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Technorati</a></li> </ul></div></span></li> </ul> </div></div> <div id="content" class="clear-block"> <div class="node clear-block node-page ltr ntype-news"> <div class="header"> <h6 class="node-title"> <a href="/web/20110706085159/http://www.hrw.org/ja/news/2011/05/12-5" title="ウクライナ：激痛に苦しむ患者たち　救済妨げる規制">ウクライナ：激痛に苦しむ患者たち　救済妨げる規制</a> </h6> </div> <h6 class="node-subtitle">政府は効果的かつ安価な投薬治療の導入を</h6> <div class="info"> <div class="meta date"> <span class="created">May 12, 2011</span> </div> </div> <div class="content clear-block filter-text"> <div class="node-sidebar"><dl><dd><div class="clear-block field field-type-nodereference field-field-related-content"><div class="field-label">Related Materials: </div><div class="field-items"><div class="field-item"><a href="/web/20110706085159/http://www.hrw.org/ja/reports/2011/05/12/uncontrolled-pain-0">Uncontrolled Pain</a></div><div class="field-item"><a href="/web/20110706085159/http://www.hrw.org/ja/reports/2009/03/02/please-do-not-make-us-suffer-any-more">“Please, do not make us suffer any more…”</a></div></div></div></dd><dd><div class="clear-block field field-type-link field-field-news-link"><div class="field-label">More Coverage: </div><div class="field-items"><div class="field-item"><a href="https://web.archive.org/web/20110706085159/http://hrw.kintera.org/Ukraine-Pain-Free">Take Action! Help Ease Someone’s Pain. </a></div></div></div></dd><dd><div class="clear-block field field-type-assetref field-field-related-audio"><div class="field-label">Related audio: </div><div class="field-items"><div class="field-item"><div class="view view-node-audio-player"><div class="view-content view-content-node-audio-player"><div class="item-list"><ul class=" clear-block"><li class="first"><div class="view-item clear-block"> <div class="view-field field-audiofile"><div id="flashcontent_mediaplayer_1">Sorry, you need to install flash to see this content.</div> <script type="text/javascript"> //<![CDATA[ var so1 = new SWFObject('/sites/all/modules/filefield_jwplayer/mediaplayer.swf', 'swf_mediaplayer_1', '300', '20', '9', '#FFFFFF'); so1.addParam('type', 'movie'); so1.addVariable('file', "/sites/default/files/media/audio/2011_UKRAINE_PAIN.mp3"); so1.addVariable('image', "/"); so1.useExpressInstall('/sites/all/modules/swfobject_api/expressinstall.swf'); $(document).ready(function () { so1.write("flashcontent_mediaplayer_1");}); //]]> </script></div> <div class="view-field field-node-body"><p>A new report shows that Ukraine is far behind the rest of Europe when it comes to providing morphine. With Diederik Lohman and Dr. Victoria Tymoshevska.</p> </div> </div></li></ul></div></div></div> </div></div></div><div class="clear-block field field-type-assetref field-field-related-features"><div class="field-label">Related Features: </div><div class="field-items"><div class="field-item"><div class="view view-asset-relatedmedia"><div class="view-content view-content-asset-relatedmedia"><div class="clear-block assets"><div class="asset first"><div class="view-field field-related-videos"><div class="field-item"></div></div><div class="view-field field-video-still"></div><div class="view-field field-related-images"></div><div class="view-field field-related-images"></div><div class="view-field field-node-type"><div class="tic-node-type-icon tic-node-type-icon-embed"></div></div><div class="view-field field-collection-type"><div class="tic-node-type-icon tic-node-type-icon-"></div></div><div class="view-field field-node-title"><a href="/web/20110706085159/http://www.hrw.org/ja/features/ukraine-pain-free">Ukraine Palliative Care</a></div><div class="view-field field-popup-link"><a href="https://web.archive.org/web/20110706085159/http://www.hrw.org/en/features/ukraine-pain-free">Ukraine: Provide Treatment for Cancer Pain</a></div></div> </div></div></div> </div></div></div></dd><dd><div class="pullquote"><div class="clear-block field field-type-text field-field-news-pullquote"><div class="field-items"><div class="field-item"><p>人生最後の限られた時間を、耐え難い痛みの中で生き長らえなければならないのがウクライナの実態だ。激しい痛みが不可避である以上、安全で効果的な鎮痛薬を、それを必要とする人びとの手に届くようにするため、ウクライナ政府はその医療政策と薬物規制を変革する必要がある。</p> </div></div></div><div class="clear-block field field-type-text field-field-news-pullquote-author"><div class="field-items"><div class="field-item">ディデリク・ローマン、ヒューマン・ライツ・ウォッチ上級調査員</div></div></div></div></dd></dl></div> <div class="node-body"><p>（キエフ）－ウクライナでは毎年数万人の末期癌患者が、激しい痛みで苦しんでいる。本来受けられるべき効果的で安全、かつ安価な疼痛の緩和治療を受けられないためである、とヒューマン・ライツ・ウォッチは本日公表した報告書で述べた。</p> <p>全93ページの報告書「<a href="https://web.archive.org/web/20110706085159/http://www.hrw.org/node/98656">耐え難い痛み：ウクライナ政府の科学的根拠に基づく疼痛緩和治療の義務について</a>」は、ウクライナ政府の政策ゆえに、地方に生活する癌患者が必要不可欠な疼痛の緩和治療を受けられていない実態を明らかにしている。都市部では、癌患者のほとんどが何らかの治療を受けられてはいるが、その治療は十分とは言えず、その程度も限られているのが実情だ。</p> <p>ヒューマン・ライツ・ウォッチ上級調査員のディデリク・ローマンは「人生最後の限られた時間を、耐え難い痛みの中で生き長らえなければならないのがウクライナの実態だ。激しい痛みが不可避である以上、安全で効果的な鎮痛薬を、それを必要とする人びとの手に届くようにするため、ウクライナ政府はその医療政策と薬物規制を変革する必要がある」と指摘する。</p> <p>本報告書は、患者20名、医療従事者35名、薬物規制及び医療当局者十数名への綿密な聞き取り調査と、関係法令及び政策文書の精査をもとに作成された。</p> <p>ウクライナにおける癌死者数に照らせば、毎年少なくとも8万人の癌患者が激しい疼痛に苦しんでいる。癌患者のみならず、HIVや結核、感染症などの他の疾病に苦しむ患者も、急性の激痛や慢性的な疼痛を患う可能性がある。</p> <p>WHO(世界保健機関)は「癌を原因とする痛みは、絶対とは言えないが、ほとんどの場合、現存する医療知識と治療を実践すれば緩和が可能である」と述べる。必要最小限の経口モルヒネは安価で、他の経口薬と同様、患者自身や家族でも投薬できる。</p> <p>本報告書は、ウクライナにおける適切な疼痛緩和治療に対する主たる阻害要因は以下の3つとしている。</p> <ul> <li>まず、経口モルヒネの不足。数十年にわたり、経口モルヒネは癌による疼痛の緩和治療の礎であり、WHO(世界保健機関)も必要不可欠な薬物としている。しかしながら、ウクライナ政府は公共医療を通じて経口モルヒネ治療を受けられるシステムを構築しなかった。私立病院でも経口モルヒネ治療は受けられない。欧州で、ウクライナ以外に経口モルヒネをストックしていないのは、アルメニアとアゼルバイジャンだけである。</li> </ul> <ul> <li>次に、薬物規制問題。ウクライナは、違法薬物の取締りのため、世界でも特に厳しい麻薬規制を行なう一方、医療のために薬物を必要とする患者に対する適切な配慮を怠ってきた。こうした薬物規制が、モルヒネなどの薬物の医療上の利用に対する重大な障害になっている。</li> </ul> <ul> <li>最後に、医療従事者への訓練という課題がある。医学生や若い医師は、疼痛緩和のための現代的治療に関する適切な訓練を受けていない。</li> </ul> <p>これら3つの障害が相俟って、患者が適切な医療を受けられない事態を引き起こしている、とヒューマン・ライツ・ウォッチは述べた。例えばウクライナの薬物規制により、同国で唯一利用可能な疼痛緩和薬である注射用モルヒネは、医療従事者が患者に投与すると義務付けられている。モルヒネの効果持続時間はたった4時間から6時間であるため、この法規制がある以上、在宅での末期医療を望めば（ウクライナのほとんどの癌患者が在宅末期医療を希望する）、医療従事者は患者を1日に6回も訪問しなければならない。ヒューマン・ライツ・ウォッチは、本報告書において、ほとんどの患者がモルヒネの投与を全く受けられていないのが実態であり、多い場合でも1日に1回か2回の投与にとどまっている実情を明らかにしている。もし経口モルヒネが利用可能であったならば、患者は在宅用の薬剤の処方を受け、疼痛緩和治療を自ら行うことが可能である。</p> <p>本調査結果について話し合うべく、ヒューマン・ライツ・ウォッチは、ウクライナ政府の薬物規制当局の関係者と複数回の会談を持ったが、その際、薬物規制当局は、現行の規制は制限が多すぎるので改正が必要であるとの考えをヒューマン・ライツ・ウォッチに示した。</p> <p>さらに、本報告書は、医療関係者に向けた疼痛緩和治療の研修を充実拡大させることも提案/勧告している。</p> <p>「患者は苦痛が余りに激しいので、痛みに耐えて生きるよりも、いっそ死んでしまった方が楽だ、と私たちに訴えた」と前出のローマンは述べる。「ウクライナ政府は経口モルヒネを早急に導入するとともに、バランスを欠いた現行の薬物規制を改正する必要がある」とも指摘する。</p> <p><strong>患者たちの言葉の一部抜粋</strong></p> <p>「今すぐ頭から真っ逆さまに落ちて死にたかった。そうすればこれ以上苦しまなくて済むから。」</p> <p><em>-</em><em>自殺を試みたが未遂に終わった時のことを話したワラド・ジュコーフスキー（</em><em>Vlad Zhukovsky</em><em>）</em></p> <p>「痛みの壮絶さはと言ったら、全身がバラバラになってしまうと思うほどだった。とても我慢しきれず2・3時間おきに救急車を呼んでしまった。」</p> <p><em>-</em><em>地方部のポルタワ（</em><em>Poltava</em><em>）にある村に住むコンスタンチン・ズワリッチ（</em><em>Konstantin Zvarich</em><em>）</em></p> <p>「夫は股関節の病気が悪化し、その痛みは少し動くだけでも耐え難いもので、しかも毎日激しくなっていった。睡眠や食欲、精神状態にも当然影響し、常にイライラして、もはや夫に幸せを感じさせるものはなかった。普通のくしゃみや咳でさえ物凄い痛みを引き起こすの・・・そこであの人が横になって寝ていたとするでしょう、もし今壁をノックするだけでも、あの人は[痛みで]叫び声を上げたと思うわ。」.</p> <p><em>-</em><em>夫（がん患者ではない）の疼痛について話すナターシャ・マリノワスカ（</em><em>Natasha Malinovska</em><em>）</em></p> </div><div class="node-translations"><span class="label">Also available in:</span><ul class="links"><li class="first 0"><a 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ウクライナ：激痛に苦しむ患者たち 救済妨げる規制 | Human Rights Watch

ウクライナ：激痛に苦しむ患者たち　救済妨げる規制 | Human Rights Watch