The scandal at the Saint Pantelimon Hospital could be the launching pad for a project to regulate the situation of terminally ill patients admitted to intensive care units. Minister Alexandru Rafila proposes that these patients can be moved from the ATI to the palliative care compartments within the state medical units, where they can continue their treatment.
Many terminally ill patients await their end in hospital ICUs. Archive
“Acceptance of this interruption of treatment at ATI and its continuation in palliation does not exist at the moment, because no one over time has reached the point of social acceptance of this. My opinion as a doctor is that we need to have this debate. I challenge it as Minister of Health”the official said. Professional societies, patient organizations and the Church should participate in the discussions, says the minister. “It is good for the Church to be part of this discussion, precisely to avoid the public interpretations that will appear related to such a situation, to understand that we are talking about a patient who no longer has the resources to recover and we are not discussing euthanasia “, Alexandru Rafila wanted to specify. The debate could most likely take place at the beginning of September, and the conclusions will be the basis of a future law in this regard. “We need examples of good practice from other countries. We requested international audit. I did not receive a written response, but the colleagues from the Romanian Society of Intensive Therapy contacted the European society, which has a section dealing with therapy and ethics”Alexandru Rafila also said.
“At the moment, in Romania there is no regulation regarding palliative care. A circuit is not set up. Where should these people end up, what are the appropriate steps. There are no logistics in terms of palliative wards or centers where we can provide care for these people for whom medicine can no longer do anything”, stated for Adevărul Radu Gănescu, the president of the Association of Chronic Patients.
And one more aspect, it attracts attention. “There is also a matter of mentality here, namely the desire, justified, by the way, of the relatives to prolong the life of their loved ones as much as possible. Even if, medically speaking, nothing can be done for them. What we need to understand, however, is the fact that that person really cannot be helped anymore and must be transferred from the ATI and the vacated bed be occupied by another patient who, perhaps, really has a real chance to survive”.
Practically, says Radu Gănescu, if a terminally ill patient should be moved from ATI to a palliative care center, the family should understand this and agree to the transfer. Which doesn’t really happen: “Outside legislation, in addition to existing, is also very clear from this point of view. In our country, for example, there is no law that allows the relatives to decide to disconnect the patient from the devices. This right should exist, and whoever wants to use it”.
The President of the Association of Chronic Patients believes that the proposal of the Minister of Health is a very good one, but there is still a long way to go: “In order for this proposal to materialize, we need, first of all, a very well-developed legislation, thought out in detail by experts and specialists.” Because some hiccups of the system must be taken into account. “Not all hospitals in Romania have palliative care departments, and where they exist, they have very few beds. Here is a first problem that should, in turn, be solved”.
“We only have 5 beds and we cannot receive patients connected to machines”
Indeed, hospitals that have a palliative care department cannot at the moment receive a very large number of patients who would come from ATI, many of them intubated or connected to machines. At the Neuropsychiatry hospital in Craiova, for example, where there is such a ward, there are only 5 allocated beds. “We are the only state hospital in the whole county that has such a ward, such a compartment. Serving staff are certified in palliative care. I mean doctors and nurses. They have courses in the field”completed the idea of Dr. Mădălina Lepădat, the manager of the medical unit. But, continues the doctor, in this compartment are hospitalized people with a certain pathology, not everyone can come here. “Almost 80% of the patients are patients with neurological conditions, who were treated in our hospital. They can also come from outside with oncological, cardiovascular diseases or chronic insufficiency of various organs. However, these people benefit from simple, basic, minimal operations and maneuvers: infusions, tube placement, suction, pressure ulcer prophylaxis, massage, physical therapy. There is no question of being able to receive intubated patients or connected to other machines. We don’t have the equipment to maintain the vital functions of an intubated patient”, the manager stated for Adevărul.
The palliative care section of the Neuropsychiatry Hospital in Craiova does not, therefore, have the capacity to receive more than five terminally ill patients. “And we can’t expand even if we wanted to, because this compartment is within a neurological recovery ward. The rest of the beds belong to the recovery ward. It is a structure approved by the Ministry of Health. Basically, we would have nowhere to “accommodate” these people. The number of beds is set nationally, at the level of each hospital. We will have neither where nor how to bring in additional beds. We would be breaking the law.”
Then, says the manager of the Neuropsychiatry Hospital in Craiova, there is also the issue of staff that should be supplemented. “However, I am convinced that things will be discussed, analyzed, a solution will be found”Dr. Mădălina Lepădat also declared.
Radu Gănescu also mentioned the lack of medical personnel that should be supplemented. “Specialized medical personnel, human resources, but also financial resources must be allocated. These centers will have to be supported financially, because the care of a terminally ill patient involves high costs”.
An idea proposed by Minister Rafil would be for these centers to operate in emergency rooms and be an extension of the intensive care units.
Where state palliative care centers could operate
However, Radu Gănescu believes that these palliative care centers could exist in emergency hospitals, county ones, but not only. “Palliative care centers could also operate in smaller, urban hospitals, if there are empty beds there or there is limited functionality of the ambulatory system. It could also work in public nursing homes. We should not start now to build such medical facilities from scratch, but to transform the ones we already have. Of course, where this possibility exists”.
Annually, in Romania, almost 200,000 sick people reach the terminal stage. In the absence of specialized centers, patients remain hospitalized in intensive care units of hospitals, which are often overcrowded.
