Resuscitation problems
Is it possible to refuse resuscitation in Russia: expert's explanation
Sofya Khromova, "Doctor Peter"
Euthanasia is prohibited in Russia – this is a well-known fact. As for resuscitation measures, questions already arise here: how should doctors act if the patient is categorically against it? Do doctors listen to relatives? What do they do in critical situations? For answers, "Dr. Peter" turned to the resuscitator Sergey Sayapin.
"Unlike most countries of the civilized world in our country, unfortunately, it is impossible to refuse resuscitation measures. Although many resuscitators would be happy to get a tattoo with the words "do not intubate do not reanimate" (Eng. "do not resuscitate, do not pump out"). I wouldn't refuse such a thing either," says the resuscitator.
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A tattoo with such a phrase was very popular for a while, both doctors and patients stuffed it for themselves. They beat her on the chest so that a resuscitator could see her. Such a tattoo was most often found in the USA. Both doctors and patients, finding themselves in a critical situation, were very afraid of one thing: after resuscitation, they would remain disabled, stop walking, talking, thinking. Such a tattoo was supposed to say: "Do not save, this is my choice, and I have made it for a long time."
– The patient is brought in critical condition, he urgently needs surgery, but he is conscious and shouts that he refuses. How do doctors act in such a situation?
– The situation is as follows: first, I will voice the answer, as they say, de jure (which means "legally" - ed.): a person has the right to refuse medical care, this is provided for by federal law. But he must take into account all the subtleties and consequences. This is de jure. De facto ("in fact"): if suddenly a person signs such a paper, and then dies, the prosecutor and the investigative committee will absolutely not care what he signed there. The doctor will be to blame, because he did not explain that the refusal will end in a fatal outcome – the position of the organs will be like this. A de facto consultation is being held, which determines that the patient needs intervention and then it is carried out. Most likely, the patient is in such a situation and is not aware of his own actions.
– And if relatives come when the patient is unconscious and demand not to be touched, what then?
– In accordance with the same law No. 323-FZ "On the basics of protecting the health of citizens in the Russian Federation", the opinion of relatives is not taken into account in any way and never. Doctors decide everything. Previously, before the adoption of this law (this happened in 2011), doctors could still consult with relatives, some such old-school doctors, if anything. For example, a patient needed an urgent hip amputation, they told them something there… Not now. It's not that they don't want to ask – they have no right to ask.
– When a patient is in a state that his brain has already died, such scenes are very fond of being filmed in dramas. In the series, we see how doctors consult with relatives, talk about turning off the device… What do doctors actually do?
– There is such a Decree of the Government of the Russian Federation No. 950 dated September 20, 2012 ("On approval of the Rules for determining the moment of death of a person, including the criteria and procedure for determining the death of a person, the rules for stopping resuscitation measures and the form of the protocol for determining the death of a person"). One of the points says that resuscitation measures are stopped when a person is pronounced dead on the basis of brain death. But! Such a diagnosis is not made by one doctor, at least 3 specialists or even a consultation are needed, this takes at least 6 hours. This is a very complicated procedure, you can't just make such a diagnosis. And relatives never have anything to do with it either. The only thing that can affect the diagnosis is the potential participation of an already deceased person in organ donation. And here the opinion of relatives can be important.
– Personally, what do you think: is it right to consult with relatives or should doctors decide everything?
– I think it's wrong to connect relatives. I believe that either the patient or a consultation of doctors has the right to decide about his condition, his life. Everything. Relatives should be out of business, because they may have their own interests. In general, I am in favor of a person being able to decide for himself whether to carry out resuscitation measures for him or not. There is no such choice now.
This topic is also often discussed on the Internet. Doctors from the forum rusmedserv.com they commented on questions about the failure of resuscitation as follows:
"As far as I remember, resuscitation measures are not carried out if there are signs of a corpse, if there is a pathological condition incompatible with life, and also if resuscitation measures are ineffective for 30 minutes. Voluntary refusal of resuscitation is not registered there, which means it is not taken into account," commented Dr. Makhotin.
"Having been tempted to refuse resuscitation measures in the presence of at least a hundred notarized or patient's refusals written in the patient's blood on stamped paper, the doctor more than really risks becoming accused and then convicted of intentionally causing death ("murder"). Euthanasia (and this is exactly it) is prohibited by law and is punished accordingly," wrote the user exp.
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