MOSCOW, October 29. /TASS/. Is it right to resort to compulsion to cure a sick person? It depends, say some Russian legislators. Communist State Duma member Alexander Kravets is going to initiate a legal act which, if adopted, will empower medics to send tuberculosis patients who refuse to receive medical aid to hospitals for compulsory treatment without waiting for a court ruling.
Currently anyone who has tuberculosis, once he or she gets into a specialized health medical centre, is free to refuse from treatment in writing. If the medics find a particular case a threat to society, medics may appeal to a court of law, which may eventually order compulsory treatment. However, before such a court ruling the sick person’s freedom of movement is not limited, and it may take judges several months to pronounce a verdict.
Kravets, whose initiative will be discussed at the forthcoming meeting of the State Duma’s health protection committee, says the current tuberculosis rates just leave no other choice. “On the excuse of human rights protection people infected with the tubercle bacillus are free to go wherever they want without any medical supervision,” the daily Izvestia quotes Kravets as saying. “The disease is to be fought as firmly as leprosy and with the same methods.”
Russia’s chief phthisiatrician, Pyotr Yablonsky, back last year came out with a proposal for establishing criminal punishment for refusal to be treated for tuberculosis as deliberate spread of the disease. In his opinion, court verdicts ordering mandatory treatment are ineffective — even after being sent for mandatory treatment patients often leave before long and nobody stops them.
The chief of the therapy department at the Central Tuberculosis Research Institute under the Russian Academy of Medical Science, Igor Stepanian, has said that around the world there are quite a few examples of far harsher attitude to compulsory treatment for tuberculosis.
“The theme of mandatory treatment has been discussed a great deal, but this has yielded no results, while in other countries, for instance, in Israel, the rules are very harsh. The patient who has refused to be treated is taken to a prison hospital within 24 hours on the basis of a court order.
Russia’s tuberculosis-related mortality rate has been declining in Russia over years, but experts are warning there are no reasons for complacency, because cases of drug-resistant TB are ever more frequent. According to the Central Research Institute for Health Service Organization and Computerization, Russia at the end of 2013 had 211,900 TB patients, including multi-drug-resistant 34,778 ones.
“According to official statistics, there is no TB epidemic in Russia yet, but the rate of the disease is high,” the chief of the tuberculosis diagnostics department at a children’s hospital in St. Petersburg, Olga Noskova, has told the news portal Miloserdiye (Charity). “In the Far East and the Far North it is far higher than, say, in Moscow or St. Petersburg.”
As for the worsening of the situation following the breakup of the Soviet Union, the expert believes the epidemic problems are rooted in a number of causes that emerged in the 1990s. “This applies to the reorganization of the entire health service, including phthisiatric children’s service, migration processes, characteristic of not only Russia but of the entire world. Cases of family tuberculosis occur not only among labour migrants, but also in asocial, problems families.”
Noskova is certain that the struggle against the disease requires addressing social problems first and foremost. The living standards are to be raised, migrants systematically examined and effective measures taken to treat drug addicts and habitual drinkers. Tuberculosis will then retreat.