative methods and forms of providing him with medical care.
The right to information is not subject to any restrictions, except in cases where the information may cause serious harm to the patient’s state of health. The information is communicated by a doctor, other medical professional who provides assistance to the patient in a form accessible to him, orally or in writing. If the patient does not speak Russian, an interpreter must be provided.
The patient has the right to refuse to receive information, which is made in writing and included in the patient’s medical records.
The patient may designate a person to whom information about the patient’s health should be provided.
Upon admission to an inpatient health care facility, the patient must be informed about the professional status, the names and surnames of the medical personnel who will provide him with medical care, as well as the rules that the patient must follow during his stay in the health care facility.
The patient has the right to receive information about his rights and obligations as a patient, about the services provided, their cost (provided that the services are paid), as well as about the procedure for their provision.Patient rights information should be posted or publicly available at the healthcare facility.
Patients over the age of 15 are entitled to access to their health information.
The doctor of the institution, at the request of the patient, is obliged to provide the necessary explanations related to the content of the medical information.
Medical information (documentation) may not be provided to the patient for review, not issued in the form of extracts and copies if this information: can cause serious harm to the patient’s health or the health of a member of his family and, thus, entail a violation of the right to safety ;
concerns other persons, the circumstances of their life and may lead to a violation of the rights of these persons to privacy;
deals exclusively with the administrative issues of the health care institution;
In case of refusal to provide the patient with medical information on the grounds that it may cause serious harm to his health, the patient has the right to instruct any person to get acquainted with the requested data or to go to court.
After the end of treatment, the patient has the right to receive a written certificate issued by the attending physician or an extract from the medical history about the diagnosis, treatment performed and relevant recommendations.

Article 16. Right to amend and supplement medical information

The patient has the right to apply to a health care institution with a request to make changes and additions to medical information. The basis for considering the issue of changes and additions to the medical information is a written statement of the patient with the conclusion of medical specialists attached to it.
The administration of the health care institution is obliged to consider the request within a month and inform the patient, or his legal representative, about the changes (additions) made, or about the reasons for refusing to satisfy the specified request. In case of disagreement with the decision of the administration of the healthcare institution, the patient has the right to apply to the appropriate healthcare authority or court.

Article 17. Observance of the principle of inviolability of the person in the provision of medical care

Interference with the patient’s private life is not allowed, except in cases when he himself gives his consent, or when such interference can be justified by the need to establish a diagnosis, treat the patient and take care of him.The patient’s right to privacy is realized through: the right to confidentiality of information, the right to anonymity of the examination, the right to confidentiality of correspondence, telephone conversations and other messages in case of being in an inpatient healthcare institution.
The exercise of these rights is not subject to any restrictions other than those established by law and necessary to protect public health and protect the rights of others.
At the request of the patient, his examination can be carried out anonymously.The list of diseases that preclude the anonymity of the patient’s examination is established by the health authorities of the Russian Federation and the constituent entities of the Russian Federation.
Patients’ right to privacy implies that medical intervention can be carried out in the presence of those who provide medical care and patient care, unless the patient decides otherwise regarding the presence of others and if the technology of medical care itself in this particular case allows it.

Article 18. Professional medical secrets

Professional medical secrets (hereinafter referred to as professional secrets) apply not only to information that the patient entrusted to a doctor or other person when receiving medical care or which became known to them in connection with the performance of professional duties, but also to any information about the patient revealed in the process medical intervention. Violation of professional secrecy entails liability in accordance with the legislation of the Russian Federation.
Information constituting a professional secret cannot be provided to persons who do not have access to it.
The patient’s permission for access to his medical information is not required:
for medical workers who directly provide him with medical assistance, or a doctor who is invited to the patient as a consultant;
in cases where it is limited only by data on the patient’s presence in the health care institution and information on his general condition;
in the performance of official duties by health officials who are responsible for the confidentiality of information;
for the bodies of inquiry, investigation, prosecutor’s office and the court upon a written request; in other cases established by the legislation of the Russian Federation.
The healthcare facility management is responsible for maintaining the confidentiality and protection of patient medical information.
It is not allowed to include and use in automated databases without the patient’s permission information of a personalized nature concerning his private life.
It is not allowed to connect automated databases of a personalized nature to networks connecting them with other databases.
Disclosure without the patient’s permission orally or in writing of information about his state of health and other data about him that became known to other persons in the course of providing him with medical care is an infringement on the patient’s privacy, regardless of whether the information disclosed was true or false.

Section V. Consent and refusal to medical intervention

Article 19. Consent to medical intervention

A prerequisite for any medical intervention is the informed informed consent of the patient or his legal representative.
If medical intervention is required for health reasons, and the patient is not able to express his will or if it is impossible to obtain the consent of his legal representative, the intervention may be carried out without obtaining consent under the conditions specified in Article 5 of this Federal Law.
For certain types of medical intervention, the list of which is approved by the health authority of the Russian Federation, the patient must give his written voluntary consent, which is certified by his signature and included in the patient’s medical documentation.
In the process of deciding on consent, the patient has the right to seek advice from any specialist of his choice.
The consent given by the patient can be withdrawn by him before the start of the medical intervention.
It is mandatory to obtain the patient’s informed consent for his participation in the process of clinical education and scientific research.Experiments on people unable to express their will and consent cannot be carried out. In exceptional cases, such studies are carried out in accordance with the legislation of the Russian Federation, when the consent of the legal representative of the patient is obtained and the study is carried out in the interests of the patient.

Article 20. Refusal of medical intervention

Does the patient have the right to refuse medical intervention or stop its implementation, except for the cases specified in Articles 27, 30? 31 of this Federal Law.
Refusal from medical intervention must be voluntary, made out in writing signed by the patient after he receives information about the possible consequences of his decision and is included in the patient’s medical documentation.
In cases where the patient’s legal representative refuses medical intervention that is not of an emergency nature, but is necessary in the interests of the patient, the decision on such intervention is made by the relevant health authority or the court on the proposal of the attending physician or the administration of the health care institution where the patient was recommended the specified medical intervention …

Section VI. Receiving medical care

Article 21. Right to accessible and necessary medical care

Ensuring the availability of necessary medical care is one of the main priorities of state policy, an indicator of its effectiveness and moral orientation.
The patient has the right to receive affordable and necessary medical care.
Local authorities, and in exceptional cases, executive authorities of the constituent entity of the Russian Federation, are obliged to ensure the transportation to health care institutions (medical centers) of those patients who need emergency (specialized) medical care.
Patients are entitled to the necessary medical care, which is provided in accordance with federal medical standards, which include ethical, technological and economic components.
With the organizational and methodological assistance of the federal health authority, the health authorities of the constituent entities of the Russian Federation, by combining efforts and funds, plan and ensure the optimal placement of rare and (or) expensive medical technologies in order to simplify access to them by the population.

Article 22. The right of patients to receive all necessary types and forms of medical care

Patients are guaranteed the right to be provided with all types of medical care, including emergency, primary and specialized, provided in various organizational forms.
The patient has the right to implement the principle of continuity and phasing in the provision of medical care through the interaction and cooperation of medical workers and (or) health care institutions involved in its provision, including diagnosis, treatment and patient care.If the healthcare institution where the patient is located cannot provide him with the necessary medical care, it is obliged, with the patient’s consent, to send him to another healthcare institution that has the ability to provide the necessary medical assistance and has given appropriate consent. All obligations associated with the organization of such a transfer, including a preliminary agreement with the administration and the provision of the move itself, are assumed by the healthcare institution where the patient is located.
The procedure for paying for the travel of patients and their accompanying persons is established by the Government of the Russian Federation.
Patients of children’s inpatient departments and specialized children’s inpatient healthcare institutions are provided with the necessary conditions for games, recreation and educational work.
Children are guaranteed the right to receive emergency and primary medical care, as well as medical and psychological assistance while in preschool, school and other educational and educational institutions.
Diagnostic medical examinations, other medical interventions are carried out with the consent of the child, his parent or a person replacing him, except for the cases established by Article 29 of this Federal Law.
The procedure for the provision of medical and medical and psychological assistance is determined by the federal health authority.
If a child who is ready for discharge from an inpatient health care institution is not taken away without good reason within a month from the date of discharge by his parents or other legal representatives, then the administration of the institution has the right to apply to the court for a decision to transfer the child to a social protection institution.
The administration of the health care institution is obliged to ensure that mothers with children who are unable to return home are transferred to a specialized institution for social protection. The conditions and procedure for the operation of such institutions are determined by the Government of the Russian Federation.

Article 23. The right of patients who are not citizens of the Russian Federation to medical care

Patients who are not citizens of the Russian Federation are guaranteed the right to medical care in the amount stipulated by the medical insurance contract, the registration of which is a prerequisite for obtaining a visa to enter the Russian Federation or other entry documents, unless otherwise provided by interstate agreements.In this case, the insurance period must coincide with the validity of the visa or other entry documents.
Insurance coverage is carried out in accordance with the terms of a health insurance contract concluded with an insurance medical organization.
If a person is sent to the territory of the Russian Federation for a long stay to work for hire or in accordance with a bilateral agreement, the costs of providing him with medical assistance are borne by the receiving party, which is confirmed by a special article in the text of the agreement or labor contract.
The obligations of the receiving party to reimburse the costs of medical care to the persons specified in part three of this article also apply to family members of the mentioned persons living with them on the territory of the Russian Federation.
For persons staying on the territory of the Russian Federation with private trips, a condition for extending a visa is the conclusion of a new medical insurance contract for the next period of stay, unless the reason for the increase in the time of stay is the occurrence of the circumstances mentioned in part three of this article.
Refugees, stateless persons and displaced persons permanently residing in the Russian Federation enjoy all the rights of patients on an equal basis with citizens of the Russian Federation, unless otherwise provided by international treaties.

Article 24. The right to medical care of patients – citizens of the Russian Federation located on the territory of other states

The right to medical care for patients who are citizens of the Russian Federation located on the territory of other states is ensured in accordance with intergovernmental agreements or an agreement on medical insurance, concluded without fail for the purpose of insurance coverage.
Insurance coverage of citizens of the Russian Federation traveling abroad on business trips is provided through the targeted insurance contribution of the authorities, institutions, organizations and enterprises sending them, and those traveling abroad on tourist and private trips, at the expense of a targeted insurance contribution covered from personal funds of the citizen himself or the receiving party.
Insurance coverage of citizens of the Russian Federation traveling abroad, as well as the minimum insurance liability for this category of patients, is established by a health insurance contract concluded with an insurance company.

Article 25. Right to a medical examination

Patients are granted the right to a medical examination, including examination of professional suitability, examination of temporary disability, medical and social, forensic, forensic psychiatric and pathological examination (including examination of biopsy material).
In the event of disputes related to the conduct of a medical examination, patients have the right to apply to the appropriate health authority, executive authority or court.
The conditions and procedure for carrying out all types of examinations, as well as reimbursement of costs for their implementation, are determined by the legislation of the Russian Federation.
Section VII. Obligations of patients and medical measures of a restrictive nature
The rights of patients may not be subject to any restrictions other than those established by the legislation of the Russian Federation, including this Federal Law, and are necessary in the interests of public health, as well as the fundamental rights and freedoms of others.

Article 26. Responsibilities of patients

The patient is obliged:
to show respect and tact in communication with medical workers;
to provide the doctor with all the information necessary for the diagnosis and treatment of the disease;
after giving consent to medical intervention, strictly follow all the prescriptions of the attending physician;
comply with the internal regulations of the health care institution where it is located;
cooperate with a doctor when receiving medical care;
Immediately inform the doctor about the change in his state of health in the process of diagnosis and treatment;
immediately consult a doctor if you suspect or have a disease that poses a danger of mass spread;
Do not take actions that could violate the rights of other patients.

Article 27. Restrictive medical measures

Medical measures of a restrictive nature include measures of a mandatory, involuntary and coercive nature, carried out for medical reasons in accordance with the legislation of the Russian Federation.
A patient may be subject to mandatory or involuntary measures related to the implementation of preventive, diagnostic and therapeutic measures without his consent in the event that his state of health and the interests of protecting the health of others do not allow him to use voluntary forms of organizing medical care for him and (or ) require compulsory medical treatment.
Mandatory measures are permissive, including for those areas where the health factor is one of the determinants, and are implemented in accordance with the legislation of the Russian Federation. These measures do not require a special proactive decision for their implementation and allow the patient to refuse. In case of refusal, the patient is deprived of the opportunity to obtain the necessary permission or admission.
Measures of an involuntary nature are carried out on the basis of a court decision or in another manner provided for by the legislation of the Russian Federation, and do not allow the patient to refuse.
Coercive measures are applied in the manner established by the legislation of the Russian Federation in relation to persons who have committed a socially dangerous act.

Article 28. Preventive measures of a compulsory and involuntary nature

Mandatory preventive measures provide for preventive vaccinations (planned and according to epidemiological indications) in order to prevent the occurrence or spread of infectious diseases.The decision to carry out quarantine measures is taken by an official of the Sanitary and Epidemiological Service or by authorities on the proposal of an official of the Sanitary and Epidemiological Service.
The procedure and conditions for the implementation of preventive measures of a mandatory or non-voluntary nature are determined by the regulatory legal acts of the executive authorities of the Russian Federation and the constituent entities of the Russian Federation.

Article 29. Mandatory diagnostic measures

Diagnostic measures of a mandatory nature include:
a) mandatory preliminary examination;
b) compulsory professional examination;
c) medical examination of professional suitability.
Mandatory preliminary examination is carried out in order to issue a permit or admission in the circumstances provided for by law, where the health factor is one of the determining factors and associated with the need to protect the health of the patient himself or other citizens.
Mandatory professional examination is carried out in a planned, regular manner in relation to persons entering work or employed in such types of work, where the health factor is one of the determining ones, and is carried out in the interests of protecting the health of the patient himself and other persons.
The list of types of labor activity, where the health factor is one of the determining ones, is established by the Government of the Russian Federation.
Examination of professional suitability is carried out in the case when it is required to decide the question of the patient’s ability to perform work in a special category for health reasons, where the health factor is one of the determining factors.

Article 30. Involuntary diagnostic measures

Involuntary diagnostic measures include involuntary examination, including for sanitary and epidemiological indications, without the consent of the patient.
Involuntary examination for sanitary and epidemiological indications is carried out in relation to persons who have been in contact with infectious patients and have not given consent to participate in quarantine measures, convicts sent to places of imprisonment, persons belonging to the risk group for the spread of sexually transmitted diseases in in relation to persons involved in the commission of road traffic accidents and other emergencies, as well as among certain categories of workers whose activities involve a risk to the life and health of the population, causing harm to the environment, and significant damage to state interests.
The decision on an involuntary examination for sanitary and epidemiological indications is made by a specialist doctor, an official of the state sanitary and epidemiological service.
The conditions and procedure for involuntary examination for sanitary and epidemiological indications are determined by the legislation of the Russian Federation, regulatory legal acts of the executive authorities of the Russian Federation and the constituent entities of the Russian Federation.
The decision on involuntary certification in road traffic accidents is made by an employee of the internal affairs bodies responsible for the investigation and in accordance with the regulatory legal acts of the executive authorities of the Russian Federation.
The decision to involuntarily conduct an examination of certain categories of workers in accordance with paragraph 2 of this article is made by an official in accordance with the procedure and rules for this type of examination developed and approved by the Government of the Russian Federation.

Article 31. Medical measures of a compulsory nature; involuntary hospitalization

Mandatory medical measures provide for the establishment of a mandatory dispensary observation for the patient.It involves monitoring the health of patients through regular examinations by a specialist doctor and providing the patient with the necessary medical care and related services in a timely manner.
The list of diseases requiring compulsory dispensary observation is determined by the federal health authority.
The decision to establish compulsory dispensary observation is made by a specialist doctor, an official of a health authority, a commission of doctors.
The conditions and procedure for compulsory dispensary observation are determined by the regulatory legal acts of the executive authorities of the Russian Federation.
Treatment of an involuntary nature includes involuntary hospitalization.
Involuntary hospitalization is allowed in the presence of infectious diseases that pose a danger of mass spread.
In relation to patients with sexually transmitted diseases and leading an antisocial lifestyle that poses a threat to the life and health of other people, a decision on involuntary hospitalization may be made by a court on the basis of a reasoned opinion and submission to the court by a commission of medical specialists of a territorial or higher health authority under obligatory participation in the work of the commission of a representative of the internal affairs bodies.
The conditions and procedure for involuntary hospitalization, its extension and patient discharge are determined by the legislation of the Russian Federation, regulatory legal acts of the executive authorities of the Russian Federation.
A patient hospitalized without his consent has the right to treatment, care and conditions of stay similar to those provided for patients hospitalized voluntarily.
Treatment of a patient who is not voluntarily hospitalized can be carried out without his consent only on the basis of a decision of a commission of specialist doctors, with the exception of urgent cases.
The patient’s stay in an inpatient health care facility without his consent continues until the grounds for hospitalization have disappeared.
Involuntary hospitalization may be terminated by a decision of the attending physician, a commission of doctors or a court, which is accepted either on their own initiative, or on the basis of a patient’s request or the petition of any other interested person.
Termination of involuntary hospitalization does not necessarily mean the end of treatment, which can be continued on a voluntary basis if the patient agrees to do so.

Section VIII. Responsibility for violations of the rights and obligations of patients

Article 32. Guarantees for the protection of patients’ rights

Protection of patients ‘rights is carried out by the administration of health care institutions, commissions for the protection of patients’ rights under health authorities, public organizations, including associations of patients and (or) their families, ethical committees (commissions), which operate within the limits established by their statutes.
In case of violation of their rights, the patient or his legal representative may turn to the health authorities, to the court, to the Ombudsman for human rights in a constituent entity of the Russian Federation, to the Ombudsman for human rights in the Russian Federation.
The procedure for appealing against unlawful acts against patients is established by the legislation of the Russian Federation.

Article 33. Commissions for the Protection of Patients’ Rights

Commissions for the protection of patients’ rights are created under the health authorities and deal with all issues related to the observance and implementation of these rights.Under the federal health authority, there is a Federal Commission for the Protection of Patients ‘Rights, which, among other things, resolves conflict issues arising at the level of the constituent entities of the Russian Federation in the field of patients’ rights.
Commissions for the protection of patients’ rights:
check the validity of complaints and appeals from patients related to violation of their rights;
apply to the licensing commission for the suspension or revocation of the license for medical and pharmaceutical activities of persons who have committed unlawful acts against patients;
send materials of verification to the prosecutor’s office if there is evidence of a crime in the actions of medical and pharmaceutical workers;
file a claim with the court on all facts of illegal actions requiring its decision;
apply to the licensing commission to suspend the license for medical and pharmaceutical activities for advertisers who carry out illegal (prohibited) advertising.
The procedure for the creation and operation of the Federal Commission for the Protection of Patients’ Rights is determined by the regulations on it, approved by the Government of the Russian Federation.

Article 34. Responsibility for violation of patient’s rights

Persons guilty of violating the patient’s rights defined by this Federal Law shall be held liable in the cases and in the manner provided for by the civil, administrative or criminal legislation of the Russian Federation.
The harm caused to the health of patients as a result of violation of their rights is subject to compensation in the manner prescribed by the civil legislation of the Russian Federation.
The fact of unlawful actions against patients that resulted in harm to their health may be recognized as a result of pre-trial proceedings with the participation of the Commissions for the Protection of Patients ‘Rights, representatives of public organizations for the protection of patients’ rights and professional medical associations, insurance organizations and / or in court okay.
The conditions and procedure for insurance of civil liability for harm caused to the patient’s health, as well as the procedure for payment of compensation, are determined by the legislation of the Russian Federation.

Article 35. State and public control over the observance of the patient’s rights and ensuring his safety

State and public control over the observance of the patient’s rights and ensuring his safety is carried out by health authorities, commissions operating under them for the protection of patients’ rights, as well as other ministries and departments within their competence in accordance with the legislation of the Russian Federation.Public control over the observance of patients’ rights can be carried out by associations of medical (pharmaceutical) workers, associations of patients or their family members, other public associations within the limits established by the legislation of the Russian Federation.
Supervision over compliance with the rule of law while ensuring the rights and safety of patients is carried out by the Prosecutor General of the Russian Federation, prosecutors of the constituent entities of the Russian Federation and prosecutors subordinate to them.

Section IX.Final clauses

Article 36. Procedure for the entry into force of this Federal Law

This Federal Law shall enter into force from the date of its official publication.
Laws and other normative legal acts of the Russian Federation, as well as laws and other normative acts of the constituent entities of the Russian Federation, agreements concluded by the state authorities of the Russian Federation with the state authorities of the constituent entities of the Russian Federation that were in force on the territory of the Russian Federation before the entry into force of this Federal Law, are applied in the part that does not contradict this Federal Law.
Propose to the President of the Russian Federation to instruct the Government of the Russian Federation, state authorities of the constituent entities of the Russian Federation, within three months from the date of the official publication of this Federal Law, to bring their legal acts into conformity with this Federal Law.
The Government of the Russian Federation, within three months, to submit to the State Duma proposals on introducing amendments and additions to previously adopted federal laws in accordance with this Federal Law and on establishing (strengthening) responsibility for violation of this law.90,011 90,000 The right to die. When will euthanasia be allowed in Ukraine and what does the money have to do with it

In 2019, in Kiev, a woman with cancer threw herself out of the window of a high-rise building in front of her son. Before that, she had repeatedly said that she was suffering from severe pain and wanted to end it. Now only about ten countries of the world are allowed to legally deprive a person of his life when he or his guardians asks about it. Euthanasia is prohibited in Ukraine. Together with a lawyer and a doctor of philosophy, Zaborona tells why euthanasia and assisted suicide provoke discussions, and whether it is worth waiting for the legalization of these practices in Ukraine.

What is euthanasia and assisted suicide?

Euthanasia is one of the ways to deprive a terminally ill person of life when he asks for it. There are three ways in total that allow a person to die early. These are euthanasia, orthanasia and suicide, assisted by a doctor. As a rule, the main condition for them is an incurable disease that causes suffering to a person.

Orthanasia is when a doctor takes the life of a patient at the request of his legal guardians, authorized persons, parents or the court.Usually they resort to it when a person is in an irreversible coma, and special devices support his life. This also applies when a baby is born without a brain. In the case of orthanasia, it does not matter whether a person is suffering physically or mentally, because often it is simply impossible to confirm or deny this, given the patient’s condition.

Physician-assisted suicide is the most common voluntary death practice. A medical specialist only gives the patient a lethal drug or writes out a prescription for it – that is, he does not decide the fate of a person in his place and does not take his life with his own hands.But euthanasia provides that the doctor himself makes a lethal injection. Assisted suicide is legalized in more countries precisely because the doctor takes minimal part in interrupting life, says attorney Yana Trineva.

Euthanasia and assisted suicide is considered a way to prevent uncontrolled suicide. When a person does not receive proper pain relief and realizes that such a condition is with him for the rest of his life, he can commit suicide on his own.But these are not always painless methods, and their consequence is not always death. An unsuccessful suicide can lead to disability.

Scientist David Goodall traveled from Australia to Switzerland to end his life there of his own free will in 104

Who in the world has the right to such methods of interrupting life?

Only a terminally ill person. “Incurable” means that the disease progresses and after six months the patient will die from it. This fact is established and recorded in the patient’s card by a council of doctors.Another condition is the unquenchable physical or mental suffering of the patient or their complex.

The patient must tell the doctor himself that he wants to die and chooses assisted suicide or euthanasia. He has a month to make a final decision. During this time, the doctor twice (or more – depending on the legislation) invites the patient to refuse the procedure in writing. And he must confirm twice in writing that he still seeks to resort to one of the methods. The doctor is obliged to tell how the disease will develop, how the drug that the patient wants to take works, and talk about the possible consequences – for example, the remedy may not work corny.If within a month the patient does not change his mind, he receives the desired drug. In the case of euthanasia, the lethal drug is administered by a doctor in a medical facility. If it is an assisted suicide, the patient can take the drug either in the presence of a doctor or at home.

European Parliament meeting on euthanasia, Strasbourg, 2001

Where is euthanasia and other similar practices legalized?

Practice euthanasia, orthanasia or assisted suicide in Denmark, Belgium, Spain, New Zealand, France, more than 20 American states, Australia, Switzerland and the Netherlands.

For the first time, the English scientist Francis Bacon spoke about euthanasia in medicine in the 16th century. He said that the goal of a doctor is not only to heal, but also to stop the suffering that illness causes the patient, when there is no longer any hope of salvation.

Psychologist Ana Estrada has been suffering from incurable and progressive polio since she was 12 years old. In 2021, the court ordered the government to respect her wish to die.

However, methods that take a person’s life began to be applied only in the 20th century.Switzerland has had a law since 1942 that permits physician-assisted suicide. At the same time, a public organization was created there, which helps to implement this procedure. Its cost today is from 6 to 10 thousand euros. The price depends on the range of services: how many people will arrive, in what conditions the patient will live, what the funeral will be like. By the way, Switzerland is the only country in the world where assisted suicide is also carried out for foreign citizens.

In the United States, California passed law on the human right to a dignified death in the 1970s, Trineva says.But it lasted only three months: the document did not spell out guarantees of protection for medical workers who helped patients die. Therefore, doctors were expelled from trade unions and fired, because their actions were considered immoral. The next state to decide to legalize assisted suicide was Oregon in 1994. This time, the authorities stipulated that such patient care is a right, not a duty of a doctor. And he can refuse the procedure, but then he must recommend another specialist.It was forbidden to fire a doctor for helping to end his life. Today, more than 20 states in America allow assisted suicide, and some also allow euthanasia.

The Netherlands is the most advanced country in the area of ​​voluntary deprivation of life. All forms of voluntary withdrawal from life are available there. In addition, here a person from 12 years old can ask for it. In other states, only adults have this right. The Netherlands is the only country in the world where not only a terminally ill person can commit assisted suicide.Depressed people are also allowed to leave this life.

In New Zealand last year the decision to legalize euthanasia and assisted suicide was made in a national referendum. More than 66% voted in favor. Supporters called the results of the referendum “a victory of kindness and compassion.” And opponents went out to protests with slogans in which they called on the authorities to help live, not die.

Protest against the End of Life Choice referendum, New Zealand, 2019

And in Spain, where euthanasia and assisted suicide have been available since March 2021, the right-wing populist Vox party has said it will appeal the parliamentary decision to the Constitutional Court.

Demonstration against the law on euthanasia, Spain, 2021

Is euthanasia or assisted suicide available in Ukraine?

No, they are prohibited. Therefore, any attempt to help a person die, even if he asks for it, will be regarded as murder. In October 2019, at that time, still a deputy from the Servant of the People faction, Geo Leros, announced that he was planning to introduce a bill that would legalize euthanasia. He did not disclose the details of the bill, and the document has not yet been registered in the Rada.

At the beginning of 2021, First Deputy Chairman of the Verkhovna Rada Ruslan Stefanchuk spoke about the legalization of euthanasia and assisted suicide. However, again, the matter did not go beyond talk.

Lawyer Yana Trineva wrote her own bill back in 2008. Since then, she has submitted it to parliament three times, but it has never been considered. According to the lawyer, one of the reasons is that Ukraine, like the rest of the post-Soviet space, remains hostage to the idea that euthanasia or assisted suicide violates the norms of public morality.Although, she says, this is not the case, especially given the level of palliative care in Ukraine.

• Yana Trineva

According to the Ministry of Health of Ukraine, 1.5 million patients need palliative care every year. For example, in the last stages of oncology, ordinary painkillers no longer help a person. Not all doctors decide to prescribe morphine, because there is criminal liability for his leave without proper reason. And not all pharmacies have a license to sell it.Sometimes only three or four pharmacies work in the entire region, where such a drug can be bought, so it is simply not enough for all patients. Because of this, a person simply has to suffer from pain.

Isn’t it ethical to take someone’s life and suicide is not a sin?

There is currently no consensus in the world as to how ethical it is to take a person’s life at his request. From the point of view of philosophy, this is a question about the meaning of human life, its value and significance, says Doctor of Philosophy Tatiana Gardashuk.

“Camus [French writer and philosopher of the 20th century] wrote in The Stranger: no one chooses the time of their arrival in this world, so they can at least decide when to leave this world. But this is a general phrase and it must be perceived through a person’s personal history, explains Gardashuk. – It is one thing when a person wants to leave life, because he does not see what to do with himself in it and believes that he has completed his mission. The other is when we talk about assisted suicide or euthanasia.This is not about a person’s spontaneous desire to say goodbye to life. It is about physical and mental suffering from illness. A person suffers from pain, sometimes also from the fact that he hurts his loved ones, who invest in him care, time, money. ”

• Tatiana Gardashuk

In the 20th century, they began to talk about allowing the deprivation of a patient’s life when he asks for it. And this is due, in particular, to the fact that the value of human life has increased, there has been a reassessment of the criteria for its quality.After all, today a person lives not just as a biological being: he is able to fill his life with the meanings that he wants.

Euthanasia advocates in Perth, Australia, 2019

Religion generally disapproves of euthanasia, much less assisted suicide. The Catholic Church appeals to the authority of God and the concept of the sanctity of human life, explains Gardashuk. According to religious dogmas, a person should deserve an easy death with his life. And the suffering he has to endure is either the reckoning for sins, or the prerequisite for eternal life after physical death.

Protest against the decriminalization of euthanasia in front of parliament in Lisbon, 2020

The institution of the church may have its own position regarding euthanasia and other methods of deprivation of life, but this should in no way affect the adoption of a law that legalizes such practices, says attorney Trineva. Indeed, according to the Constitution, the church in Ukraine is separated from the state.

In addition to moral and ethical issues, the economic factor should also be taken into account, Gardashuk said.After all, there are situations in which individual families simply cannot afford to support a terminally ill person. A drug that can instantly interrupt life costs about a thousand hryvnias, and palliative care costs tens and even hundreds of thousands of hryvnias. This argument “against” is used by opponents of euthanasia or assisted suicide. They believe that in this way it will be easier to get rid of “uncomfortable” patients, because it is cheaper and faster. To prevent this from happening, you need to spell out the law in detail and provide for liability for such actions, says Trineva.And also – to improve the quality of palliative care and make it accessible to everyone, so that a person really has a choice: to go through life to the end with the support of medications or leave it earlier.

There is no consensus on whether euthanasia, assisted suicide and orthanasia are needed. And the decision on their legalization should be made by officials, having previously learned the opinion of the population. According to Trineva, before making such a decision, the authorities should conduct an information campaign to explain to people what these practices are in principle.

90,000 How to let go of a person if the relationship is not joyful

Parting with loved ones is always difficult. How to survive a traumatic situation, tell the psychologists of family centers, who are ready to help people overcome various periods of crisis. By contacting the specialists at My Family Center, you will receive comprehensive psychological assistance – individual or family consultations, you will be able to participate in interactive group sessions in order to see the situation from a different angle in a supportive environment and get a resource for overcoming life’s difficulties.

Difficulties of separation

Entering into a relationship, a person consciously or unconsciously seeks to realize his basic need for love. But everyone’s understanding of love is very different, our expectations are not always justified and coincide with the vision of a partner.

“When the feeling of dissatisfaction becomes constant, and the joy of the relationship is decreasing, it makes sense to think about whether this relationship has a future and whether it is worth keeping it. Of course, everything here is very individual, and before making a decision, it is important to be honest with yourself and your partner.Most often it happens that in the depths of the soul the decision has already matured, but there is not enough psychological strength to implement it. A person still hopes for something, is a prisoner of self-deception, has fears of the future or is not ready to take responsibility for his life “, says Svetlana Timchenko, a psychologist at the Vostochnoye Degunino Family Center .

The main difficulty in parting lies in the emotional attachment to the partner, and it is sometimes much stronger than the arguments of reason. Sometimes, physically apart, people cannot psychologically “take” themselves out of the relationship.This can take years.

“The fact is that our ego often plays a cruel joke with us. Even at the stage of falling in love, when everything is good, it automatically, unconsciously tries to appropriate not only the joy from the relationship, but also the person who gives it to us. And then, when the natural difficulties of development in a couple arise and our expectations from a partner are not met, there is a feeling of disappointment and loss. The main pain arises not even from the actions of the partner and his “imperfection”, but from the collapse of our illusion of expectations from him “, – the psychologist notes.

What is relationship for us

We invest in relationships mentally, psychologically, physically, and financially, and also spend precious time with another person. This is akin to an investment, and we unconsciously expect to receive dividends in the future in the form of stability, security, and loyalty. The partner owes us, as it were, and if this does not happen and he does not pay the bills, then the ego feels robbed.

Two paths of healthy coping with a crisis of relations

1. If a couple has the potential for development, then through an open dialogue, partners will be able to clarify their goals, shared values ​​and decide to stay together.
2. If the inevitability of parting is obvious, then experiencing the pain of loss, letting go of the person and taking yourself out of the relationship is possible only by changing your perception and stopping to look at the relationship from the position of obligation.

How can this be done?

Step 1 . First of all, to accept and live the whole range of feelings that will inevitably cover, since the acceptance of a new reality will require considerable mental strength and time. Here you will be helped by a healthy supportive environment (close people, psychological support groups, individual consultations with a psychologist).Allow yourself to accept help from others, as how you deal with the trauma will affect your emotional well-being in future relationships.

Step 2 . After the first wave of feelings, believe and admit the thought that there is still a lot of interesting and pleasant things ahead in life. Your ability to experience happiness should not depend on anyone, no one is responsible for how much you are able to extract positive emotions from various events.

Step 3 .Turn towards personal interests, remember if you have forgotten what you used to love, what attracted attention and from what you received positive emotions. Each of us has great potential and extraordinary abilities. Maybe it’s time to make your old dream come true? We live in a time when a lot is possible. You can choose the image of a hero that is close to you as an internal support, who would serve as a motivating force.

If you can’t find your bearings in your area of ​​interest right away, just switch.Bring variety to life, try different :

• Sports, any physical activity will help release the energy of tension. The body is our very grateful friend.
• Creativity will fill with positive energy and inspiration, develop imagination, switch from destructive thoughts.
• Consider changing the exterior or updating the interior.

It is important to work with your self-esteem, it often falls when parting, since depreciation is a common strategy of behavior between former partners.

Try to communicate more with positive people who prove by personal example that there is happiness, learn from them the ability to overcome difficulties and find reasons for joy.

Appreciate what you have, be attentive to even the smallest things, make a habit of counting 10 pleasant moments at the end of the day.

It is very important to take time for yourself and remember that the most important person in life is YOU, without you nothing will happen.

Key point at parting

This is gratitude.No matter what happens, no matter how painful your partner may cause you, it is very important to abandon the position of resentment and find the best and most valuable for you, for which you can thank him. After all, every person we meet on our way is a teacher through whom we gain invaluable experience, develop and grow as a person. If you still can’t thank the person, then all that remains is to thank the situation itself and learn from it.

“Meeting and parting is a part of our life. If you do not try to appropriate and forcibly keep something, then it turns out that there are simply no losses, but there is an invaluable time to realize your potential.Take care of yourself and you will simply have no time to suffer ”, sums up Svetlana Timchenko .

Source

Press service of the Department of Labor and Social Protection of the Population of the City of Moscow

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