Умереть в России: институциональная антропология хосписного ухода

Abstract

In most countries, the development of hospices occurs as a double import: first, as single initiatives based on the high standards of successful world hospices, and then as an attempt to scale these cases into the national healthcare system. As world practice shows, the result of this process is unpredictable: with the development of the hospice network, some structural elements are deformed, which leads to a decrease in the quality of care. However, avoiding a normative view of this process, it is worth recognizing that the upscaling leads not only to a deformation of care practices, but also to a change in the institutional environment into 56 which hospices are incorporated. In such a case, care practices become a source of analysis of these deformations, capable of showing structural factors. I describe and interpret mutual distortions using ethnographic data conducted in state hospice departments in contemporary Russia. As a result of the integration of the hospice into the hospital infrastructure, the provision of care for the dying is not being implemented. Instead, hospices were adapted to the existing protocols and their usual interpretation. Hospices have acquired unexpected functions: they cover the resource needs of the hospital and make it possible to receive funding using the bed fund. The idea of caring for the dying in contemporary Russia is reduced and now imitates the usual therapeutic practices of treatment, which is illustrated by the protocols of patients staying in hospices.