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. Last Updated: 07/27/2016

Doctors Keep Patients in the Dark




After more than two years of suffering, Zhanna Cherkashenko died last September at 51 without knowing what was wrong with her. Her doctors wouldn't tell her.


Cherkashenko's doctors had diagnosed her cancer. But by telling her, they would have violated a pillar of Soviet-era medical ethics: Never tell patients they are dying.


The standards of Russian medical ethics still forbid doctors to inform patients if they are terminally ill - making doctors themselves the arbiters of fate.


In Cherkashenko's case, she was told only that she was suffering from "female problems," and tried various remedies to cure herself as a result. Although she had been in and out of several hospitals and even underwent surgery, she was never told her diagnosis.


Doctors say withholding medical information is the only way to maintain hope in Russia's rundown health care system, where even basic treatments are often unavailable or unaffordable.


"We don't have enough doctors, necessary medicines often aren't available and we can't afford to feed our patients. I watch all these people die and it's a very hopeless feeling," said a young trauma doctor, who asked not to be identified.


Giving these dying patients this information could enable them to make their own choices - about treatments and about how they choose to live during the time remaining. But Russian medicine says that's a Western approach that they don't accept.


Dr. Grigory Tigliyev, a prominent Russian surgeon and professor of medical ethics at the Polenov Neurosurgical Institute in St. Petersburg, says compassion and ethics are where Russian and Western styles of medical treatment diverge.


"The strongest aspect of Russian medicine is the relationship doctors have with patients," said Tigliyev. "We believe that words can kill a patient, so we never tell them the truth. We only tell the person closest to them and only if they want to know."


Tigliyev maintains that patients cannot deal with the fact that they're dying. Informing them they have cancer, for instance, may cause them to give up hope and this affects how their bodies react to treatment. "The truth," he said, "can sometimes shorten what little time they have left." Relatives often share such views and keep information from the patient if the doctor tells them.


"This practice in Russian medicine is clearly culturally conditioned and speaks volumes about the paternalism which has plagued Russia for so long," said Dr. Frank Letcher, an American neurosurgeon who has worked with Tigliyev for six years at their private clinic in St. Petersburg.


"The practitioner might well come to the conclusion that the doctor is obligated to shield the psyche of the patient, and, in a place like Russia where the individual is not expected to manifest initiative, such logic may be valid," Letcher said.


But Sergei Grinberg, a close friend and colleague of Cherkashenko, strongly disagrees. "Zhanna was a bright, colorful and strong-willed woman," he said. "And the doctors had no right to decide for her that she was mentally too weak to accept that she had cancer."


Russian Orthodox clergy, who have re-established a presence in hospitals, have criticized the practice of keeping patients in the dark, saying terminally ill people should know about their condition so they can prepare spiritually for death.


Not knowing what was wrong with her, Cherkashenko sought alternative medical opinions. But even after surgery - in Russia, doctors are not even obliged to tell patients the nature of their surgery or treatment options - she knew nothing about her worsening condition and continued to treat herself with self-prescribed medications.


The dilemma is perhaps best described in Alexander Solzhenitsyn's 1968 book "Cancer Ward." The character Kostoglotov tells his oncology nurse: "I want to understand exactly how I'm being treated, what the long-term prospects are, what the complications are. But they don't tell me anything, they just give me the treatment as if I were a monkey."