Hospital neglect
Russian cancer patients are denied access to quality care.Bhopal.org

Russian media recently reported that at least eight cancer patients in Moscow had committed suicide over the previous two weeks. Two shot themselves, two hanged themselves, two jumped off buildings, one cut his throat, and one stabbed himself. The news accounts don't say why they did it, but these deaths follow the widely reported suicide of a retired navy admiral, also a cancer patient, in early February.

Shockingly, Moscow's deputy mayor, Leonid Pechatnikov, nonchalantly dismissed these human tragedies as the result of an "aggravation of psychiatric disorders" caused by the spring. He said: "The fact that this eruption of suicides happens at this time, against the background of an early turbulent spring, is not surprising. People don't want to torment themselves or those close to them. This is their form of euthanasia."

What Pechatnikov omits from consideration is that the inhumane way Russia's public healthcare system treats most people with advanced cancer drives patients and their families to desperation. Research by Human Rights Watch found that when cancer patients become incurable, oncologists tend to just send them home, saying there is "nothing we can do for you anymore." Patients are referred to their local clinic for pain treatment but that is it.

At the end of life, people with cancer have numerous health needs. They are likely to develop pain and may experience breathlessness, anxiety and depression. These symptoms can generally be controlled well, including at home, but not without adequate professional support. Our research found that kind of support almost completely lacking in Russia. Numerous relatives of cancer patients told us they felt completely lost and abandoned when sent home. They suddenly had to care for a dying loved-one but the healthcare system had not bothered to prepare them for what was to come, or offered them real help in managing the process.

Treatment for strong pain—very common in people with cancer—is particularly problematic. Russian laws around morphine are far more restrictive than required under the international drug control conventions or recommended by the World Health Organization (WHO) and International Narcotics Control Board.

Multiple people must sign off on every prescription for these medicines; you can only get a limited supply per prescription; and very few pharmacies stock the medications. According to WHO, morphine is absolutely necessary for the treatment of cancer pain and should be available to any patient with a medical need for it.

Problems obtaining pain medicines appear to have played an important role in several of the suicides in Moscow. Vyacheslav Apanasenko, the retired admiral who shot himself on 10 February, left a suicide note saying: "I ask not to blame anyone except for the Health Ministry and the government." His family had been unable to get the final signature on a prescription for a strong pain killer on the day of the suicide. Major-General Boris Saplin, who shot himself on March 18, left a note saying he was "tired of living in agony."

People afflicted with cancer in Russia have a right to live without the indignity of treatable pain and other physical or psychological symptoms. Instead of callously dismissing these suicides as part of the spring season, the government needs to ensure it offers high quality palliative care services to people who need it so that their psychological and physical distress are controlled properly. In that case, these patients would not have to invent "their form of euthanasia."

Diederik Lohman is a senior health researcher at Human Rights Watch. You can visit the HRWuman Rights Watch website to find out more about the group's activities in all spheres of human rights.