ministrTa komitetis rekomendacia REC (2003) 24 evropis ...2003)24-Georgian.pdf · Photo: Làszló Valuska, Hungary danarTi CM (2003) 24 rekomendacia REC (2003)-s danarTi . .

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ppaalliiaattiiuurrii mmzzrruunnvveelloobbiiss oorrggaanniizzeebbiissaaTTvviiss

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RECOMMENDATION REC (2003) 24

OF THE COMMITTEE OF MINISTERS TO MEMBER STATES

ON THE ORGANISATION OF PALLIATIVE CARE

Adopted by the Committee of Ministers on 12 November 2003

at the 860th meeting of the Ministers' Deputies

COUNCIL Of EUROPE

mmiinniissttrrTTaa kkoommiitteettiiss rreekkoommeennddaacciiaa REC ((22000033)) 2244

eevvrrooppiiss ssaabbWWooss wweevvrr ssaaxxeellmmwwiiffooeebbSSii

ppaalliiaattiiuurrii mmzzrruunnvveelloobbiiss oorrggaanniizzeebbiissaaTTvviiss

mmiiRReebbuulliiaa mmiinniissttrrTTaa kkoommiitteettiiss mmiieerr 22000033 wwlliiss 1122 nnooeemmbbeerrss

mmiinniissttrrTTaa wwaarrmmoommaaddggeenneellTTaa 886600--ee ssxxddoommaazzee

evropis sabWo

ISBN: 99940 - 0 - 010 - 1ISBN: 92 - 871 - 5557 - 7 Council of Europe

qarTuli gamocemis redaqtorebi: docenti rema RvamiCava

m.m.k. ioseb abesaZe

mTargmneli da teqnikuri redaqtori: inga SariqaZe

Editors of Georgian edition: Rema Gvamichava, M.D. Ass. ProfessorIoseb Abesadze Ph.D.

Translator and technical editor: Inga Sharikadze

CM(2003)130 3

zogadi mosazrebebi

I. saxelmZRvanelo principebi - - - - - - - - - - - - - - - - - - - 9

II. dawesebulebebi da samsaxurebi - - - - - - - - - - - - - - - - -11

III. politika da organizeba - - - - - - - - - - - - - - - - - - -12

IV. xarisxis gaumjobeseba da kvleva - - - - - - - - - - - - - - -14

V. ganaTleba da treningi - - - - - - - - - - - - - - - - - - - - -14

VI. ojaxi - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -16

VII. komunikacia pacientsa da ojaxis wevrebTan - - - - - - - - -16

VIII. terminebi, gunduri muSaoba da mzrunvelobis dagegmva - -17

IX. mZime danakargi - - - - - - - - - - - - - - - - - - - - - - - -18

ministrTa komitetis rekomendacia REC (2003) 24

wevri saxelmwifosadmi paliatiuri mzrunvelobis

organizebisaTvis ganmartebiTi memorandumi

zogadi mosazrebebi - - - - - - - - - - - - - - - - - - - - - - - -20

mokle istoriuli mimoxilva - - - - - - - - - - - - - - - - - - -21

paliatiuri mzrunvelobis zogierTi monacemi evropis qveynebSi25

gansazRvrebebi da ZiriTadi principebi - - - - - - - - - - - - - -31

dawesebulebebi da samsaxurebi - - - - - - - - - - - - - - - - - -44

politika da organizeba - - - - - - - - - - - - - - - - - - - - -56

xarisxis gaumjobeseba da kvleva - - - - - - - - - - - - - - - -60

profesionalebisa da volontiorTa ganaTleba da treningi - -67

komunikacia - - - - - - - - - - - - - - - - - - - - - - - - - - - -69

terminebi, gunduri muSaoba da mzrunvelobis dagegmva - - - - -75

volontiorebi - - - - - - - - - - - - - - - - - - - - - - - - - -77

mZime danakargi - - - - - - - - - - - - - - - - - - - - - - - - - -79

ganmartebiTi leqsikoni - - - - - - - - - - - - - - - - - - - - - -83

gamoyenebuli literatura - - - - - - - - - - - - - - - - - - - -89

ministrTa komiteti, evropis sabWos wesdebis 15-b muxlis

moTxovnebis Tanaxmad,

iTvaliswinebs ra evropis sabWos mizans, miaRwios met erTianobas

mis wevrebs Soris da rom es mizani SesaZloa ganxorcieldes, maT

Soris jandacvis sistemaSi, erTiani wesebis miRebiT;

Segvaxsenebs ra evropis socialuri qartiis janmrTelobis dacvis

uflebis me-11 muxlis, adamianis uflebaTa da biomedicinis konvenci-

is me-3 muxlis (ETS No 164) moTxovnas, rom kontraqtori mxareebi

unda uzrunvelyofdnen Sesabamisi xarisxis jandacvis Tanabar mis-

awvdomobas; muxli 4-is moTxovnas - nebismieri Careva jandacvis

sferoSi, kvlevis CaTvliT, tardebodes Sesabamisi profesiuli

movaleobebisa da standartebis mixedviT; me-10 muxlSi xazgasmiT

aRniSnuli yoveli adamianis uflebas, flobdes informacias

sakuTari janmrTelobis Sesaxeb;

aRiarebs ra, jandacvis sistemis pacietze orientirebisa da

sakuTar janmrTelobasTan dakavSirebiT gadawyvetilebis miRebaSi

moqalaqeebis monawileobis aucileblobas;

am konteqstSi, Segvaxsenebs ra ministrTa komitetis rekomendacias

wevri qveynebisadmi (rekomendacia #R(2000)5) sakuTari janmrTe-

lobis dacvasTan dakavSirebiT gadawyvetilebis miRebaSi moqalaqe-

Ta da pacientTa monawileobiTi struqturebis ganviTarebis Sesaxeb;

darwmunebulia ra, rom terminaluri pacientisa da momakvdavi

pirovnebis Rirsebis pativiscema da dacva upirveles yovlisa

moicavs Sesaferis garemoSi iseTi saxis mzrunvelobis uzrunvely-

ofas, rac aZlevs mas Rirseulad gardacvalebis saSualebas;

am konteqstSi, Segvaxsenebs ra saparlamento asambleis rekomenda-

cias 1418 (1999) adamianis uflebebis, terminaluri da momakvdavi

pirovnebis Rirsebis dacvis Sesaxeb;

Segvaxsenebs ra rekomendacia #R(89)13-s, onko-pacientebisaTvis

multidisciplinuri mzrunvelobis organizebis Sesaxeb;

CM(2003)130 5

aRiarebs ra paliatiuri mzrunvelobis Semdgomi ganviTarebis

saWiroebas evropis qveynebSi;

am mimarTebiT, Segvaxsenebs ra 1998 wlis poznanis deklaracias

aRmosavleT evropaSi paliatiuri mzrunvelobis Sesaxeb;

aRiarebs ra, rom samedicino daxmarebaze uflebis mizania

pacientisaTvis janmrTelobis maqsimalurad misawvdomi atmosferos

Seqmna miuxedavad asakisa, eTnikuri warmomavlobisa, ekonomiuri Tu

socialuri statusisa, daavadebis an uZlurebis bunebisa;

iTvaliswinebs ra paliatiuri mzrunvelobis saWiroebis mqone

pacientebis raodenobis zrdas;

iTvaliswinebs ra, evropis farglebSi paliatiuri mzrunvelobis mi-

sawvdomobasa da xarisxSi arsebul gansxvavebas, qveynebs Soris

TanamSromloba mimarTuli unda iyos am gansxvavebis daZlevaze.

acnobierebs ra, rom paliatiuri mzrunveloba aris aqtiuri, sru-

lyofili zrunva pacientze Sorswasuli, progresirebadi daava-

debiT da misi mizania tkivilisa da sxva simptomebis kontroli,

fsiqologiuri, socialuri da sulieri daxmareba;

acnobierebs ra, rom paliatiuri mzrunvelobis mizania pacientebisa

da maTi ojaxis wevrebisaTvis sicocxlis SesaZlo saukeTeso

xarisxis miRweva;

acnobierebs ra, rom paliatiuri mzrunvelobis mizania daexmaros

daavadebis Sorswasuli, progresirebadi formis mqone mamakacebs,

qalebs, bavSvebs, sicocxlis bolomde SeinarCunon sicocxlis SesaZ-

lo saukeTeso xarisxi da ar gulisxmobs sikvdilis daCqarebas an

Seferxebas;

mxedvelobaSi iRebs ra, rom paliatiuri mzrunveloba ganamtkicebs

sicocxles da ganixilavs sikvdils, rogorc normalur process da

ar xelmZRvanelobs uimedobiTa da fatalizmiT;

CM(2003)1306

mxedvelobaSi iRebs ra, rom paliatiuri mzrunveloba aris jan-

dacvis sistemis janmrTelobis dacvaze yoveli moqalaqis uflebis

ganuyofeli nawili da amdenad, saxelmwifos pasuxismgeblobas war-

moadgens paliatiuri mzrunvelobis uzrunveloba yvelasaTvis,

visac igi esaWiroeba;

mxedvelobaSi iRebs ra, rom aucilebelia humanuri gziT ganxor-

cielebuli xarisxiani mzrunvelobis miRweva, raTa igi gaxdes

pacientze mzrunvelobis umTavresi nawili misi sicocxlis bolos;

acnobierebs ra, rom sococxlis bolos yovel adamians surs jan-

dacvis profesionalebisagan uzrunvelyofili iqnas samedicino

momsaxurebiT, rogorc Rirseuli pirovneba; uzrunvelyofili iqnas

Rirsebis SenarCunebaze, damoukideblobis stimulirebaze, simptome-

bis Semsubuqebasa da maqsimaluri komfortis miRwevaze mimarTuli

kvalificiuri zrunva;

acnobierebs ra, rom paliatiuri mzrunveloba, iseve rogorc mTeli

samedicino momsaxureba, unda iyos pacientze orientirebuli da

xorcieldebodes misi saWiroebebis, faseulobebisa da arCevanis

gaTvaliswinebiT; rom paliatiur pacientebze mzrunvelobis

umTavres aspeqtebs warmoadgens Rirseba da damoukidebloba,

rekomendacias uwevs wevri qveynebis mTavrobebs:

miiRon paliatiuri mzrunvelobis yovlismomcveli erovnuli poli-

tikisaTvis aucilebeli moqmedebis, sakanonmdeblo da sxva normebi.

am mizniT, SesaZleblobis gaTvaliswinebiT miiRon winamdebare

rekomendaciis danarTSi warmodgenili midgomebi, maTi adgilobrivi

garemoebebTan adaptirebiT;

popularizacia gauwion paliatiuri mzrunvelobis sferoSi aqtiu-

rad momuSave organizaciebs, kvleviT institutebsa da sxva saagen-

toebs Soris saerTaSoriso qselur TanamSromlobas;

mxari dauWiron rekomendaciisa da misi ganmartebiTi memorandumis

aqtiur, mizanmimarTul gavrcelebas, SesaZleblobis SemTxvevaSi

misi Targmnis saSualebiT.

CM(2003)130 7

zzooggaaddii mmoossaazzrreebbeebbii

maSin, rodesac mraval qveyanaSi jandacvis biujetis udidesi naw-

ili adamianis sicocxlis bolo wlebSi ixarjeba, pacientebi xSirad

ver iReben maTi saWiroebebis Sesabamis zrunvas.

paliatiuri mzrunveloba ar aris mimarTuli specifikur daavade-

baze da moicavs periods daavadebis Sorswasuli formis dadgenis

momentidan sicocxlis bolomde, romelic SeiZleba varirebdes

wlebidan ramodenime kviramde an (iSviaTad) dReebamde.

umniSvnelovanesia wevr saxelmwifoebSi iseTi klimatis Seqmna,

romelic aRiarebs paliatiuri mzrunvelobis mniSvnelobas.

CM(2003)1308

Photo: Làszló Valuska, Hungary

danarTi CM (2003) 24rekomendacia REC (2003)-s danarTi . . .

sazogadoeba, pacientebisa da maTi ojaxebis CaTvliT, saWiroebs ga-

naTlebas paliatiuri mzrunvelobis mniSvnelobasTan dakavSirebiT.

gvawvdis ra srul monacemebs evropis ocdaTxuTmeti qveynis Sesa-

xeb, bolo periodis kvlevam gamoavlina sxvadasxva qveyanaSi pali-

atiuri mzrunvelobis ganviTarebaSi arsebuli gansxvaveba, romelTa

Sorisac aris variaciebi anazRaurebaSi (iq sadac misaRebia), jan-

dacvis sistemis organizebasa da masSi paliatiuri mzrunvelobis

adgilSi; eTikuri da kulturuli faqtorebis sxvaobaSi; pali-

atiuri mzrunvelobis ganviTarebaSi erovnuli organizaciebis

rolsa da saerTaSoriso TanamSromlobaSi; muSa jgufis treninge-

bisa da ganviTarebis sakiTxebSi.

II.. ssaaxxeellmmZZRRvvaanneelloo pprriinncciippeebbii

paliatiuri mzrunvelobis politika unda efuZnebodes evropis

sabWos mier SemoTavazebul Rirebulebebs: adamianis, pacientis

uflebebi, adamianis Rirseba, demokratia, Tanasworoba, solidaroba,

Tanaswori genderuli SesaZleblobebi, monawileoba da arCevanis

Tavisufleba.

paliatiuri mzrunveloba moicavs Semdeg mTavar aspeqtebs;

- simptomebis kontroli;

- fsiqologiuri, sulieri da emociuri daxmareba;

- ojaxis wevrebis daxmareba;

- daxmareba axloblis gardacvalebiT gamowveuli mZime danakar-

gis dros.

rekomendacias ganamtkicebs Semdegi principebi:

1. paliatiuri mzrunveloba jandacvis sistemis ganuyofeli, sasic-

ocxlo mniSvnelobis mqone nawilia. mis ganviTarebasa da funq-

cionalur intergirebaze mimarTuli rezervebi CarTuli unda

iqnas jandacvis erovnul strategiebSi.

CM(2003)130 9

2. nebismieri pirovneba, romelsac paliatiuri mzrunveloba

esaWiroeba, unda iRebdes mas yovelgvari Seferxebis gareSe,

misi saWiroebebisa da arCevanis Sesabamis garemoSi.

3. paliatiuri mzrunvelobis amocanas pacientebisaTvis sicocxlis

SesaZlo saukeTeso xarisxis miRweva da SenarCuneba warmoadgens.

4. paliatiuri mzrunveloba mimarTulia Sorswasuli daavadebiT

gamowveul fizikur, fsiqologiur da sulier aspeqtebze; amde-

nad igi moiTxovs maRalkvalificiuri, adekvaturi resursebiT

aRWurvili interdisciplinuri da multiprofesiuli gundis

monawileobas.

5. mwvave Sualeduri problemebis mkurnaloba xdeba im SemTxvevaSi,

Tu amis survili aqvs pacients da ar xdeba maSin, rodesac igi

upiratesobas paliatiur mzrunvelobas aniWebs.

6. paliatiuri mzrunvelobis misawvdomoba unda emyarebodes

saWiroebebs. masze gavlenas ar unda axdendes daavadebis tipi,

geografiuli mdebareoba, socialur-ekonomiuri statusi an sxva

msgavsi faqtorebi.

7. paliatiuri mzrunvelobis saswavlo programebi CarTuli unda

iqnas jandacvis yvela dainteresebuli profesionalis

treningebSi.

8. unda Catardes mzrunvelobis xarisxis gaumjobesebaze

mimarTuli kvleva. paliatiuri mzrunvelobis yoveli Careva

maqsimalurad unda iqnas gamyarebuli Sesabamisi kvlevebis

monacemebiT.

9. paliatiurma mzrunvelobam unda miiRos adekvaturi da obieq-

turi dafinanseba.

10. iseve, rogorc jandacvis yvela seqtorSi, paliatiur

mzrunvelobaSi CarTuli samedicino personali srulad unda

CM(2003)13010

aRiarebdes pacientis uflebebs, Seesabamebodes profesiul mova-

leobebsa da standartebs; moqmedebdes pacientis interesebis

sruli dacviT.

IIII.. ddaawweesseebbuulleebbeebbii ddaa ssaammssaaxxuurreebbii

1. paliatiuri mzrunveloba aris interdisciplinuri da multi-

profesiuli saqmianoba, romelic emsaxureba pacientTa saWiro-

ebebs da ar uaryofs iseTi araformaluri mzrunvelebis monaw-

ileobas, rogoricaa ojaxis wevrebi.

2. paliatiuri mzrunvelobis momsaxureba da politika pacients

unda sTavazobdes resursebis farTo speqtrs, rogoricaa: binaze

mzrunveloba, mzrunveloba stacionaris specifikur da saerTo

ganyofilebebSi, dRis stacionarsa da ambulatoriul klini-

kebSi, saswrafo daxmarebis da droebiTi movlis ganayofile-

bebSi. aRniSnuli mzrunveloba unda iyos mravalmxrivi, jandac-

vis sistemis, kulturis Sesabamisi, yuradReba gamaxvilebuli un-

da iqnas pacientis saWiroebebisa da survilebis cvalebadobaze.

3. daxmarebas unda iRebdnen araformaluri mzrunvelebic. isini ar

unda ganicdidnen iseT socialur marxcs, rogoricaa mzrunvelo-

basTan dakavSirebiT samsaxuris dakargva. sasurvelia arsebobdes

`mzrunvelobisaTvis Svebulebis~ oficialuri nebarTva.

4. saWiroebis SemTxvevaSi, Sorswasuli, progresirebadi daavadebis

mqone pacientze mzrunvelobaSi CarTuli yvela profesiona-

lisaTvis xelmisawvdomi unda iyos nebismieri saxis eqspertiza.

5. saWiroebis SemTxvevaSi yvela pacientisaTvis, nebismier drosa

da nebismier situaciaSi misawvdomi unda iyos paliatiuri

mzrunvelobis specialistis momsaxureba.

6. saxelmwifo doneze unda iqnas uzrunvelyofili paliatiuri

CM(2003)130 11

mzrunvelobis ganviTarebis marTva da momsaxurebaTa swori

koordinacia, pasuxismgeblobis mkafio gadanawilebiT. aRniSnuli

miznis misaRwevad rekomendebulia regionaluri qselebis

Camoyalibeba.

7. pacientebs garantirebuli unda hqondeT paliatiuri mzrun-

veloba miuxedavad maTi finansuri mdgomareobisa. finansuri da

sxva saxis meqanizmebi adaptirebuli unda iqnes pacientebis

saWiroebebis gaTvaliswinebiT da iZleodes paliatiuri mzrun-

velobis uwyvetobis garantias.

8. unda arsebobdes droebiTi movlis forma, romelic gadatvir-

Tvis SemTxvevaSi droebiT daxmarebas SesTavazebs binaze momvle-

lebs.

IIIIII.. ppoolliittiikkaa ddaa oorrggaanniizzeebbaa

1. paliatiuri mzrunveloba unda warmoadgendes qveynis jandacvis

sistemis ganuyofel nawils da amdenad igi unda iyos jandacvis

gegmebisa da im specifikuri programebis elementi, romelic

exeba mag. kibos, Sidss an geriatrias.

2. saxelmwifoebma unda Caataron momsaxurebaTa, eqspertizis

sxvadasxva donis personalisa da profesionalebis treningis

(volontiorebis CaTvliT) saWiroebebis Sefaseba.

3. saWiroebaTa Sefasebis safuZvelze, erovnulma da regionulma

xelisuflebam profesionalebTan, pacientebTan, maTi ojaxis

wevrebTan da warmomadgenlebTan urTierTTanamSromlobiT unda

SeimuSaos da ganaxorcielos paliatiuri mzrunvelobis yovlis-

momcvli strategia.

4. xelisuflebam rogorc aseTi strategiebis nawilma, unda gansaz-

Rvros paliatiuri mzrunvelobis misawvdomobis sakanonmdeblo,

socialur-ekonomiuri, kulturuli, administraciuli da/an

fizikuri barierebi. iniciativebi da programebi unda xorcield-

CM(2003)13012

ebodes im barierebis Sesamcireblad, romelTac xSirad uTanas-

worobamde mivyavarT.

5. kanonmdeblobam unda uzrunvelyos opioidebisa da sxva medika-

mentebis misawvdomoba, samedicino mizniT maTi farTo Semadgen-

lobiTa da dozirebiT gamoyenebisaTvis. aradaniSnulebisamebr

gamoyenebis SiSi ar unda aferxebdes aucilebeli da efeqturi

medikamenturi mkurnalobis misawvdomobas.

6. politikuri da socialuri yuradRebis uzrunvelsayofad

rekomendebulia erovnul, regionul da adgilobriv doneze

paliatiuri mzrunvelobis interdisciplinuri fokus jgufebis

an sabWoebis Camoyalibeba pacientebis, ojaxis wevrebisa da

sxvaTa monawileobiT. moqmedebaTa gegmis SesamuSaveblad,

umjobesia aRniSnuli jgufebi TanamSromlobdnen xelisuf-

lebasTan da sxva pirebTan.

7. paliatiuri mzrunvelobis xarisxis monitoringisaTvis aucile-

belia saxelmwifo doneze ̀ monacemTa minimalur nakrebis~ (mmn)

SemuSaveba.

8. Tanasworobis uzrunvelsayofad gansakuTrebuli yuradReba unda

daeTmos arapriviligirebul jgufebze (mag. swavlis SezRudvis

mqone pirebi, patimrebi, usaxlkaroebi da ltolvilebi) pali-

atiur mzrunvelobas da pacientis saWiroebebTan dakavSirebul

kulturul da eTnikur gansxvavebebs. aseve gansakuTrebuli

yuradReba unda daeTmos paliatiur mzrunvelobas bavSvebSi.

9. profesionali momvlelebi uflebamosili arian miiRon kanonieri

anazRaureba da aRiareba maT mier Sesrulebuli samuSaosa da

kompetenciisaTvis.

10. yovelwliurad unda iqnas gamoqveynebuli saxelmwifo angariSi

paliatiuri mzrunvelobis organizebisa da funqcionirebis

Sesaxeb.

CM(2003)130 13

IIVV.. xxaarriissxxiiss ggaauummjjoobbeesseebbaa ddaa kkvvlleevvaa

1. xeli unda Seewyos xarisxiani paliatiuri mzrunvelobis

maCveneblebis gansazRvras da SemuSavebas.

2. meTodurad, pacientebis monawileobiTa da arsebul saukeTeso

mtkicebulebebze dayrdnobiT, unda Seiqmnas paliatiuri mzrun-

velobis klinikuri praqtikis saxelmZRvaneloebi.

3. xarisxis kontrolisaTvis umTaversia praqtikuli saqmianobis

uwyveti ukugebis auditi.

4. miuxedavad imisa, rom paliatiur mzrunvelobaSi samecniero

kvleva SesaZloa dadges specifikuri eTikuri problemebis

winaSe, samedicino Carevebi unda fasdebodes aRiarebuli,

rogorc xarisxobrivi, aseve raodenobrivi samecniero meTodebis

gamoyenebiT.

5. xeli unda Seewyos saxelmwifo da evropul doneze erTobliv

kvlevas.

6. paliatiuri mzrunvelobis ganviTarebisa da xarisxis Sesaxeb

zusti informaciis Segrovebis, gadamuSavebisa da gavrcele-

bisaTvis organizebuli unda iqnas dakvirvebis punqti.

VV.. ggaannaaTTlleebbaa ddaa ttrreenniinnggeebbii

1. kvlevisa da ganaTlebisaTvis mniSvnelovania paliatiuri mzrun-

velobis akademiuri aRiareba.

2. paliatiuri mzrunveloba CarTuli unda iqnas eqimebisa da

eqTnebis yvela sauniversiteto kursSi. unda SemuSavdes stan-

dartuli kurikulumebi, iseve rogorc saaspiranto treningebi

CM(2003)13014

da ganaTleba; unda arsebobdes trening programebi paliatiuri

mzrunvelobis eqspertebisaTvis.

3. xeli unda Seewyos ganaTlebis sferoSi saerTaSoriso

TanamSromlobas. mag. paliatiuri mzrunvelobis im struqture-

bis cnobaris Sedgena, romelTac erTobliv programebSi monawi-

leobis survili aqvT.

4. paliatiur mzrunvelobaSi CarTulma yvela profesionalma da

araprofesionalma unda gaiaros maTi amocanebis Sesabamisi tre-

ningi; treningis yvela doneze maT unda miiRon paliatiur

mzrunvelobaSi konkretuli, ganWvretis unarsa da kulturuli

gansxvavebebis gaTvaliswinebaze mimarTuli zusti instruqciebi.

5. paliatiur mzrunvelobaSi ganaTleba unda iyos monodisciplinu-

ri da aseve interdisciplinuri.

6. paliatiur mzrunvelobaSi ganaTleba unda xorcieldebodes uwy-

vetad. mag. zedamxedvelobis formiT.

7. paliatiuri mzrunvelobis swavlebisa da treningisaTvis yovel

qveyanaSi unda Seiqmnas sabazo centrebi.

8. idealur variantSi, profesionalebisaTvis unda arsebobdes

ganaTlebis (uwyveti) Semdegi sami done: sawyisi, Sualeduri da

umaRlesi ganaTleba.

9. rekomendebulia qveynebma gansakuTrebuli yuradReba dauTmon pa-

liatiur mzrunvelobasTan dakavSirebiT sazogadoebis ganaTlebas.

10. unda gamoswordes pacientebSi, ojaxebSi, profesionalebsa da

sazogadoebaSi opioidebTan dakavSirebiT arsebuli gaumarT-

lebeli negatiuri imiji. profesiul ganaTlebaSi, iseve rogorc

sazogadoebriv kampaniaSi, aqcenti unda gakeTdes Zireul gansx-

vavebaze opioidebis klinikur gamoyenebasa da medikamentebze

potenciuri mavne damokidebulebis sakiTxebze.

CM(2003)130 15

VVII.. oojjaaxxii

1. pacientebis axloblebis (umetesad ojaxis wevrebi) daxmarebis

mizania maTi SesaZleblobebis saukeTesod gamoyeneba da gan-

viTareba pacientisaTvis emociuri da praqtikuli daxmarebis

gasawevad; procesisadmi adaptirebis, mwuxarebasa da danakargTan

Sesagueblad. gansakuTrebuli yuradReba unda mieqces gamo-

fitviT gamowveuli depresiis prevenciasa da mkurnalobas.

VVIIII.. kkoommuunniikkaacciiaa ppaacciieennttTTaann ddaa oojjaaxxTTaann

1. paliatiuri mzrunveloba moiTxovs iseT atmosferos, damokide-

bulebas da momvleli-pacientis urTierTobas, romelic xels

uwyobs informaciis misawvdomobas pacientebisa da ojaxebi-

saTvis.

2. profesionalebma unda gaiTvaliswinon, Tu ra moculobiT surT

pacientebs miiRon informacia sakuTari mdgomareobis Sesaxeb;

amasTan dakavSirebiT yuradReba unda mieqces kulturul

Taviseburebebs.

3. profesionalebma unda moaxdinon pacientisaTvis informaciis

miwodebis xerxebis adaptireba, im emociuri da SemecnebiTi bari-

erebis gaTvaliswinebiT, rac xSirad dakavSirebulia Sorswasul

da progresirebad daavadebasTan.

4. rodesac sakuTari janmrTelobis, an mSoblebis avadmyofobis

gamo urTierToba gvaqvs bavSvebTan, komunikacia adaptirebuli

unda iqnas asakobrivi specifikis gaTvaliswinebiT.

CM(2003)13016

VVIIIIII.. gguunnddii,, gguunndduurrii mmuuSSaaoobbaa ddaa

mmzzrruunnvveelloobbiiss ddaaggeeggmmvvaa

1. paliatiuri mzrunveloba aris interdisciplinuri da multi-

disciplinuri saqmianoba, romelSic umTavresad CarTuli arian

pacientisa da ojaxis wevrebis fizikuri, fsiqologiuri, suli-

eri saWiroebebis Sesabamisi kompetenciis mqone eqimi, eqTani da

sxva sferos muSakebi. aseTi gundebis funqcionireba saWiroebs

xelSewyobas.

2. gadawyvetilebis miReba, gansakuTrebiT ki sawyisi individualu-

ri gegmis SemuSaveba, monitoringi da sistematiuri ganxilva

pacientis survilis Sesabamisad, unda xdebodes pacients, ojax-

sa da gunds Soris. uzrunvelyofili unda iqnas Sesabamisi komu-

nikacia sxvadasxva saxis momsaxurebas Soris (mkurnaloba da

mzrunveloba).

3. volontiorebi SesaZloa gundis mniSvnelovan wevrebs warmoad-

gendnen. isini ar asruleben profesionalebis samuSaos, magram

gaaCniaT sakuTari wvlili da kompetencia. unda moxdes

volontiorTa momsaxurebis organizebisa da moxaliseobis pro-

cesis xelSewyoba.

4. gundis yvela wevrs unda gaaCndes Tavisi rolis Sesabamisi kom-

petencia; isini unda icnobdnen sakuTar da aseve gundis sxva wev-

rebis SesaZleblobebsa da sust mxareebs.

5. pacientisa da ojaxisaTvis umniSvnelovanesia zusti informa-

ciis miReba gundis sxvadasxva wevrebisagan. amdenad, gaugebrobi-

sa da Seusabamobis Tavidan asacileblad mTavaria momvlelebs

Soris informaciis optimaluri gacvla. rekomendebulia koor-

dinatoris xelmZRvanelobis daweseba. garemoebebidan gamomdi-

nare, umjobesia am funqcias asrulebdes pirveladi qselis eqimi.

6. efuZneba ra pacientisa da ojaxis samedicino saidumlosa da

CM(2003)130 17

piradulobis uflebebis srul pativiscemas, profesionalebs

Soris mTeli komunikacia pacientsa da mis ojaxTan mimarTebaSi

profesiul saidumlos warmoadgens.

7. paliatiuri mzrunveloba Cveulebriv Zalian sasargebloa, magram

amave dros is SeiZleba iyos Zalian momTxovni. amdenad mzunve-

lebze zrunva paliatiuri mzrunvelobis umTavres nawils war-

moadgens da am sferoSi momuSaveTa Sromis higienas moqmedebaTa

gegmaSi gansakuTrebuli yuradReba unda eqceodes.

IIXX.. mmZZiimmee ddaannaakkaarrggii

1. momsaxureba axloblis gardacvalebiT gamowveuli mZime danakar-

gis dros unda miiRon maT, visac aseTi daxmareba esaWiroeba;

2. yvela profesionali muSaki yuradRebas unda iCendes axloblis

gardacvalebiT gamowveuli garTulebebisa da aRelvebis

niSnebisadmi.

CM(2003)13018

CM(2003)130 19

Communicating with patient and family

mmiinniissttrrTTaa kkoommiitteettiiss rreekkoommeennddaacciiaa REC ((22000033)) wweevvrrii

ssaaxxeellmmwwiiffoossaaddmmii ppaalliiaattiiuurrii mmzzrruunnvveelloobbiiss

oorrggaanniizzeebbiissaaTTvviiss ((aaxxssnnaa--ggaannmmaarrtteebbiiTTii mmeemmoorraanndduummii))

zzooggaaddii mmoossaazzrreebbeebbii

1. kacobriobis dasabamidan, yoveli sazogadoeba avadmyofi da

momakvdavi adamianebis daxmarebasa da maTTvis komfortis Seqmnas

cdilobda. Cveulebriv, adamianis gardacvalebas Tan axlavs Rrma

mowiweba da mistiuroba. gardacvalebis Semdgomi periodisaTvis

damaxasiaTebelia ritualebisa da tradiciuli wes-Cveulebebis

mkacri dacva. axlobeli adamianis dakargviT gamowveuli glovis

saWiroeba aRiarebulia umetesi sazogadoebebis mier, Tumca

glovis gamoxatva da misi xangrZlivoba sxvadasxva kulturaSi

gansxvavebulia.

2. avadmyofoba da sikvdili aris da yovelTvis iqneba adamianis

sasicocxlo gamocdilebis ganuyofeli nawili. is, Tu ramdenad

veswrafiT momakvdavisa da misi ojaxis wevrebis individualuri

saWiroebebis gansazRvrasa da maTze reagirebas, sazogadoebis

srulyofilebis mniSvnelovan maCvenebels warmoadgens. yovel

SesaZlo SemTxvevaSi xels unda vuwyobdeT daavadebis prevenci-

as. avadmyofobis SemTxvevaSi, ki unda vecadoT aRmovfxraT, an

ukidures SemTxvevaSi SevaferxoT misi progresireba. am

mcdelobaTa paralelurad fsiqologiur, emociur da sulier

daxmarebasTan erTad, pacientebs unda SevTavazoT tkivilisa da

simptomebis marTvis optimaluri done.

3. bolo 2 - 3 aTwleulis ganmavlobaSi damsaxurebuli yuradReba

eTmoba sicocxlis bolos mzrunvelobas. gamoica specifikuri

samedicino Jurnalebi, Camoyalibda organizaciebi profesionale-

bisa da araprofesionalebisaTvis (rogoricaa evropis paliatiu-

ri mzrunvelobis asociacia), daibeWda erovnuli politikis

rekomendaciebi, mag. irlandiis saxelmwifosa (paliatiuri

mzrunvelobis erovnuli sameTvalyureo komitetis 2001) da aSS-s

medicinis institutis (Field and Cassell 1997).

CM(2003)13020

mmookkllee iissttoorriiuullii mmiimmooxxiillvvaa

4. sazRvari sicocxlesa da sikvdils Soris aris kontiniumi

(janmrTelobasa da avadmyofobis monacvleoba), romelic arse-

bobs dabadebidan gardacvalebamde. sicocxleSi Cven vkvdebiT da

sikvdilisas gveZleva sicocxlis Sansi. mTels msoflioSi jan-

dacvisa da socialuri zrunvis programebi mimarTulia indivi-

debis, ojaxebisa da sazogadoebis daxmarebaze, raTa miRweuli

da SenarCunebuli iqnas sicocxlis optimaluri xarisxi. palia-

tiuri mzrunvelobis konteqstSi, rodesac sicocxlis

xangrZlivoba mkveTrad limitirebulia da vibrZviT darCenili

drois saukeTesod gamoyenebisaTvis, aRniSnuli sakiTxi xdeba

gadaudebeli da saswrafo.

5. kacobriobis dasabamidan avadmyofi da momakvdavi adamianebis dax-

marebas yoveli sazogadoeba cdilobda. Tumca, gasuli saukunis

Sua periodamde, samedicino mecnierebas Zalian cota ramis

SeTvazeba Tu SeeZlo tkivilis marTvisa da simptomebis kontro-

lis mxriv. me-20 saukunis 50-ian wlebSi momakvdavi pacientebis

fsiqologiuri da sulieri saWiroebebis ukeT gagebasTan

Serwymulma medikamenturi Terapiis ganviTarebam, gza gaukvala

paliatiuri mzrunvelobis samsaxurebis Camoyalibebas. paliati-

uri mzrunvelobis principebi ufro farTod iqna gagebuli da

gamoyenebuli saukunis meore naxevarSi.

6. Sua saukuneebSi, termini `hospisi~ piligrimebisa da mogzaure-

bis TavSesafris aRsawerad gamoiyeneboda. evropaSi, kavSiri pos-

pissa da momakvdavi pacientisaTvis gaweul daxmarebas Soris

ukavSirdeba 1842 wels frangi, lioneli qalbatonis J. garnies

saqmianobas. irlandiaSi, irlandieli mowyalebis debma, deda

meri aikenhedis TaosnobiT 1870 wels gaxsnes hospisi dublinSi

da korkSi, SemdgomSi 1905 wels londonSi. es dawesebulebebi

mWidrod iyo dakavSirebuli Sorswasuli da ukurnebeli seniT

daavadebul adamianebze mzrunvelobasTan. Tumca, tkivilisa da

sxva simptomebis marTvis mcdeloba ferxdeboda am simptomebis

CM(2003)130 21

bunebis arasakmarisi codniTa da efeqturi medikamentebis nakle-

bobis gamo.

7. 50-ian wlebSi moxda iseTi mniSvnelovani medikamentebis asorti-

mentis wardgena, rogoricaa fsiqotropuli nivTierebebi,

fenoTiazinebi, antidepresantebi da anTebis sawinaaRmdego ara-

steroiduli preparatebi. am droisaTvis arsebobda meti codna

kiboTi gamowveuli tkivilis bunebisa da mis marTvaSi opioide-

bis mniSvnelobaze. axali preparatebis misawvdomobam SesaZle-

beli gaxada tkivilisa da simptomebis ufro efeqturi marTva.

8. opioidebis gamoyenebis maCveneblebis mixedviT, arsebobda udide-

si winaaRmdegoba, romelic maTi aradaniSnulebisamebr gamoyene-

basa da dausabuTebeli SiSidan gamomdinareobda. gazviadebulma

wuxilma iseT sakiTxebTan mimarTebaSi, rogoricaa wamalze damo-

kidebulebis mavne Cveva, tolerantoba da sunTqvis garTuleba,

samedicino praqtikaSi maTi Sesaferisi gamoyeneba Seaferxa. aseT

SiSs Tanabrad iziarebda rogorc samedicino sazogadoebis bevri

warmomadgeneli, aseve mTlianad sazogadoeba. saxelmwifo done-

ze mniSvnelovani gaugebroba arsebobda aRniSnuli nivTierebebis

Terapiul rolsa da potenciur mavne damokidebulebas Soris.

zogierT qveyanaSi opioidebis gamoyeneba kanonmdeblobiT iyo

akrZaluli, sxva qveynebSi ki legalizebuli. Tumca, maTi misawv-

domoba daniSvnis, Senaxvisa da ganawilebis gadaWarbebulad

biurokratiuli marTviT ferxdeboda. sasicocxlo mniSvneloba

aqvs im faqts, rom Cven vswavlobT istoriis Secdomebze. ar

unda arsebobdes aranairi gaugebroba opioidebis klinikur

gamoyenebasa da maTze potenciur mavne damokidebulebas Soris.

9. Tanamedrove hospisisa da paliatiuri mzrunvelobis evolucia

mniSvnelovnad ganapiroba deim sisli saundersis xedvam, gambeda-

obam da pasuxismgeblobam. iyo ra eqTani, socialuri muSaki da

eqimi, igi miCneuli da aRairebulia Tanamedrove hospisuri

moZraobis pionerad. muSaobda ra ramodenime weli londonSi,

wminda jozefis saxelobis hospisSi, deim sislim 1967 londonSi

daaarsa wminda kristoferis sax. hospisi. es iyo pirveli

CM(2003)13022

Tanamedrove saswavlo-kvleviTi hospisi. deim sislim Tavisi pro-

fesiuli da piradi cxovreba Sorswasuli da progresirebadi

seniT daavadebul pacientebze zrunvasa da Seswavlas miuZRvna.

man gansazRvra da pasuxi ipova im naklovanebebze, romelic

momakvdavi adamianisa da misi ojaxis wevrebis saWiroebebis

dakmayofilebaSi arsebobda. igi aqcents akeTebda yoveli pacien-

tisa da misi ojaxis saWiroebebze. deim sisli saundersma gvas-

wavla pacientze, ojaxze mzrunveloba da namdvili interdisci-

plinuri gunduri muSaobis saWiroeba. saocrad mokle droSi man

gardaqmna jandacvis es sfero da eWvqveS daayena mravali nega-

tiuri midgoma da crurwmena. mokled rom vTqvaT, man moaxdina

Zireuli cvlilebebi imaSi, Tu rogor vpasuxobT momakvdavi

pacientebisa da maTi ojaxebis sxvadasxva saWiroebas.

10. wminda jozefis saxelobis hospisi yovelTvis iRwvoda jandacis

dawesebulebebSi paliatiuri mzrunvelobis principebis popu-

larizaciisaTvis. codnisa da gamocdilebis gavrcelebis es

enTuziazmi vrceldeboda ara marto gaerTianebul samefoze, ara-

med mTels msoflioSi. msoflios yvela kontinentidan jandac-

vis profesionalebi swavlobdnen wminda jozefis hospisSi da

axlad miRebul codnasa da Cvevebs iyenebdnen sakuTar qveynebSi.

ar arsebobs paliatiuri mzrunvelobis erTi modeli, romelic

misaRebia yvela situaciisaTvis. Tumca, paliatiuri mzrunvelo-

bis ZiriTadi principebi, romlebic gansakuTrebul mniSvnelobas

yoveli pacientisa da misi ojaxis saWiroebebs aniWeben, univer-

saluria. is, Tu rogor xdeba am amocanebis Sesruleba, gansxvav-

deba ara marto qveynebs, aramed SesaZloa regionebs Sorisac.

11. rodesac ganvixilavT paliatiuri mzrunvelobis ganviTarebas

msoflios sxvadasxva qveyanaSi, aRsaniSnavia Tu ra didi gavle-

nis moxdena SeuZlia Tundac erT motivirebul pirovnebas.

Cveulebriv, erT pirovneba, romelic acnobierebs, rom arsebobs

mzrunvelobis ukeTesi gza, axdens cvlilebis stimulirebas.

xSirad, piradi gamocdilebis gamo, es pirovneba moqmedebs

rogorc katalizatori da sxvebsac ganawyobs cvlilebebis

ganxorcielebisaTvis. ar aris SesaZlebeli an swori sxvadasxva

CM(2003)130 23

qveyanaSi paliatiuri mzrunvelobis ganviTarebis katalogis

Sedgena. sakmarisia imis Tqma, rom paliatiuri mzrunvelobis sam-

saxurebi amJamad viTardeba yvela kontinentze, Tumca sxvadasx-

va tempiTa da xarisxiT.

12. paliatiuri mzrunveloba ar niSnavs institucionalur mzrunve-

lobas. mniSvnelovanwilad, igi warmoadgens mzrunvelobis filo-

sofias, romelic misaRebia mzrunvelobis yvela dawesebu-

lebisaTvis. Cveulebriv, Cven vxvdebiT Temze dafuZnebul gun-

debs, romelic mzrunvelobas axorcielebs binaze, an moxuce-

bulTa saxlSi. aseve, Cven vxvdebiT paliatiuri mzrunvelobiT

uzrunvelyofas zogadi profilis saavadmyofoebSi. idealur

SemTxvevaSi, pacientebs eqnebaT arCevani da saSualeba Tavad

airCion mzrunvelobis adgili, mag. saxli, hospisi, saavadmyofo.

SesaZlebelobis SemTxvevaSi pacientebs unda SeeZloT mzrunve-

lobis miReba sxvadasxva dawesebulebaSi, maTi klinikuri

saWiroebebisa da sakuTari arCevanidan gamomdinare.

13. garkveuli drois Semdeg hospisis pacientebisa da maTi ojaxe-

bis konkretuli saWiroebebi yvela kontinentis jandacvis pro-

gramebis yuradRebis centrSi eqceva da iwvevs diskusias. maSin,

rodesac paliatiuri mzrunvelobis ZiriTadi principebi univer-

saluria, dadgenili amocanebis miRwevis meTodebi sxvadasxva

qveyanaSi SesaZloa gansxvavdebodes. yovel qveyanaSi, sakuTari

specifikuri saWiroebebis Sefaseba da Sesabamisi dagegmva warmo-

adgens jandacvis organizatorTa pasuxismgeblobis sakiTxs.

paliatiuri mzrunvelobis samsaxurebis samomavlo dagegmvasTan

mimarTebaSi, unda gaviTvaliswinoT warsulis gakveTilebi.

nebismieri mcdeloba fokusirebuli unda iqnas yoveli pacien-

tisa da misi ojaxis wevrebis sicocxlis optimaluri xarisxis

miRwevasa da SenarCunebaze. individualuri, instituciuri da

jgufuri dRis ganawesebi unda eqvemdebarebodes pacientebisa da

maTi ojaxebis saWiroebebs.

CM(2003)13024

ppaalliiaattiiuurrii mmzzrruunnvveelloobbiiss zzooggiieerrTTii

mmoonnaacceemmii eevvrrooppuull qqvveeyynneebbSSii

14. bolo drois kvlevebi gvawvdian monacemebs evropis qveynebSi

paliatiuri mzrunvelobis ganviTarebis msgavsebebsa da gansxva-

vebebze. aRmosavleT evropisa da centraluri aziis 28 qveynis

kvlevebSi, raodenobrivi da xarisxobrivi meTodebis gamoyenebiT

naTeli gaxda, rom arsebobs mniSvnelovani gansxvaveba sxvadasx-

va qveyanaSi paliatiuri mzrunvelobis misawvdomobaSi da aseve

mniSvnelovani msgavseba im interessa da energiaSi, rac palia-

tiuri mzrunvelobis samsaxurebis daarsebas eTmoba (Clark &Wright 2002).

15. poloneTsa da ruseTs gaaCniaT paliatiuri mzrunvelobis sam-

saxurebis yvelaze didi raodenoba; zogierT yofil sabWoTa

respublikas saerTod ar gaaCnia msgavsi samsaxurebi. aRmosavleT

evropaSi, binaze movla aris paliatiuri mzrunvelobis yvelaze

gavrcelebuli forma, rasac mosdevs stacionaruli paliatiuri

mzrunveloba; aRmoCnda, rom gacilebiT iSviaTia saavadmyofos

gundi, dRis movlis centri, moxucebulTa saxlis gundebi. kvle-

vis Sedegad ganisazRvra xuTi e.w. `Suqura~ (sabaziso centri)

oTx qveyanaSi (rumineTi, ungreTi, poloneTi (2) da ruseTi); es

centrebi istoriulad Zalian mniSvnelovani iyo paliatiuri

mzrunvelobis ganviTarebisaTvis da dResac jer kidev asrule-

ben eqspertizis centris rols.

16. kvlevis Sedegad ganisazRvra aRmosavleT evropis qveynebisaTvis

saerTo ramodenime mniSvnelovani problema:

- politikis oficialuri aRiarebis, dafinansebisa da sicocx-

lisunarianobis nakleboba;

- opioidebis arasakmarisi misawvdomoba;

- samuSao Zalis dasaqmeba;

- samedicino da saeqTno aRWurvilobis nakleboba;

- kvlevis arasakmarisi SesaZleblobebi;

- negatiuri kulturuli stereotipebi.

CM(2003)130 25

17. `palium~ kvlevam, romelic dafinansebuli iqna evro komisiis

mier, ganixila aRmosavleT evropis qveynebis paliatiuri mzrun-

velobis koncefciebi da masTan dakavSirebuli moqmedebis gzebi.

(Ten Have & Jansenns 2002)

18. holandiaSi, 70-ian wlebSi paliatiuri mzrunvelobis specifiku-

ri proeqtebis dawyebis pioneri gaxda roterdamis moxucebulTa

saxli (msgavsad `Suqurisa~). zemoTaRniSnuli kvlevis mixedviT,

holandiaSi paliatiuri mzrunvelobis udides nawils binaze

movla warmoadgenda, romelsac axorcielebdnen moxucebulTa

saxlisa da Cveulebrivi momvlelebi. hospisebi paliatiuri

mzrunvelobis mcired nawils Seadgendnen ; arsebobs gansxvaveba

`dabali~ da `maRali~ zrunvis hospisebs Soris: pirveli umete-

sad imarTeba moxaliseebis mier, xolo ukanasknelSi ki metia

profesionalTa wvlili.

19. 1998 wels saxelmwifos mier miRebuli iqna gadawyvetileba pali-

atiuri mzrunvelobis ganviTarebis centrebis akademiur samedi-

cino centrebSi CarTvis programis sasargeblod. holandiaSi

politika mimarTulia hospisebis profesionalur jandacvis

sistemaSi integrirebaze. aseTi ganviTarebis Sedegs warmoadgens

samedicino saswavleblebis gazrdili interesis maCvenebeli

niSnebi: kvalifikaciis amaRlebis treningebisa da uwyveti sam-

edicino ganaTlebis programebi. moxucebulTa saxlebma daiwyes

paliatiuri mzrunvelobis ganyofilebebis gaxsna sakuTar

Senobebsa da maT teritoriaze mdebare sxva specifikur

SenobebSi.

20. tradiciulad, keTdeba ra aqcenti binaze movlis formaze,

holandiaSi yuradReba maxvildeba zogadi praqtikis eqimebis

treningebsa da daxmarebaze, rasac sxva SedegebTan erTad mTel

qveyanaSi mobiluri sakonsultacio gundebis qselis SeqmnasTan

mivyavarT. 2000 wlidan moqmedebs volontiorTa daxmarebis sax-

elmwifo programa, romelic ZiriTadad koordinaciasa da tre-

ningebs exeba.

CM(2003)13026

21. `palium~ kvlevam gamoavlina, rom belgiaSi saxelmwifom gamos-

ca ramodenime samefo brZaneba, sadac sxva sakiTxebTan erTad

miTiTebulia, rom yovel saavadmyofosa Tu moxucebulTa saxls

unda hyavdes paliatiuri mzrunvelobis multiprofesiuri

gundi; aseve miTiTebulia is profesiebi, romelic am jgufebSi

unda iqnas warmodgenili. meore mxriv, akeTebdnen ra aqcents

paliatiuri mzrunvelobis jandacvis saerTo sistemaSi integri-

rebaze da binaze movlis samsaxurebis ganviTarebaze, profesio-

naluri organizaciebi TanamSromlobdnen regionalur da erov-

nul mTavrobebTan.

22. SvedeTSi, specializirebuli paliatiuri mzrunvelobis ganviTa-

reba daiwyo 1977 wels qveynis samxreTSi binaze dafuZnebuli

hospisis programidan; Semdgom aTwleulSi es modeli gavrcel-

da mTel qveyanaSi. 1979 wels SvedeTis mTavrobam Tavis angariSSi

araorazrovnad uaryo momakvdavi adamianebisaTvis gancalkevebu-

li dawesebulebebis arseboba (Fürst 2000)

23. germaniaSi, paliatiuri mzunvelobis organizeba daiwyo germanu-

li sazogadoebis sensibilizaciis periodidan, 1983 wels, pirve-

li paliatiuri palatis daarsebiT, rasac moyva sxvadasxva hos-

pisebisa da saxelmwifo iniciativebi paliatiuri mzrunvelobis

12 dawesebulebis daarsebis Sesaxeb.

24. espaneTSi, `palium~ kvlevis mixedviT, iseve rogorc sxva

qveynebSi paliatiuri mzunvelobis ganviTareba ar dawyebula

Zireuli hospisuri moZraobidan. procesi inicirebuli iqna jan-

dacvis saxelmwifo sistemis mier; pirveli centrebi ganlagebu-

li iyo specializirebul saavadmyofoebSi. 2000 wels paliatiu-

ri mzrunvelobis saxelmwifo gegmaSi moxseniebulia paliatiu-

ri mzrunvelobis 241 dawesebuleba. maTgan naxevars binaze mov-

lis samsaxuri Seadgens, romelic yovelwliurad 23000 paci-

ents uwevs mzrunvelobas. Tumca, arian ra qveyanaSi araTanabrad

ganawilebuli, aRniSnuli dawesebulebebi srulad ver akmayofi-

leben mosaxleobis saWiroebebs.

CM(2003)130 27

25. gaerTianebuli samefo specifikuri paliatiuri mzrunvelobis

samsaxurebis akvnad aris miCneuli. kvlevis ingliseli monawi-

leebi aRniSnaven, rom Zlieri britanuli hospisuri moZraoba

yovelTvis rCeboda jandacvis erovnuli sistemis gareT, rac am-

cirebda mis SesaZleblobas èqadaga~ misi midgomebi sistemis

SigniT. paliatiuri medicina mravali wlis manZilze iyo

aRiarebuli medicinis erT-erT dargad da amdenad misi akademi-

uri statusi sakmaod myaria. Tumca qveyanaSi paliatiuri mzrun-

velobis dafinanseba umetesad jer kidev kerZo seqtoris mier

xdeba.

26. italiaSi paliatiuri mzrunvelobis ganviTareba daiwyo 70-iani

wlebidan, rasac mTel qveyanaSi hospisebis didi raodenobiT

daarseba moyva; bolo periodSi italiis mTavrobam paliatiur

mzrunvelobas gansakuTrebuli adgili miakuTvna jandacvis sax-

elmwifo gegmaSi.

27. 1999 wlis bolosaTvis, `palium~ proeqtis monawile Svidi qvey-

nis mier warmodgenili iqna Semdegi suraTi:

28. SveicariaSi, jandacvis organizebaze sxvadasxva olqSi sxvadasx-

va aqcenti keTdeba. Sveicariis frangulenovani olqebis mTav-

CM(2003)13028

belgia germania italianider-

landebiespaneTi SvedeTi

gaerTiane

buli

samefo

mosaxleoba

(milionebSi)10.1 81.9 57.4 15.6 40 8.8 57.1

stacionaruli

hospisi1 64 3 16 1

{ 69 { 219stacionaruli

ganyofileba49 50 0 2 23

saavadmyofo

da moxucebulTa

saxlis gundebi

55 1 0 34 45 41 336

binaze movla 45 582 88 286 75 67 355

dRis movlis

centri2 9 0 0 0 13 248

roba CarTulia paliatiur mzrunvelobaSi, xolo germanuleno-

van da italiurenovan olqebSi, paliatiuri mzrunveloba kerZo

iniciativad aris miCneuli. 2000 wlisaTvis qveyanas gaaCnia 9

stacionaruli ganyofileba, 6 hospisi, 6 binaze movlis da 5 saa-

vadmyofos mobiluri gundebi (2 maTgani sauniversiteto klini-

kaSi). medicinisa da paliatiuri mzrunvelobis sazogadoebis

2000 wlis angariSis Tanaxmad, paliatiuri mzrunvelobis swav-

leba samedicino da saeqTno saswavleblebSi Zalian gansxvavebu-

lia; paliatiuri mzrunvelobis swavlebas sul eTmoba 8 saaTi;

ar tardeba gamocda, ganaTleba Zalian cvalebadia.

29. Sveicariis zemoTxsnebul angariSSi miTiTebulia ramodenime spe-

cifikuri barieri. maTgan pirvelia qveynis federaluri struq-

tura, romelic uaryofiT gavlenas axdens paliatiuri mzrunve-

lobis ganviTarebaze mimarTul aqtivobebsa da maT koordinacia-

ze; meore bariers warmoadgens specializaciis ar arseboba im

motiviT, rom, TiTqosda `Cven yvelam viciT ra aris paliatiuri

mzrunveloba~. mesame barieria biujetis SezRudvebi, romelic

aferxebs jandacvis iseTi axali sferos ganviTarebas, rogori-

caa paliatiuri mzrunveloba.

30. binaze movlis specifikuri sakiTxebi:

- tradiciulad mraval regionSi Seicvala ojaxis struqtura;

- bevri xandazmuli adamiani cxovrobs marto da ver iqneba

ojaxis daxmarebis imedad;

- seriozulad daavadebulTa 50% upiratesobas aniWebs saxlSi

darCenas

- xSirad mTavar winaaRmdegobas warmoadgens finansuri resur-

sebis nakleboba

31. angariSSi miTiTebulia ramodenime SemaSfoTebeli momenti: war-

matebis sawyisi periodis Semdeg, SeicariaSi moxda paliatiuri

moZraobis blokireba. darCa ra ramodenime `pioneris~ pirad

iniciativad, dargma Semdgomi ganviTareba ver ganicada. Tumca,

zogierT olqSi (gansakuTrebiT vaudSi) paliatiuri mzrunvelo-

ba viTardeba yvela profesionalis konsensusis safuZvelze, rac

CM(2003)130 29

rTuli, magram gadamwyvetia. aseve SeSfoTebas iwvevs sazogado-

ebis jer kidev arasakmarisi informireba, rac ara mxolod

SveicariisaTvisaa damaxasiaTebeli.

32. ungreTSi, bolo wlebSi paliatiuri mzrunveloba mniSvnelovnad

ganviTarda. 1997 wels SemuSavda janmrTelobis dacvis kanoni,

romelic moicavda ra paliatiuri mzrunvelobis detalurad

damuSavebul rekomendaciebs, oficialurad aZlevda pacientebs

simptomebis marTvisa da naTesavebis wreSi cxovrebis uflebas;

kanonSi aRniSnulia, rom SesaZleblobis SemTxvevaSi, SeTavazebu-

li unda iqnas binaze movla, xolo naTesavebisa da ojaxis wev-

rebis mxardaWera da sulieri daxmareba misawvdomi unda iyos

yvelasaTvis.

33. jandacvis saministrosa da hospis-paliatiuri asociaciis mier

momzadda da gavrcelda profesionaluri saxelmZRvanelo, rom-

lis sruli versia arcTu didi xnis win daibeWda.

34. 2001 wlis seqtemberSi, daiwyo hospisis eqTnebisa da koordi-

natorTa erTwliani saswavlo programa. 2001 wlisaTvis qveynis

gankargulebaSi iyo 4 hospisi (sul 55 sawolze); 14 binaze mov-

lis gundi; 2 dRis movlis centri; 2 mobiluri gundi

(budapeStSi); ganyofilebebi 5 moxucebulTa saxlSi.

35. umaRles samedicino saswvleblebis studentebis programaSi 10

saaTi daTmobili aqvs tkivilisa da simptomebis marTvas,

daaxloebiT 30 saaTi fsiqo-socialur sakiTxebs. saeqTno sas-

wavleblebSi arsebobs kvalifikaciis amaRlebis 80 saaTiani tre-

ning kursi; aseve kvalifikaciis amaRlebis trening kursi

eqimebisaTvis.

36. avstriaSi, 3 wlis win jandacvis politikis mier ganxiluli

iqna paliatiuri mzrunveloba da SemuSavebuli iqna gegma, sadac

miTiTebulia paliatiuri sawolebis saWiro raodenoba, romelTa

3/4-i misawvdomi iqneba 2005 wlisaTvis.

CM(2003)13030

37. avstriaSi paliatiuri mzrunveloba ar aris aRiarebuli speci-

alobad da specifikur kvalifikaciad. sul arsebobs 8

hospisi/ganyofileba, mTlianad 100 sawolze (2001).

38. 1998 wlidan paliatiuri mzrunvelobis sakiTxebze treningi war-

moadgens eqTnebis saswavlo programis (kurikulumis) nawils.

xolo 2002 wlidan is gaxda eqimTa saswavlo programis nawili;

specialistTa trening programebSi, mciredi, Tumca mzardi

yuradReba eqceva paliatiur mzrunvelobas.

39. SeSfoTebis mizezs warmoadgens stacionaruli da binaze movlis

gundebis dafinanseba, ramdenadac jer kidev didia damokidebule-

ba SedarebiT arastabilur damxmare dafinansebaze.

ggaannssaazzRRvvrreebbeebbii ddaa ZZiirriiTTaaddii

pprriinncciippeebbii

40. rogorc aRniSnulia rekomendaciaSi, dokumentebSi gamoyenebulia

1991 - 2002 wlebSi paliatiur mzrunvelobasTan dakavSirebiT

janmo-s (jandacvis msoflio organizacia) mier mowodebuli da

paliatiuri mzrunvelobis sferos mier farTod mxardaWerili

gansazRvrebebi da aRwerilobebi.

41. gansazRvrebebisa da principebis ganxilvamde mniSvnelovania

aRvniSnoT, rom paliatiuri mzrunveloba ar unda iqnas miCneuli

jandacvis sxva sferoebisa da formebisagan Zireulad gansxvave-

bul sferod. aseTi Zireuli gansxvaveba ara marto gaarTulebs,

aramed SeuZlebelsac gaxdis mis jandacvis saerTo sistemaSi

integrirebas. paliatiuri mzrunvelobis bevri sakvanZo sakiTxi

aseve exeba kuraciul medicinasac. meore mxriv, akeTebs ra

aqcents zogierT iseT arasaTanadod Sefasebul elementze,

rogoricaa sulieri problemebi, paliatiuri mzrunvelobis

ganviTarebam SesaZloa dadebiTi gavlena iqonios jandacvis sxva

dargebzec.

CM(2003)130 31

ggaannssaazzRRvvrreebbeebbii

42. paliatiuri mzrunvelobis gansazRvreba viTardeboda wlebis

manZilze, ramdenadac Tavad dargi viTardeboda sxvadasxva

qveyanaSi. paliatiuri mzrunveloba ganisazRvreba ara

organosTan, asakTan, daavadebis tipsa an paTologiasTan

mimarTebaSi, aramed SesaZlo prognozis Sefasebis, yoveli paci-

entisa da misi ojaxis wevrebis specifikuri saWiroebebis

gaTvaliswinebiT. tradiciulad, paliatiuri mzrunveloba

saWirod iTvleboda mxolod im momentSi, rodesac sikvdili gar-

dauvali xdeboda. dRes miCneulia, rom paliatiur mzrunvelobas

gacilebiT metis SeTavazeba SeuZlia progresirebadi daavadebis

mimdinareobis adreul etapze.

43. termini paliatiuri mzrunveloba warmoiSva laTinuri `paliu-

mi`-sagan, rac niSnavs `niRabs~, `mantias~. aseTi etimologia

miuTiTebs, rom paliatiuri mzrunveloba ZiriTadad warmoadgens

ukurnebeli daavadebis efeqtis SeniRbvas an `mantiiT maT dac-

vas, vinc siciveSi darCa~, maSin, rodesac SeuZlebelia daxmare-

ba kuraciuli medicinis saSualebiT.

44. paliatiuri mzrunveloba moicavs yvela saxis paliatiur

Carevas, rac gulisxmobs daavadebis marTvaze mimarTul

Terapiebs: rogoricaa qirurgia, radioTerapia, qimioTerapia,

hormonaluri manipulaciebi da a.S. yvela aseTi Carevis saboloo

amocanas warmoadgens pacientis maqsimaluri reabilitacia da

sicocxlis saukeTeso xarisxis miRweva. amdenad, sasicocxlo

mniSvneloba aqvs paliatiuri mzrunvelobis programebis srul

integrirebas saavadmyofoebsa da saTemo dawesebulebebSi arse-

bul jandacvis programebSi. Sesabamisi mkurnalobis gansaxorci-

eleblad, individualurad, xSiri intervalebiT unda Catardes

mzrunvelobis rogorc simptomuri, aseve daavadebis marTvaze

mimarTuli RonisZiebebis Sedegebis Sefaseba, raTa SemuSavebuli

iqnas mkurnalobis optimaluri sqema.

CM(2003)13032

45. msoflio jandacvis organizacia iZleva paliatiuri mzrunvelo-

bis Semdeg gansazRvrebas: `paliatiuri mzrunveloba aris sru-

lyofili, efeqturi mzrunveloba pacientze maSin, rodesac daa-

vadeba aRar eqvemdebareba mkurnalobas. umTavresi xdeba tkivi-

lisa da sxva simptomebis, fsiqologiuri, socialuri da suli-

eri problemebis kontroli. paliatiuri mzrunvelobis mizania

pacientebisa da maTi ojaxis wevrebis sicocxlis xarisxis gaum-

jobeseba~. (janmo 1990 w.)

46. aseTi gansazRvreba misaRebia, ramdenadac akeTebs ra aqcents ada-

mianis mdgomareobis mravalaspeqtovan bunebaze, igi orientire-

bulia pacientze da sicocxlis xarisxis gaumjobesebas ganixi-

lavs mTavar amocanad. zogierTi qronikuli mdgomareobis gan-

kurnebis SeuZleblobis gamo termini `kuraciuli~-s gamoyeneba

gaumarTlebelia, Tumca mravali aTwleulis ganmavlobaSi igi

sicocxlis molodins ukavSirdeba.

47. situacia ganmarta doilma, rodesac dawera, rom `paliatiuri~

mzrunveloba fokusirebulia sicocxlis im ukanasknel wlebsa

Tu Tveebze, rodesac sikvdili ufro mosalodnelia vidre

SesaZlebeli.

48. janmos bolo periodis gansazRvrebebSi meti aqcenti keTdeba

tanjvis prevenciaze:

`paliatiuri mzrunveloba aris midgoma, romelic simptomTa

prevenciiTa da tanjvis SemsubuqebiT, adreuli aRmoCenis, Sefasebis,

tkivilis an sxva fizikuri, fsiqologiuri da sulieri probleme-

bis mkurnalobis gziT aumjobesebs ukurnebeli seniT Sepyrobili

pacientebisa da maTi ojaxis wevrebs sicocxlis xarisxs.~

paliatiuri mzrunvelobis principebi

uaxlesi gansazRvrebis danarTis saxiT, janmo-m SeimuSava ZiriTadi

principebi, romlis mixedviTac paliatiuri mzrunveloba:

- uzrunvelyofs tkivilisa da sxva simptomebis Semsubuqebas;

CM(2003)130 33

- ganamtkicebs sicocxles da ganixilavs sikvdils normalur

procesad;

- miznad ar isaxavs sikvdilis daCqarebas an gadavadebas;

- axdens pacientze mzrunvelobis fsiqologiuri da sulieri

aspeqtebis integrirebas;

- gvTavazobs pacientis daxmarebisa da gardacvalebamde aqtiu-

ri cxovrebis wesis SenarCunebis sistemas;

- gvTavazobs ojaxebisaTvis pacientis avadmyofobis periodSi

Seguebisa da gardacvalebiT gamowveuli mZime danakargis

dros daxmarebis sistemas;

- pacientebisa da maTi ojaxebis saWiroebaTa dakmayofi-

lebisaTvis, maT Soris mZime danakargis Sedegad saWiro kon-

sultaciebis CaTvliT, gamoiyenebs gundur midgomas;

- aumjobesebs sicocxlis xarisxs da SesaZlo dadebiT gavle-

nas axdens avadmyofobis mimdinareobaze.

- misaRebia avadmyofobis adreul etapze sicocxlis gaxan-

grZlivebaze mimarTul sxva iseT TerapiebTan kavSirSi, rogo-

ricaa qimioTerapia, sxivuri Terapia; moicavs klinikuri

garTulebebis ukeT gaazrebisa da marTvisaTvis saWiro kvle-

vas.

50. sasurvelia aRniSnuli ZiriTadi principebis Semdgomi dakonkre-

teba.

� paliatiuri mzrunveloba did mniSvnelobas aniWebs tkivilisa

da sxva simptomebis marTvis optimaluri donis miRwevasa da

SenarCunebas. es moiTxovs yoveli pacientis detalur Sefasebas,

rac moicavs avadmyofobis anamnezs, fizikalur gasinjvas da

Sesabamis gamokvlevas. pacientebisaTvis misawvdomi unda iyos

yvela saWiro medikamenti, maT Soris opioidebis farTo speqtri,

rogorc es formulirebaSia mocemuli. moTxovnis SemTxvevaSi

aseve misawvdomi unda iyos daavadebis marTvaze mimarTuli

Terapiebi, romelTac aseve SeuZliaT sasargeblo simptomuri

sargeblobis motana.

CM(2003)13034

� paliatiuri mzrunveloba ganamtkicebs sicocxles da ganixilavs

sikvdils normalur procesad. es ZiriTadi principi mimarTulia

paliatiuri mzrunvelobasadmi damokidebulebis sirTuleebis

gaazrebaze. ZiriTadad, erTi ram, rasac yvela viziarebT aris

is, rom sikvdili gardauvalia. pacientebi, romelTac paliatiu-

ri mzrunveloba esaWiroebaT, ar unda CaiTvalon `medicinis

marcxad~. paliatiuri mzrunveloba eZiebs gzebs, raTa gaamxnevos

pacientebi da uzrunvelyos sasargeblo, aqtiuri cxovrebis

wesis SenarCuneba gardacvalebamde.

� paliatiuri mzrunveloba miznad ar isaxavs sikvdilis daCqare-

bas an gadavadebas. paliatiuri mzrunveloba ar aris da ar unda

iyos mimarTuli sicocxlis droze adre dasrulebaze. aseve

mniSvnelovania, rom Tanamedrove samedicino praqtikaSi arsebu-

li teqnologiebi ar gamoiyenebodes sococxlis arabunebrivi

gziT gagrZelebisaTvis. eqimebi ar unda iyvnen iZulebulni

ganagrZon mkurnaloba maSin, rodesac igi aSkarad usargeblo da

pacientisaTvis zedmetad mZimea. paliatiuri mzrunvelobis amo-

canas warmoadgens pacientisaTvis sicocxlis saukeTeso xarisx-

is uzrunvelyofa. im momentisaTvis, rodesac avadmyofobis pro-

cesi uaxlovdeba bunebriv bolos, pacients saSualeba unda hqon-

des miiRos srulyofili fizikuri, emociuri da sulieri daxma-

reba. gansakuTrebuli yuradReba eTmoba im faqts, rom paliati-

uri mzrunvelobis arcerTi ganmarteba ar moicavs eftanazias da

eqimis daxmarebiT ganxorcielebul suicids. aRniSnulis gamo am

sakiTxze komiteti ar SeCerebula. ix. Tavi VIII

� paliatiuri mzrunveloba aerTianebs pacientze zrunvis fsiqo-

logiur da sulier aspeqtebs. ra Tqma unda sasicocxlo

mniSvneloba aqvs fizikuri movlis maRal xarisxs, magram

TavisTavad es sakmarisi ar aris. adamianis pirovneba ar unda

davakninoT martiv biologiur yofamde.

� paliatiuri mzrunveloba gvTavazobs mxardaWeris sistemas,

romelic daexmareba pacients sicocxlis bolomde SeinarCunos

CM(2003)130 35

maqsimalurad aqtiuri cxovrebis wesi. amasTan mimarTebaSi

mniSvnelovania imis aRniSvna, rom miznebsa da prioritetebs

gansazRvravs Tavad pacienti. jandacvis profesionalebis rols

ki warmoadgens pacientebisaTvis daxmarebis gaweva maTi miznebis

miRwevaSi. naTelia, rom garkveuli drois Semdeg yoveli pacien-

tis prioriteti SeiZleba sakmaod dramatulad Seicvalos. jan-

dacvis profesionalebs unda esmodeT aseTi cvlilebebi da

Sesabamisad reagirebdnen maTze.

� paliatiuri mzrunveloba exmareba ojaxs pacientis avadmyofoba-

sa da gardacvalebasTan SeguebaSi. paliatiur mzrunvelobaSi

ojaxi aseve warmoadgens mzrunvelobis obieqts. ojaxis wevrebs

SesaZloa gauCndeT garkveuli sirTuleebi, risi gamovlenis Sem-

deg maT daxmareba unda gaewioT. mZime danakargis Semsubuqe-

bisaTvis, daxmareba ar unda daiwyos mxolod pacientis gardac-

valebis momentidan ix. Tavi VIII.

� paliatiuri mzrunveloba saWiroebs koordinirebul gundur

muSaobas. aRniSnuli dasturdeba imiTac, rom arcerT pirovneba-

sa da arcerT disciplinas ar ZaluZs adekvaturi pasuxi gasces

yvela im rTul sakiTxs, romelic Cveulebriv paliatiuri mzrun-

velobis periodSi wamoiWreba. da Tumca xSirad eqimisa da

eqTnis SemadgenlobiT momuSave ZiriTad gunds SeuZlia aucile-

beli mzrunvelobis uzrunvelyofa, xSir SemTxvevaSi saWiro

xdeba medicinis da masTan dakavSirebuli sxvadasxva specia-

listis monawileoba. aseTi gundis SeTanxmebuli muSaobisaTvis

aucilebelia miznebis, amocanebis ganawileba da aseve komunika-

ciis efeqturi da swrafi saSualebebis arseboba. ix. Tavi VIII.

� paliatiuri mzrunveloba miznad isaxavs sicocxlis xarisxis

gaumjobesebas. bolo wlebSi ̀ sicocxlis xarisxi~-s sakiTxi mra-

vali kvlevis sagani gaxda. mniSvnelovania vaRiaroT, rom igi ar

warmoadgens mxolod fizikuri komfortisa da funqcionirebis

sazoms, aramed aris is `raRac~, risi ganmartebac mxolod

TiToeul pacients SeuZlia da rac, SesaZloa mniSvnelovnad

Seicvalos droTa ganmavlobaSi.

CM(2003)13036

� paliatiuri mzrunveloba misaRebia daavadebis adreul period-

Sic, daavadebis marTvasa da sicocxlis gamaxangrZlivebel sxva

TerapiebTan kavSirSi. istoriulad, paliatiuri mzrunveloba

asocirdeboda sasikvdilod ganwirul onko pacientebze mzrun-

velobasTan. aRiarebulia, rom paliatiur mzrunvelobas gaci-

lebiT metis SeTavazeba SeuZlia pacientebisa da maTi ojaxis

wevrebisaTvis daavadebis adreul etapebze, Tundac im momenti-

dan, rodesac daavadeba ukurnebeli xdeba da misi progresirebis

SeCereba SeuZlebelia. yovelive aRniSnuli moiTxovs, rom pali-

atiuri mzrunveloba integrirebuli iqnas jandacvis samsaxure-

bis speqtrSi saavadmyofoebsa da Temze dafuZnebul dawesebu-

lebebSi.

51. rogorc zemoTmoyvanili gansazRvrebebidan xdeba naTeli, palia-

tiuri mzrunveloba ar Semoifargleba romelime konkretuli

daavadebiT. efuZneba ra SesaZlo prognozsa da konkretul

saWiroebebs, igi potenciurad misaRebia yvela asakis pacienti-

saTvis.

52. terminaluri mzrunveloba aris paliatiuri mzrunvelobis kon-

tiniumi da aRwers pacientis mdgomareobis marTvas maSin, rode-

sac sikvdili gardauvali xdeba da ramodenime saaTSi an dReSia

mosalodneli. araswori da umarTebuloa am terminis gamoyeneba

paliatiuri mzrunvelobis yvela elementis aRwerisaTvis.

53. paliatiuri medicina aris adekvaturi samedicino mzrunveloba

daavadebis aqtiuri, progresirebadi, Sorswasuli formis mqone

pacientze, romlis prognozi SezRudulia da mzrunvelobis

mTavar fokuss sicocxlis xarisxi warmoadgens. paliatiuri

medicina moicavs ojaxis interesebis gaTvaliswinebas pacientis

gardacvalebamde da Semdgom.

CM(2003)130 37

ppaalliiaattiiuurrii mmzzrruunnvveelloobbiiss mmiiddggoommaa.. jandacvis yvela profesionali

unda icnobdes paliatiuri mzrunvelobis umTavres principebs da

saTanadod iyenebdes maT.

zzooggaaddii ppaalliiaattiiuurrii mmzzrruunnvveelloobbaa.. aRiarebulia, rom jandacvis

zogierTma profesionalma, romelic eqskluziurad ar aris

CarTuli praqtikul paliatiur mzrunvelobaSi, unda gaiaros

damatebiTi treningi da kvalifikaciis amaRlebis kursi paliatiu-

ri mzrunvelobis sferoSi. termini ̀ zogadi paliatiuri mzrunvelo-

ba~ gamoiyeneba aseTi personalis saqmianobis aRwerisaTvis.

ssppeecciiaalliizzeebbuullii ppaalliiaattiiuurrii mmzzrruunnvveelloobbaa.. specializebuli palia-

tiuri mzrunvelobis samsaxurebis ZiriTadi saqmianoba Semoifar-

gleba paliatiuri mzrunvelobis uzrunvelyofiT. aseTi samsaxure-

bi Cveulebriv CarTuli arian gansakuTrebulad rTuli

saWiroebebisa da moTxovnebis mqone pacientebze mzrunvelobaSi.

amdenad, maTTvis saWiroa ganaTlebis ufro maRali xarisxi,

profesionalTa Stati da resursebi.

CM(2003)13038

54. maSinac ki, rodesac e.w. aqtiuri, daavadebis marTvaze mimarTuli

mkurnaloba aRar aris efeqturi, paliatiuri mzrunveloba

SeiZleba iyos mzrunvelobis Zalian aqtiuri, intensiuri Tera-

piis eqvivalenturi forma, Tumca gansxvavebuli imisagan, rasac

vxvdebiT reanimaciul ganyofilebaSi. Cveulebriv, xSiria aqtiu-

ri Careva iseT SemTxvevaSi, rogoricaa hiperkalcemiis mkurna-

loba, tkivilis sxivuri Terapia, zurgis tvinis kompresiis

sisxldenis kupireba, sawyis stadiaze zeda Rru venis obstruq-

ciis qimioTerapia, qirurgiuli Careva motexilobebis an

nawlavTa gauvalobis dros. aseve aqtiur moqmedebas moiTxovs im

pacientebTan da maT ojaxebTan muSaoba, romlebic progresire-

bad, danakargTan dakavSirebul Zlier da zogjer yovlismomcvel

tanjvas ganicdian. reabilitacia, zogadad miCneulia aqtiuri

paliatiuri mzrunvelobis erT-erT mniSvnelovan formad. (Doyle,Hanks and , MacDonald 1998)

55. paliatiuri mzrunveloba aris ara mxolod aqtiuri, aramed pro-

aqtiuric: misi mizania winaswar gaTvalos, SesaZleblobis Sem-

TxvevaSi Seaferxos, magram yovelTvis mxedvelobaSi miiRos daa-

vadebis procesSi wamoWrili SesaZlo axali problemebi.

56. ZiriTadi principebi, romelic paliatiuri mzrunvelobis samsax-

urebis qvakuTxeds warmoadgens, fokusirebulia pacientebisa da

maTi ojaxebisaTvis sicocxlis saukeTeso xarisxis miRwevaze.

aRniSnuli moicavs: simptomebis kontrolze mkacr yuradRebas;

globalur midgomas, romelic iTvaliswinebs pirovnebis ganv-

lil cxovrebas da dRevandel mdgomareobas; momakvdavsa da

masTan dakavSirebul pirebze mzrunvelobas; pacientebTan, momv-

lelebsa da profesional kolegebTan mimarTebaSi Ria komunika-

cias.

57. irlandiaSi, jandacvis departamentma 1996 wels gamosca kibosTan

brZolis strategia. aRniSnul dokumentSi gamoikveTa ganviTa-

rebadi paliatiuri mzrunvelobis samsaxurebis mier misaRebi

principebi:

CM(2003)130 39

- pacientebs unda SeeZloT gamoxaton sakuTari arCevani

imasTan dakavSirebiT, Tu sad miiReben mzrunvelobas da gaa-

tareben sicocxlis ukanasknel periods.

- samsaxurebi unda iyos Sesabamisad moqnili da imgvarad inte-

grirebuli, rom advili iyos pacientis erTi dawesebulebidan

meoreSi gadayvana, misi klinikuri mdgomareobisa da piradi

arCevanis gaTvaliswinebiT.

- saboloo mizans unda warmoadgendes yvela pacientisaTvis

specializebuli paliatiuri mzrunvelobis samsaxurebis

misawvdomoba yvelgan, sadac es saWiroa.

58. paliatiuri mzrunveloba aris sfero, sadac mravali eTikuri

sakiTxi wamoiWreba. maTi umetesoba medicinis sxva sferoebisaT-

vis damaxasiaTebeli sakiTxebis analogiuria. Tumca, zogierTi

sakiTxi, mag. sicocxlis bolo periodi, paliatiuri mzrunvelo-

bis mniSnelovnad gamokveTil sakiTxs warmoadgens.

59. paliatiur mzrunvelobaSi arsebuli eTikuri principebis gaaz-

reba emyareba im faqtis aRiarebas, rom ukurnebeli an termina-

luri pacienti ar aris ̀ biologiuri narCeni~, romelic mxolod

gautkivarebas saWiroebs; rom ukve aRarafris gakeTeba SeiZleba

da misi cxovrebis gaxangrZlivebas mniSvneloba aRar aqvs.

piriqiT, yoveli pacienti warmoadgens pirovnebas, romelic

saTanado urTierTobebis SemTxvevaSi, bolomde inarCunebs cxov-

rebiseuli zrdisa da miRwevebis aRqmis unars.

60. profesionalebi unda aRiarebdnen medicinis SezRudul SesaZle-

blobebs da Tavs ikavebdnen gadametebuli mkurnalobisagan.

mniSvnelovania kiTxvis qveS davayenoT iluzia, rom arsebobs

tkivilisa da tanjvis Semsubuqebis mxolod erTi gza: tkivilis

Sesusteba. aseve unda gvaxsovdes, rom ar SeiZleba `totaluri~

tkivilis (sikvdilis SiSi, daSorebis wuxili, martooba, realo-

bis aRqmis sakiTxebi, SegrZneba imisa, rom xdebi zedmeti tvirTi

sxvebisaTvis) srulfasovani marTva mxolod samkurnalwamlo

saSualebebiT. aqedan gamomdinare, tkivilis dros analgetikebis

CM(2003)13040

moqmedebis efeqturoba damokidebulia mkurnalobaSi pacien-

tisaTvis mniSvnelovani fsiqologiuri momentebis CarTvaze.

61. biuCemfisa da Cildresis (Beauchamp and Childress 1994) mier

gansazRvruli Semdegi oTxi principis dacvisas, (damoukideblo-

bis pativiscema, keTilganwyoba, àr avno~ da samarTlianoba)

iseve rogorc medicinis sxva sferoebSi, eqimebma da sxva mzrun-

velebma, pacientTan da maT momvlelebTan erTad priorotetebi-

sa da miznebis SeTanxmebiT, unda gamoavlinon pativiscema paci-

entis damoukideblobisadmi. ar unda iqnas ugulvebelyofili

pacientis ufleba, flobdes misTvis saintereso informacias, an

uari ganacxados mkurnalobaze.

62. mzrunvelebma unda daicvan balansi mkurnalobis upiratesobebsa

da sirTuleebs Soris (keTilganwyoba) da Seafason yoveli kli-

nikuri gadawyvetilebis upiratesobis Tanmdevi riski (àr avno~)

imisaTvis, rom Tavidan iqnas acilebuli fuWi mkurnaloba, rome-

lic ar emsaxureba arc daavadebis prevenciasa da mkurnalobas

da arc reabilitaciasa da tkivilis Semsubuqebas. aseve Tavidan

unda iqnas acilebuli is Carevebi, romlic Tumca iZleva gar-

kveul Sedegebs, magram mTlianobaSi damRupvelia pacientis

janmrTelobisaTvis.

63. miuxedavad aRniSnulisa, paliatiuri mzrunvelobis sferoSi

SeiZleba arasakmarisi iyos samedicino eTikis zogad wesebze

damyarebuli is midgoma, romelic xasiaTdeba zemoaRniSnuli

oTxi principiT. bolo periodSi Camoyalibebuli midgomebi,

rogoricaa mzrunvelobis eTika (Tronto 1993) da zneobriobis

eTika (MacIntyre 1995) paliatiuri mzrunvelobisaTvis gansakuT-

rebiT Sesaferisad gvesaxeba. mzrunvelobis eTika aqcents

akeTebs adamianis mowyvlad da damokidebulebiT bunebaze. amde-

nad is amtkicebs, rom eTika exeba ara mxolod gadawyvetilebis

miRebas, aramed urTierTobebis xarisxis iseT maCveneblebs,

rogoricaa: uwyvetoba, gulaxdiloba, ndoba da saimedooba.

64. zneobriobis eTika akritikebs gadawyvetilebebze eTikur foku-

CM(2003)130 41

sirebas pirovnebis Sexedulebebidan gamomdinare; igi yuradRebas

amaxvilebs xangrZlivi droiT zneobrivi moqmedebis mniSvne-

lobaze.

65. daavadebis Sorswasuli formis mqone da momakvdav pacientebs

aqvT samedicino daxmarebisa da pirovnuli daxmarebis miRebis

iseTive uflebebi, rogorc sxva pacientebs (mag. axlo naTesavis

sawolTan yofna). maT aseve aqvT ufleba miiRon an uaryon infor-

macia da/an sadiagnostiko procedurebi, iseve rogorc mkurna-

loba. mkurnalobaze uaris ufleba garantirebuli unda iqnas,

gansakuTrebiT maSin, rodesac samedicino CareviT SeuZlebelia

sikvdilis Tavidan acileba. mkurnalobaze uarma aranairad ar

unda moaxdinos gavlena paliatiuri mzrunvelobis xarisxze.

yvelaze mniSvnelovania, rom paliatiuri mzrunveloba pacien-

tebs aZlevs tkivilis da tanjvis efeqturi Semsubuqebisa da

adamianuri Rirsebis SenarCunebis uflebas.

66. magaliTad mogvyavs paliatiuri mzrunvelobis is eTikuri prin-

cipebi, romelic formulirebulia ungreTis hospisisa da pali-

atiuri mzrunvelobis asociaciis mier (Hegedüs 2000):

1. paliatiuri mzrunvelobis gundis wevrebi pativs scemen paci-

entis damoukideblobas, aTanxmeben prioritetebsa da miznebs

pacientsa da mis momvlelebTan, ganixilaven mkurnalobis

alternatiul gzebs da erToblivad adgenen mzrunvelobis

gegmebs; ar umalaven pacientebs maTTvis saintereso informa-

cias; akmayofileben mkurnalobis mimdinareobis Sesaxeb

informaciis miRebis saWiroebas da pativs scemen pacientis

survils uaris Tqvas mkurnalobaze.

2. paliatiuri mzrunvelobis gundis wevrebma unda awon-dawonon

mkurnalobis upiratesobebi da sirTuleebi (keTilganwyoba),

Seafason yoveli klinikuri gadawyvetilebis upiratesobis

Tanmdevi riski (àr avno~); gaacnobieron pacientis ufleba,

yvela SesaZlo resursis gamoyenebiT miiRos mzrunveloba

umaRlesi standartebiT; miiRon gadawyvetileba resursebis

CarTvisa da gadanawilebis Sesaxeb.

CM(2003)13042

3. momakvdavi pacientis umTavresi uflebebia: samedicino daxma-

rebis ufleba, adamianuri Rirsebis ufleba, personaluri dax-

marebis ufleba, tkivilisa da sxva simptomebis Semsubuqebis

ufleba, informirebulobis, TviT-gamorkvevisa da mkurnaloba-

ze uaris Tqmis uflebebi.

4. pacientebs ufleba aqvT miiRon detaluri informacia Semdeg

sakiTxebze: janmrTelobis mdgomareoba da samedicino

Sefaseba; SeTavazebuli gamokvlevebi da Careva; gamokvleve-

bisa da Carevis rogorc ganxorcielebis, aseve ganuxociele-

blobis SemTxvevaSi potenciuri upiratesobebi da riskebi;

gamokvlevebisa da Carevebis savaraudo TariRi. pacients

ufleba aqvs miiRos gadawyvetileba: gamokvlevebsa da

Carevebze; alternatiul procedurebsa da meTodebze; mkurna-

lobasa da mosalodnel Sedegebze.

5. pacientebs ufleba aqvT monawileoba miiRon gamokvlevebsa da

mkurnalobaze gavlenis mqone gadawyvetilebebis miRebaSi.

informirebuli Taxmobis miReba aris nebismieri samedicino

Carevis winapiroba.

6. mkurnalobaze uaris Tqmis ufleba: Tu pacienti itanjeba

ukurnebeli avadmyofobiT, romelic Tanamedrove etapze

medicinaSi arsebuli codnis gamoyenebiT, Sesabamisi mkurna-

lobis SemTxvevaSic ki, mokle periodSi iwvevs sikvdils,

sicocxlis gamaxangrZlivebel da damxmare Carevebze uaris

TqmiT SeiZleba avadmyofobas mieces bunebrivi gziT mimdina-

reobis saSualeba. qmedunarian pirovnebas SeuZlia oficialu-

rad (mag. ànderZi sicocxlis Sesaxeb~) ganacxados uari

sicocxlis gamaxangrZlivebel da damxmare Carevebze ukurne-

beli daavadebis, TviTmovlis unaris dakargvisa da iseTi tki-

vilis arsebobis SemTxvevaSi, romelic mkurnalobas ar eqvem-

debareba. pacenti uflebamosilia daasaxelos pirovneba, rome-

lic misi qmeduunarobis SemTxvevaSi gamoiyenebs am uflebas.

ganacxadi SeiZleba gakeTdes nebismier dros. mkurnalobaze

CM(2003)130 43

uaris Tqmis SemTxvevaSi pacientebs srulad unarCundebaT

tkivilisa da tanjvis Semsubuqebis ufleba.

7. yovel qmedebasa da gadawyvetilebaze unda Sedges weri-

lobiTi dokumenti.

ddaawweesseebbuulleebbeebbii ddaa ssaammssaaxxuurreebbiiddaawweesseebbuulleebbeebbii

67. paliatiuri mzrunveloba SeiZleba ganxorcieldes sxvadasxva

dawesebulebaSi:

a. saxli

b. kerZo klinika

g. moxucebulTa saxli

d. saavadmyofo

e. hospisi

68. paliatiuri mzrunveloba umetesad xorcieldeba saxlis

pirobebSi. maSinac ki, rodesac pacientebi institucionalur

dawesebulebaSi gardaicvlebian, isini paliatiuri mzrunvelobis

udides periods saxlSi atareben. paliatiuri mzrunvelobis

samsaxurebisaTvis mniSvnelovani Sedegebi aqvs qvemoT ganxilul

aspeqtebs.

69. ori aTeuli wlis win, gaerTianebuli samefodan miRebulma

angariSebma gavlena iqonia paliatiuri mzrunvelobis samsaxure-

bis ganviTarebaze. aRniSnul angariSebSi gansazRvruli iqna

paliatiuri mzrunvelobis Semdegi principebi:

paliatiuri mzrunvelobis umTavres princips warmoadgens

pacientisaTvis mzrunvelobis misawvdomoba nebismier dros misi

saWiroebebisa da arCevanis Sesabamis dawesebulebaSi. praqtikulad,

paliatiuri mzrunveloba nebismier garemoSi misawvdomi unda iyos

CM(2003)13044

yvela pacientisaTvis. rogorc es aRwerilia gansazRvrebebis TavSi,

paliatiuri mzrunvelobis mTavari principebis gacnoba jandacvis

yvela profesionalis pasuxismgeblobas warmoadgens. am miznis

misaRwevad aucilebeli iqneba paliatiuri mzrunvelobis samedici-

no da masTan dakavSirebuli profesionalebis momzadebis saswavlo

programebSi CarTva. aseve, jandacvis profesionalebs unda qondeT

saSualeba uwyveti profesiuli ganaTlebis programebis meSveobiT

aimaRlon kvalifikacia da SeiZinon saWiro unar-Cvevebi. ase rom, Tu

pacienti jandacvis profesionals mimarTavs konsultaciisaTvis

saavadmyofoSi, zogadi praqtikis qirurgiul ganyofilebaSi, kerZo

klinikaSi an sxva dawesebulebaSi, igi darwmunebuli unda iyos, rom

miiRebs misi mdgomareobis Sesabamis paliatiur mzrunvelobas.

70. aseve aRiarebulia, rom mzrunvelobis zogierTi dawesebulebebi,

romlebic eqskluziurad paliatiuri mzrunvelobis sferos ar

emsaxurebian, miizidaven im pacientebis did nawils, visac pali-

atiuri mzrunveloba esaWiroeba. amasTan dakavSirebiT cxadia,

rom paliatiur mzrunvelobaSi kvalifikaciis gacilebiT maRali

moTxovnileba eqnebaT zogierT kerZo klinikebs, moxucebulTa

movlis dawesebulebebsa da onkologiasTan dakavSirebul samsax-

urebs. aRniSnul dawesebulebebSi momuSave Tundac zogierT

profesionals unda qondes SesaZlebloba gaiaros treningi da

miiRos damatebiTi gamocdileba paliatiur mzrunvelobaSi. aseve

mosalodnelia, rom isini daamyareben mWidro profesionalur

kavSirebs specializebuli paliatiuri mzrunvelobis speci-

alistebTan. aseTi diferencirebis mTavari mizania pacientebis

specifikuri saWiroebis Sesabamisi eqspertizis doniT uzrunve-

lyofa.

ssaammssaaxxuurreebbii

71. paliatiuri mzrunvelobis araspecializebul da specializebul

samsaxurebs Soris gansxvaveba praqtikul xasiaTs atarebs. aras-

pecializebuli an zogadsamedicino samsaxurebi paliatiur

mzrunvelobas uzrunvelyofen mis ZiriTad saqmianobad aRiarebis

CM(2003)130 45

gareSe. aseTi samsaxurebia: saubno saeqTno samsaxuri, zogadi

praqtikosebi, binaze movlis gundebi, zogadi Terapiuli palate-

bi da moxucebulTa saxlebi.

72. paliatiuri mzrunvelobis uzrunvelyofa umetesad xdeba, da

savaraudod ase iqneba yovelTvis, araspecializebuli samsaxure-

bis mier. xSir SemTxvevaSi araspecialisti profesionalebi

uzrunvelyofen mzrunvelobas specialistebis Carevis gareSe;

bevr sxva SemTxvevaSi araspecializebuli mzrunvelobis konteq-

stSi SeiZleba saWiro gaxdes specialistis CarTva. Tumca, mci-

rea im SemTxvevaTa ricxvi, rodesac mzrunveloba mTlianad spe-

cialistis mier unda ganxorcieldes.

73. araspecializebuli samsaxurebi aseve moicavs mxolod garkveul

SemTxvevebSi CarTul iseT momsaxurebasac, rogoricaa

qimioTerapia, sxivuri Terapia da qirurgiuli Careva. aRniSnul

samsaxurebs zogjer aqvT pacientTa rigi, rac gansakuTrebiT

damRupvelia paliatiuri mzrunvelobis pacientebisaTvis, ramde-

nadac Zalze mcirea is sasicocxlo periodi, rodesac mkurnalo-

bas garkveuli Sedegebi moaqvs. amdenad, paliatiuri pacien-

tebisaTvis daxmarebis misawvdomobis uzrunvelyofisaTvis

SemoTavazebuli iqna e.w. `paliatiuri avtobusis sagzao xazi~-s

koncefcia.

74. bolo wlebis ganmavlobaSi paliatiuri mzrunvelobis koncefci-

as meti yuradReba daeTmo saqmianobis iseT specifikur sferoSi,

rogoricaa intensiuri Terapiis ganyofileba.

75. araspecialists SeuZlia SeiZinos sakmarisi gamocdileba palia-

tiuri mzrunvelobis SedarebiT martiv sakiTxebSi, magram pali-

atiuri pacientebis SezRuduli raodenobis gamo (mag. holan-

diaSi, zogadi praqtikosebi weliwadSi saSualod 2-6 paliatiur

pacients xvdebian), ar xdeba paliatiur mzrunvelobaSi rTuli

SemTxvevebis marTvis gamocdilebis SeZena. im SemTxvevaSi, Tu

pacienti araspecialist profesionalTa zrunvis obieqtad rCeba,

CM(2003)13046

specialistTa daxmarebis karg SesaZleblobas iZleva xelmisawv-

dom sakonsultacio samsaxurebTan urTierToba.

76. specializebulia samsaxurebi, romlTa saqmianoba mTlianad

paliatiur mzrunvelobas eZRvneba da romelTa gundebi specia-

lurad arian momzadebulni mzrunvelobis am sferosaTvis. aseTi

samsaxurebi ar ikaveben mzrunvelobis im adgils, sadac momsax-

urebas pirveli rigis profesionalebi ewevian (binaze movla,

saavadmyofo, sareabilitacio dawesebulebebi), Tumca yoveli

konkretuli situaciis sirTulisa da saWiroebebis Sesabamisad

daxmarebas uweven maT. aseTi samsaxurebis arsebobis pirobebSi,

pacientebs SesaZlebloba unda qondeT aucileblobis

SemTxvevaSi miiRon daxmareba nebismier dros, yovelgvari dagvi-

anebis gareSe.

77. yvelaze gavrcelebul samsaxurebs warmoadgens secializebuli

stacionaruli ganyofilebebi, saavadmyofoebis paliatiuri

mzrunvelobis gundebi, binaze movlis gundebi, dRis movlis

dawesebulebebi, binaze hospitalizeba, poliklinikebi.

78. arsebobs mciredi pozitiuri mtkicebuleba, Tu ra saxis palia-

tiur mzrunvelobas aniWeben upiratesobas pacientebi.

mimoxilvaSi, vilkinsoni da sxvebi aRniSnaven zogad

saavadmyofoebTan SedarebiT specializebuli momsaxurebis upi-

ratesobis tendencias, rogorc saavadmyofoebSi, aseve TemebSi.

(Wilkinson et.al 1999) aRniSnuli Sedegebis interpretacia gar-

kveul sifrTxiles moiTxovs.

79. araspecialuri samsaxurebi moicavs:

- araformalur mzrunvelebs;

- volontiorebs (?);

- ubnis eqTnebs;

- arapaliatiuri mzrunvelobis specialistebs;

80. specialur paliatiur samsaxurebs warmoadgenen is samsaxure-

bi, romelTa mTavari saqmianoba paliatiuri mzrunvelobaa. maT

CM(2003)130 47

esaWiroebaT maRali profesiuli unar-Cvevebis mqone personali

da pacientebisa da personalis Sesabamisi Sefardeba. aseTi sam-

saxurebi misawvdomi unda iyos yvela samkurnalo dawesebule-

baSi; maT unda SeeZloT daxmarebis gaweva pacientisaTvis yvel-

gan, sadac ar unda iyos igi: saxlSi, saavadmyofoSi, kerZo

klinikaSi, dRis movlis centrebSi, poliklinikebsa da paliati-

uri mzrunvelobis specialur centrebSi. aseve mniSvnelovani

roli eniWebaT specializebul paliatiuri mzrunvelobis sam-

saxurebs jandacvis im profesionalTa daxmarebaSi, vinc Tavad

axorcielebs paliatiur mzrunvelobas saavadmyofoebsa da

saTemo doneze. saWiroebis SemTxvevaSi, jandacvis yvela

profesionalisaTvis misawvdomi unda iyos paliatiuri mzrun-

velobis gundis rCevebi da daxmareba.

81. specialuri paliatiuri mzrunvelobis umTavresi maxasiaTeblebi

aRwerili iqna gaerTianebulo samefos hospisis erovnuli

sabWosa da specialuri paliatiuri mzrunvelobis samsaxuris

mier da mxardaWerili iqna irlandiis paliatiuri mzrunvelo-

bis erovnul sakonsultacio komitetis mier, rac Camoyali-

bebulia Semdegi saxiT:

- multiprofesionaluri, erTiani gunduri midgomiTa da

Sesabamisi unarCvevebis gamoyenebiT fizikuri, fsiqologiuri,

socialuri da sulieri daxmarebis aRmoCena;

- multiprofesionaluri gundis profesionalTa jgufis erTi

lideri mainc unda warmoadgendes paliatiur mzrunvelobaSi

momzadebul da aRiarebul specialists;

- pacientebi da maTi ojaxebi iReben daxmarebas da CarTuli

arian administrirebis procesSi;

- pacientebs eZlevaT saSualeba airCion, Tu sad urCevniaT

mzrunvelobis miReba da sad surT sikvdili;

- mzrunvelebi da ojaxebi iReben daxmarebas pacientis avadmyo-

fobis periodSi da misi gardacvalebis Semdgom.

- pacientebis dasaxmareblad, sadac ar unda imyofebodnen isini,

pirveladi jandacvis profesionalebs, saavadmyofoebisa da

CM(2003)13048

binaze movlis samsaxurebs Soris arsebobs TanamSromloba da

partnioroba;

- aRiarebulia da dafasebulia volontiorTa wvlili;

- paliatiur samsaxurebs rogorc pirdapir, aseve arapirdapir

eniWeba aRiarebuli akademiuri saganmanaTleblo da kvalifi-

kaciis amaRlebis uzrunvelyofis roli.

- SemuSavebulia ganaTlebis standartebi da uzrunvelyofilia

treningebi;

- arsebobs mkurnalobisa da misi Sedegebis kvlevisa da klini-

kuri Sefasebis programebi;

- arsebobs paliatiuri mzrunvelobis sferoSi sruli an aras-

ruli droiT momuSave personalis saWiroebebis Sesabamisi

damxmare saSualebebi.

specialuri paliatiuri mzrunvelobis samsaxuris saStato moT-

xovnebi

82. aRiarebulia, rom paliatiuri mzrunveloba evropis qveynebSi

ganviTarebis sxvadasxva safexurze imyofeba. mTeli rigi faqto-

rebi, maT Soris ekonomikuri, gansazRvraven Statebis dakompleq-

tebis masStabsa da xelmisawvdomobas. Tumca, paliatiuri mzrun-

velobis yvela samsaxurs unda yavdes Sesabamisi ganaTlebisa da

kvalifikaciis eqimebisa da eqTnebis Stati.

83. gaerTianebul samefoSi, paliatiuri mzrunvelobis samsaxurebi-

sa da hospisis erovnuli sabWos rekomendaciiT, gaTvaliswi-

nebulia Semdegi Statebis arseboba, iqneba es sruli droiT,

nawilobrivi an regularuli sesiebisaTvis:

- fizikuri Terapevti;

- okupaciuri Terapevti;

- socialuri muSaki;

- pacientebis, ojaxis wevrebisa da momvlelebis fsiqo-socia-

luri saWiroebebis mcodne, specialurad momzadebuli Stati;

- axloblis gardacvalebiT gamowveuli mZime danakargis

CM(2003)130 49

SemTxvevaSi momsaxurebisaTvis momzadebuli Stati;

- sulieri mzrunvelobis koordinatori;

- enisa da metyvelebis Terapevti;

- dietologi/samkurnalo kvebis specialisti;

- damxmare Terapevti;

- volontiori koordinatori;

- ganaTlebis personali;

- biblioTekari;

- administraciuli, samdivno da zogadi damxmare Stati.

84. paliatiuri mzrunvelobis yvela samsaxurs rodi aqvs

SesaZlebloba daakmayofilos zemoTmoyvanili rekomendaciebi.

politika

85. specialuri paliatiuri mzrunvelobis samsaxurebi unda uzrun-

velyofdnen momsaxurebis farTo speqtrs sxvadasxva dawese-

bulebaSi. samsaxurebis struqtura unda iZleodes mzrunvelo-

bis erTi dawesebulebidan meoreSi pacientebis gadayvanis

SesaZleblobas, maTi saWiroebebisa da arCevanis gaTvaliswinebiT.

am ukanasknels miekuTvneba paliatiur mzrunvelobaSi speciali-

zebuli sxvadasxva dawesebulebebi, romlebic ar arian izolire-

buli, aramed funqcionireben rogorc koordinirebuli, integri-

rebuli da mWidrod dakavSirebuli erTeulebi.

paliatiuri mzrunvelobis stacionaruli ganyofilebebi

86. aRniSnul dawesebulebaSi sawolebi gankuTvnilia paliatiuri

momsaxurebis miznebisaTvis. aseTi ganyofileba moiTxovs maRal-

kvalificiur, interdisciplinur gunds da gankuTvnilia Sedare-

biT ufro rTuli fizikuri, fsiqo-socialuri da/an sulieri sa-

Wiroebebis mqone pacientebisa da maTi ojaxebisaTvis. aRniSnuli

dawesebulebebi mWidrod unda iyvnen integrirebuli saavadmyo-

foebsa da Temze dafuZnebul samsaxurebTan. xSirad isini ganla-

gebuli arian zogadi profilis saavadmyofoebis bazaze.

CM(2003)13050

saavadmyofos bazaze arsebuli paliatiuri mzrunvelobis gundi

87. aRniSnuli termini aRwers situacias, rodesac specialuri

paliatiuri mzrunvelobis gundi funqcionirebs zogadi profi-

lis saavadmyofoSi sakonsultacio da damxmare doneze.

Temze dafuZnebuli paliatiuri mzrunvelobis gundi

88. bevr pacients SesaZloa survili qondes mzrunveloba miiRos

sakuTar saxlSi, an im dawesebulebaSi, romelic misTvis saxlad

iqca, mag: moxucebulTa saxli, patronaJi sacxovrebeli adgilis

mixedviT da sxv. ewvevian ra aseT dawesebulebebs, specialuri

paliatiuri mzrunvelobis gundebi personals aZleven rCevebs

samuSaoTa warmarTvis Sesaxeb. konkretuli rTuli problemis

gadasaWrelad SeiZleba saWiro gaxdes zogierTi pacientis

gadayvana specialuri paliatiuri mzrunvelobis ganyofilebaSi.

aseT SemTxvevaSi maT eZlevaT ukan dabrunebis saSualeba.

dRis movlis dawesebulebebi

89. dRis movla SeiZleba xorcieldebodes stacionarebsa da aseve

kerZo klinikebSi, sadac pacientebi SeiZleba modiodnen kviraSi

erTi an ramodenime dRiT. maTTvis SeTavazebuli momsaxureba

SeiZleba iyos samedicino xasiaTis (sisxlis gadasxma, tkivili-

sa da simptomebis marTvis Sefaseba da sxv.) socialuri xasiaTis

(Sxapis, abazanis miReba), sareabilitacio (fizioTerapia/ okupa-

ciuri Terapia). sarelaqsacio (masaJi) an garTobiTi xasiaTis

(xelovneba da xelosnoba). aseve, aseTi saxis dawesebulebebi mom-

vlelebs droebiTi gamonTavisuflebisa da Sesvenebis saSualebas

aZleven.

dRis stacionarebi

90. dRis stacionaris tipis dawesebulebebi paliatiuri mzrunve-

lobis programis Rirebul elements warmoagenen.

CM(2003)130 51

[Wilkinson EK § COL. pacientTa da momvlelTa arCevani da kmayofi-

leba paliatiuri mzrunvelobis specialuri modelebiT: literatu-

ris meToduri mimoxilva. paliatiuri medicina 1999; 13:197-216]

91. specialur dRis stacionarebs Cveulebriv 10 - 15 sawoli

gaaCniaT da iReben pacientebs, romelTa tanjvis done (fiziku-

ri/fsiqocosialuri/socialuri) droebiT an gardacvalebamde,

specializebul interdisciplinur paliatiur mzrunvelobas

moiTxovs. maT aseve eniWebaT saswavlo da kvleviTi funqcia.

aRniSnuli dawesebulebebi SeiZleba ganTavsdnen rogorc damou-

kideblad, aseve saavadmyofoSi, rac sxvadasxva specialistis

daxmarebis wvlilisa da xelmisawvdomi samedicino teqnologie-

bis gamoyenebis saSualebas zrdis. damoukideblad arsebobis

SemTxvevaSi, sasurvelia mWidro kavSirebis damyareba Sesabamisi

teqnologiebiT aRWurvil saavadmyofosTan.

92. specialuri stacionaruli ganyofilebis datvirTvis done nebis-

mier dros unda uzrunvelyofdes pacientebis Seuferxebel

miRebas, gansakuTrebiT im pacientebisa, romelTac binaze mzrun-

veloba ukve miRebuli aqvT. bolo dromde, onkologiuri pacien-

tebis paliatiuri mzrunvelobisaTvis saWiro sawolTa raodeno-

ba Sefasebuli iyo rogorc 50 sawoli yovel milion mosaxleze.

Tumca, es monacemi, romelSic gaTvaliswinebuli ar aris arc

araonkologiuri pacientebis saWiroebebi da arc evropis mosax-

leobis siberiT gamowveuli qronikul daavadebaTa mzardi gavr-

celeba, SesaZloa sanaxevrodac ar akmayofilebdes realur

saWiroebas. zogadad rom visaubroT, sawolTa raodenoba yovel

mocmul regionSi damokidebulia demografiul da socialur-

ekonomikur konteqstze da sxva specialuri paliatiuri samsax-

urebis misawvdomobaze (droebiTi movlis centri, binaze hospi-talizireba da sxv.)

93. saavadmyofos paliatiuri mzrunvelobis gundebi, romelic

Cveulebriv Sedgeba paliatiur mzrunvelobaSi specializebuli

erTi eqimisa da erTi eqTnisagan mainc, magram xSirad aerTianebs

sxvadasxva specialists (socialuri muSaki, fsiqologi,

CM(2003)13052

mRvdeli, da a.S.), romlebic moqmedeben rogorc konsultantebi

mzrunvelobaSi monawile personalis, hospitalizirebuli paci-

entisa da misi naTesavebis moTxovnis safuZvelze. isini mWidrod

TanamSromloben sxvadasxva specialistebTan (eqimi, onkologebi,

sxivuri Terapevtebi da sxv), jandacvis sxva iseT profe-

sionalebTan, rogoricaa socialuri muSaki, fsiqologi da aseve

mRvdeli. paliatiuri mzrunvelobis gundebi aseve asruleben

saganmanaTleblo funqcias.

94. binaze movlis gundebis funqciebi da moqmedebis meTodebi saa-

vadmyofos gundis muSaobis msgavsia. pirvelad mzrunvelobaSi

monawile personalis Txovnis safuZvelze isini exmarebian

saxlebSi, kerZo klinikebsa da sxva saTemo dawesebulebebSi

mcxovreb pacientebs.

95. kvlevebSi aRwerilia mravali organizaciuli, fuqcionaluri da

finansuri winaaRmdegoba, rasac izolirebulad arsebuli saavad-

myofo da binaze movlis gundebi xvdebian. umTavresia, aRniSnuli

gundebi funqcionirebdnen stacionarul ganyofilebSi, an ukidu-

res SemTxvevaSi mWidrod iyvnen dakavSirebuli maTTan. aseve

uzrunvelyofili unda iqnas gundisaTis daxmarebisa da uwyveti

ganaTlebis miReba. aseTi saxis formalur Tu araformalur

kavSirebs mivyavarT pacientebze mzrunvelobis uwyvetobisaken.

96. dRis stacionarebi saxlSi myof pacientebs sTavazoben kviraSi

erT an ramdenime dRian mzrunvelobas. aseTi tipis dawesebule-

bebi ufro metad gavrcelebulia gaerTianebul samefoSi. arse-

buli monacemebi gviCveneben did gansxvavebas maT funqciebsa da

moqmedebis meTodebs Soris. dRis stacionaris mizans SeiZleba

warmoadgendes: simptomTa Sefaseba; mkurnalobis sxvadasxva

formebis marTva keTilmosurne garemoSi; droebiTi Svebis

SeTavazeba pacientebis, naTesavebisa da mzrunvelobis pirveladi

gundebisaTvis, rac iZleva pacientis binaze datovebis da hospi-

talizebis Tavidan acilebis SesaZleblobas; fsiqologiuri dax-

marebis uzrunvelyofa; pacientebisa da maTi naTesavebis sicocx-

lis xarisxis gaumjobesebaze mimarTuli damxmare midgomebis

gamoyeneba (art Terapia da sxv.)

CM(2003)130 53

97. zogierT qveyanaSi, mag. safrangeTsa da fineTSi, samsaxurebi

`binaze hospitalizeba~ da ̀ saavadmyofo binaze~ moicaven samedi-

cino da saeqTno mzrunvelobis farTo speqtris uzrunvelyofas

binaze myofi im pacientebisaTvis, romlebic sxva SemTxvevaSi

hospitalizebuli unda yofiliyvnen. aseTi momsaxureba moicavs

saavadmyofosTvis damaxasiaTebel ufro srulyofil mzrunvelo-

bas, vidre amas Cveulebriv binaze movlis gundebis momzadeba

uzrunvelyofs. arsebobs sxvadasxva organizaciuli modelebi,

dawyebuli binaze arsebuli resursebis gaumjobesebiT, dam-

Tavrebuli yvela saWiroebisaTvis specialuri gundis momsaxu-

rebis uzrunvelyofiT.

98. dRis stacionarebi umetesad ganlagebulia saswrafo daxmarebis

klinikebSi. konsultaciebi ZiriTadad xorcieldeba klinikis mo-

biluri gundis mier, romelic uzrunvelyofs specialur kon-

sultaciebs binaze myofi im pacientebisaTvis, romelTac SeuZ-

liaT klinikaSi misvla.

99. satelefono daxmarebis xazi profesionalebs sTavazobs rCevebs

paliatiuri pacientebis movlis sakiTxebze da xels uwyobs spe-

cializebuli paliatiuri mzrunvelobis iseTi samsaxurebis

xelmisawvdomobas, rogoricaa mobiluri gundebi an stacionaru-

li ganyofilebebi. im oficialuri kavSirebis saSualebiT, rome-

lic mas gaaCnia sxva profesionalebTan da volontiorebTan, is

aseve sTavazobs yovel spcifikur situaciasTan dakavSirebul

rCevebsa da daxmarebas. aseTi saxis damxmare satelefono xaze-

bi Cveulebriv erTi regionis farglebSi arsebuli sxvadasxva

specializebuli samsaxuris TanamSromlobis Sedegs warmoad-

gens.

100. regionSi mzrunvelobis uzrunvelyofis xarisxi damokidebulia

ara marto TiToeuli samsaxuris mier SemoTavazebuli mzrunve-

lobis xarisxze, aramed samsaxurebs Soris arsebul TanamSrom-

lobasa da specializebul dawesebulebebsa da pirvelad mzrun-

velebs Soris arsebul koordinaciaze. koordinirebuli regio-

nuli qselis saxiT samsaxurebis organizeba aumjobesebs palia-

CM(2003)13054

tiuri mzrunvelobis misawvdomobas da amaRlebs mzrunvelobis

xarisxsa da uwyvetobas. (Elsey and McIntyre 1996; Mitchell and Price2001; Schroder and Seely 1998)

101. aseTi qselis muSaoba moiTxovs makoordinirebel organos an pi-

rovnebas (aRniSnuli funqcia SeiZleba Sesrulebuli iqnas qsel-

Si CarTuli sxvadasxva samsaxurebis warmomadgenel profesi-

onalTa interdisciplinuri gundis, an stacionaruli ganyofi-

lebis mier), pacientebisaTvis saWiro sxvadasxva donis mzrun-

velobisaTvis Sesabamisi dawesebulebebis speqtrs (stacionaru-

li ganyofilebebi, droebiTi sawolebi, binaze hospitalizeba,

dRis stacionarebi, xangrZlivi mkurnalobis saavamdyofoebi,

saswrafo daxmarebis klinikebi), da damakavSirebel samsaxurebs

(mobiluri klinikebi da binaze movlis gundebi) (Zalot 1989).aseTi saxis qseli sxvadasxva miznebs emsaxureba: axdens ra

mzrunvelobis koordinacias, mas aseve SeuZlia Seafasos misi

Sedegebi (Caataros auditi) da moaxdinos swavlebisa da kvlevis

koordinacia.

102 Seuferxeblad momuSave qselis Semadgeneli nawilebia:

- miznebisa da xarisxis standartebis erToblivi dasaxva;

- mzrunvelobis yvela doneze sayovelTaod cnobili, misawvdo-

mobisa da tanjvis Semsubuqebis kriteriumebis gamoyeneba;

- Sefasebis farTod aRiarebuli meTodebis gamoyeneba;

- farTod aRiarebuli, SesaZleblobis SemTxvevaSi klinikur

kvlevaze dafuZnebuli Terapiuli strategiebis danergva.

CM(2003)130 55

ppoolliittiikkaa ddaa oorrggaanniizzeebbaa

103. evrosabWos mravali wevri qveynis mier bolo aTwleulebSi Semu-

Savda paliatiuri mzrunvelobis, rogorc jandacvis sistemis

Semadgeneli nawilis, ganviTarebisa da ganxorcielebis yovlis-

momcveli erovnuli gegmebi.

104. magaliTisaTvis da ara misi, rogorc srulyofili variantis

SeTavazebis saxiT, gvinda movixsenioT sami aseTi saxelmwifo.

105. espaneTma SeimuSava paliatiuri mzrunvelobis gegma, romelic

miRebuli iqna jandacvis erovnuli sistemis interregionuli

sabWos mier The Plan Nacional de Cuidados Paliativos; Bases Para SuDesarollo (18 December 2000). gegma iTvaliswinebs upiratesad

sazogadoebriv dafinansebaze myofi, saWiroebebze mimarTuli

paliatiuri mzrunvelobis SeTavazebas; jandacvis saxvadasxva

dones Soris koordinirebis xelSewyobas; Tanasworobis uzrun-

velyofas, xarisxis, efeqturobisa da qmediTobis gaumjobesebas;

ufro zustad, gegmis mizania xeli Seuwyos sxvadasxva seqto-

rebs (ara jandacvis sferos) Soris interdisciplinur da koor-

dinirebul muSaobas; yuradRebis gamaxvilebas paliatiuri

mzrunvelobis iseT yvelaze gavrcelebul formaze, rogoricaa

binaze movla; gaidlainebisa da standartebis SemuSavebas; pro-

fesionalebisa da ojaxis wevrebis ganaTlebis xelSewyobas.

ganaTlebasTan mimarTebaSi gegma ganasxvavebs sawyis, Sualedur

da umaRlesi ganaTlebis kompetenturobas. espanuri gegma aseve

moicavs misi Sefasebis mkafio aRwerilobas.

106. ungreTSi, jandacvis 1997 wlis kanoni moicavs paliatiuri

mzrunvelobis detalurad SemuSavebul rekomendaciebs, romelic

oficialurad aniWebs pacientebs simptomebis marTvisa da axlo-

blebis garemocvaSi cxovrebis uflebas. SesaZleblobis SemTxve-

vaSi SeTavazebuli unda iqnas binaze movla; kanonSi mkafiod aris

aRwerili naTesavebis daxmarebis, ojaxisa da naTesavebis suli-

eri mxardaWeris sakiTxebi. ungreTis jandacvis saministrom da

CM(2003)13056

hospis-paliatiurma asociaciam dabeWda da gaavrcela profesio-

naluri saxelmZRvaneloebi (gaidlaini).

107. 1999 wels, irlandiaSi, janmrTelobisa da bavSvTa saministrom

daaarsa paliatiuri mzrunvelobis erovnuli sakonsultacio

komiteti, romelmac gamoaqveyna paliatiuri mzrunvelobis po-

litikis aspeqtebis ganmazogadebeli rekomendacia, romelic

aseve exeba finansirebasa da saorganizacio sakiTxebs. aRniSnul

rekomendaciaSi paliatiuri mzrunveloba saxelmwifo dafinanse-

bis calke sferod iqna gamoyofili. (National Advisory Committeeon Palliative Care 2001)

108. erovnul da regionul politikasTan dakavSirebuli dokumente-

bis umravlesobaSi didi yuradReba eqceva sazogadoebriv azrs,

saxelmwifos, profesiuli jgufebisa da arasamTavrobo orga-

nizaciebis rols sikvdilisa da gardacvalebis adekvaturi gage-

bis popularizaciisa da inkurabeluri daavadebis Sorswasuli

formis mqone pacientebze mzrunelobaSi. aseTi politikis

magaliTad evropis gareT SeiZleba CaiTvalos amerikuli proeq-

ti `sikvdili amerikaSi~, romelic dafinansebuli iqna sorosis

fondis mier, sadac sikvdilisa da gardacvalebis Tema dadga sam-

oqalaqo ganxilvis dRis wesrigSi iseTi sxvadasxva saSualebis

gamoyenebiT, rogoricaa sazogadoebrivi debatebi da Teatralu-

ri warmodgenebi.

109. paliatiuri mzrunvelobis erovnuli da regionuli politikis

safuZvels pacientis saWiroebaTa codna warmoadgens. imisaTvis,

rom ganaviTaron da monitoringi gauwion paliatiuri mzrunve-

lobis erovnul strategiebs, qveynebs esaWiroebaT ZiriTad

monacemTa uwyveti Segroveba, monacemTa minimaluri nakrebi (mmn),

romelic mag. moicavs epidemiologiur, paliatiuri mzrunvelo-

bis samsaxurebiT sargeblobis jgufebad dayofil detalur

monacemebs, aseve monacemebs sxvadasxva regionSi paliatiuri

mzrunvelobis samsaxurebis misawvdomobis Sesaxeb. mmn nawilo-

briv damokidebulia sxvadasxva qveynis specifikur sainformacio

saWiroebaze.

CM(2003)130 57

110. zogierTi qveynis mier Catarebuli iqna saWiroebaTa Sefasebis

Seswavla. holandiis magaliTze, Catarebuli iqna saxelmwifos

mier dafinansebuli kvleva, romlis farglebSic ganxorcielda

Sorswasuli daavadebis mqone pacientTa mwvave da etapobrivi

saWiroebebis gansazRvris mcdeloba; aRniSnulis safuZvelze,

daarsda mzrunvelobisaTvis aucilebeli tipisa da xarisxis da-

wesebulebebi. mniSvnelovania e.w. monacemTa minimaluri nakrebis

gansazRvris is gamocdileba, romelic gvaZlevs saWiroebaTa

Sefasebis Catarebisa da monitoringisaTvis saWiro minimalur

monacemebs. (paliatiuri mzrunvelobis erovnuli sakonsulta-

cio komiteti, 2001 w)

111. miuxedavad imisa, rom mwiria informacia sazogadoebis araprivi-

legirebuli wevrebisaTvis paliatiuri mzrunvelobis misawvdo-

mobis Sesaxeb, komitetSi arsebobs mosazreba, rom usaxlkaro

adamianebs, SemecnebiTi SezRudvis mqone pirebsa da ltolvilebs

SesaZloa SeeqmnaT sirTuleebi am kuTxiT. arsebobs monacemebi,

rom eTnikuri umciresobebis warmomadgenlebi arasamkarisad

iReben paliatiur mzrunvelobas. es SesaZloa gamowveuli iyos

aRniSnuli kategoriis pacientebis Taviseburi damokidebulebiT

`sicocxlis bolos mzrunvelobisadmi~, rac maTi kulturis

moTxovnebiT aris ganpirobebuli.

112. inkurabeluri da sicocxlisaTvis saSiSi davadebis mqone

bavSvebi gansakuTrebulad saWiroeben paliatiur mzrunvelobas,

rac yvelaze xSirad saxlis pirobebSi xorcieldeba; Tumca arse-

bobs imis SemaSfoTebeli monacemebi, rom bavSvebisaTvis paliati-

uri mzrunveloba arasakmarisadaa misawvdomi (Clark 2002;Mabrouk 2001). bavSvebs esaWiroebaT pedagogiuri profilis tre-ningze momzadebuli personalis (gansakuTrebiT eqTnebis) mier

ganxorcielebuli specialuri momsaxureba, rasac Tan unda

erTvodes binaze movla, romelic daexmareba bavSvebsa da maTi

ojaxis wevrebs.

113. bevr qveyanaSi, paliatiuri mzrunveloba sazogadoebisaTvis

ucnobia an SezRudulia iseTi negatiuri gagebis gamo, rogori-

CM(2003)13058

caa fatalizmi. aman SesaZloa gamoiwvios sazogadoebrivi yurad-

Rebis nakleboba, rac TavisTavad gamoiwvevs mag. moxaliseTa

organizaciebSi gawevrianebis arasakmaris interess. sazogadoe-

brivi interesis naklebobam aseve SeiZleba gamoiwvios sikvdili-

sa da gardacvalebis Semdgomi marginalizacia.

114. arsebobs monacemebi, romlis mixedviTac, paliatiuri mzrunve-

lobis misawvdomoba damokidebulia daavadebaze (onko pacientebs

aqvT meti misawvdomoba), da aseve socialur-ekonomikur faqto-

rebze. ufro metic, zogierT qveyanaSi, intensiuri terminaluri

mzrunvelobis misawvdomoba Semoifargleba mxolod im

pacientebiT, romelTa limitirebuli sasicocxlo prognozi

daaxloebiT 3 Tves Seadgens. aseTi SezRudvebi TiTqmis yovel-

Tvis iwvevs did problemebs maSin, rodesac pacientebi sawyis

prognozze gacilebiT didxans cocxloben da maRali xarisxis

paliatiur mzrunvelobas saWiroeben.

115. farmakologiuri Careva warmoadgens simptomebis kontrolis sa-

fuZvels. adekvaturi samedicino mkurnalobis SemTxvevaSi

gacilebiT advilia tanjvis iseTi aspeqtebis Semsubuqeba, rogo-

ricaa mZime daavadebiTa da gardacvalebiT gamowveuli socialu-

ri cvlilebebi, sulieri saWiroebebi. Tumca, zogierT qveyanaSi

SesaZloa arsebobdes materialur-teqnikuri uzrunvelyofisa da

efeqturobis problemebi adgilobrivi jandacvis ganyofilebebis

doneze. aseve erovnul da adgilobriv doneze unda iqnas ganxi-

luli Sesabamisi farmakologiuri mkurnalobisaTvis saWiro

finansuri mxardaWeris sakiTxi

116. narkotikuli tkivilgamayuCeblebis arasakmarisi misawvdomoba

gansakuTrebul SeSfoTebas iwvevs maSin, rodesac es ganpirobe-

bulia sakanonmdeblo SezRudvebiT, rogorc sxvadasxva opioide-

bis gamoyenebis, aseve maTi dozebis sxvadasxvaobis reJimebis

mixedviT. morfini aris yvelaze xSirad gamoyenebadi opioidi.

kiboTi gamowveuli tkivili yvelze mgrZnobiarea opioidebze,

magram sxva analgezuri medikamentebis efeqti damokidebulia

maT dozirebaze, rac niSnavs, rom ar arsebobs standartuli

CM(2003)130 59

doza yvelasaTvis, igi SeiZleba icvlebodes dReSi aTidan ramo-

denime aTas mg-mde. (Foley 1995; Folley 1996) misawvdomi unda iyos

sxvadasxva opioidTa gamoyeneba, ramdenadac efeqturobisa da

gverdiTi movlenebis mimarT individualuri damokidebulebis

pirobebSi SesaZloa saWiro gaxdes erTi medikamentis meoreTi

Secvla. (Indelicato and Portenoy 2002)

117. tkivilis marTvisaTvis opioidebis adekvaturad gamoyenebis

SemTxvevaSi ar arsebobs wamalze damokidebulebis mavne Cvevis

Camoyalibebis problema. janmo-sa da evropis paliatiuri asoci-

aciis mier (EAPC) gamocemuli iqna tkivilis marTvisa da mkur-nalobis saxelmZRvanelo (gaidlaini) (Hanks et al. 2001; WorldHealth Organization. 1990)

118. federalur, erovnul da regionul gegmebSi gansakuTrebuli

yuradReba unda mieqces pacientebis iseT umciresobaTa katego-

riebs, rogoricaa institucionalizebuli SezRuduli SesaZleb-

lobis mqone pirebi, bavSvebi, patimrebi da sxv. maTTvis nebismi-

er dros da ara aucileblobis SemTxvevaSi uzrunvelyofili

unda iyos sxvadasxva specialuri dawesebulebebis misawvdomoba,

sadac isini miiReben maTi specifikuri saWiroebebis Sesabamis

mzrunvelobas.

xxaarriissxxiiss ggaauummjjoobbeesseebbaa ddaa kkvvlleevvaa

xxaarriissxxiiss ggaauummjjoobbeesseebbaa

119. zogadad, paliatiur mzrunvelobaSi momsaxurebis xarisxis gaum-

jobeseba ar gansxvavdeba jandacvaSi xarisxis gaumjobesebisagan,

rogorc es aRwerilia evrosabWos rekomendaciebSi R(97) 17 da

mis danarTebSi.

120. Tumca paliatiuri mzrunvelobis zogierTi specifikuri ganzo-

mileba (pacientis arCevanis umTavresoba; ojaxi, rogorc mzrun-

velobis erTeuli; sulieri da egzistencialuri sakiTxebis

CM(2003)13060

mniSvneloba da ara profesionalTa monawileoba) ganapirobebs

paliatiuri mzrunvelobis xarisxis gaumjobesebisa da marTvis

aspeqtebis specifikurobas (ix. Tavi 1)

121. mTlianobaSi, samedicino dargSi erT-erT mTavar inovacias mtki-

cebulebaze damyarebuli klinikuri gaidlainebis SemuSaveba war-

moadgens. paliatiuri mzrunvelobis gaidlaini mravali qveynis

mier iqna SemuSavebuli. Tumca, paliatiuri mzrunvelobis aRi-

arebuli Carevebis SedarebiT susti mtkicebulebiTi baza

saerTo saxelmZRvanelo meTodikis SemuSavebis mTavar winaaR-

mdegobas warmoadgenda. sabednierod, mtkicebulebaze damyarebu-

li gaidlainebis popularizaciis yvelaze mniSvnelovan saerTSo-

riso organizacias, koxreinis TanamSromlobas (CochraneCollaboration) gaaCnia paliatiuri medicinis seqcia.

122.mzrunvelobis xarisxis uwyveti gaumjobeseba SeiZleba ganisaz-

Rvros, rogorc SeTavazebuli momsaxurebis Sefasebisa da gaum-

jobesebis sistematiuri procesi.

123. paliatiur mzrunvelobaze specialzirebul bevr dawesebuleba-

Si jer kidev SezRudulia mzrunvelobis xarisxis Sefasebis

procedurebi. amis gamo am sferoSi literatura arasrul mona-

cemebs gvTavazobs.

124. arsebobs xarisxis Sefasebis araadekvaturobis mravali mizezi.

sxva sakiTxebTan erTad, xarisxis SefasebisaTvis saWiroa meTo-

dologiuri unar-Cvevebi da logariTmuli resursebi, rac miuwv-

domelia mcire dawesebulebebisTvis. Sefasebis procedurebis

ganxorcieleba moiTxovs xarisxis standartebis gansazRvras,

paliatiuri mzrunvelobis konteqstSi Sefasebis iseTi modele-

bis gamoyenebas, rogoricaa multidisciplinuri auditi da

Sedegebis sazomi Sesabamisi saSualebebi.

CM(2003)130 61

125. Catarebuli Sefaseba SesaZloa moicavdes im demografiul, admi-

nistraciul da diagnostikur monacemebs, romelic uzrunvely-

ofs standartul informacias im pacientebis Sesaxeb, romelTac

mzrunveloba utardebaT. isini SeiZleba warmoadgendnen ufro

rTul sazom erTeulebs, romelTa gamoyenebiT xdeba xarisxis

ganzomilebaTa Sefaseba. amJamad misawvdomTagan zogierTi Sem-

uSavebuli da dadasturebuli iqna specialurad paliatiuri

mzrunvelobis sferoSi, mag. damxmare gundis Sefasebis ganrigi

(Support Team Assesement Schedule) edmontonis simptomTa Sefa-

sebis sistema (Edmonton Symptom Assesement System) an paliati-

uri mzrunvelobis SedegTa Skala (Palliative Care Outcome Scale).Mag (Bruera et.al.1991; earn and Higginson 1999; Higginson andMcCarthy 1993)

126. aRniSnuli sazomi erTeulebi sasargebloa ara marto xarisxis

Sefasebis procesisaTvis, aramed yoveldRiuri klinikuri praq-

tikisaTvis. aseT SemTxvevaSi axali saSualebebis gamoyenebas

jobia arsebuli da Sefasebuli xerxebis gamoyeneba.

CM(2003)13062

Photo: Jacob Forsell, Sweden

127. mniSvnelovania xarisxis standartebis SemuSaveba da maTi gavr-

celeba paliatiur mzrunvelobaSi specializebul yvela dawese-

bulebaSi. mravali samsaxurisa da klinikuri Sefasebis auditi

damokidebulia aRniSnuli standartebis arsebobaze, romelTa

Sesabamisad SesaZlebelia praqtikis Sefaseba. standarti aris

mzrunvelobis specifikur sferoSi arsebuli `kargi praqtikis~

identificireba.

128. standartebi SeiZleba SemuSavdes saxelmwifo da regio-

nul/adgilobriv doneze. saxelmwifo done uzrunvelyofs ganvi-

Trebisa da monitoringis mkafio strategias, izogeba dro da

energia. regionuli/adgilobrivi done iZleva erovnuli stan-

dartebis regionisa Tu dawesebulebisaTvis specifikur maxasi-

aTebelebTan mimarTebaSi adaptaciis saSualebas. saukeTeso mid-

gomas warmoadgens am ori momentis kombinacia.

129. xarisxis standartebis wardgenas, misi maqsimaluri dasabuTebi-

sa da iuridiuli Zalis uzrunvelyofisaTvis, win unda uswreb-

des rac SeiZleba farTo konsultaciebi sakiTxze momuSave yve-

la partniorTan. zogierTma qveyanam SeimuSava standartebi,

romelic SeiZleba gamoyenebuli iqnas ganxilvis safuZvlad maT-

Tvis, visac igi jer ar gaaCnia.

130. rogorc es miTiTebulia higinsonisa da sxvebis naSromSi, audi-

tis teqnika paliatiuri mzrunvelobis sferoSi, kerZod specia-

luri multidisiplinuri gundebisaTis Sefasebis gansakuTre-

buli meTods warmoadgens.

131. pacientsa da mis axloblebze orientirebuli es meTodi iZleva

momsaxurebis rogorc klinikuri, aseve araklinikuri aspeqtebis

Sefasebis saSualebas. mis mizans warmoadgens ara marto xarisx-

is gaumjobesebis mudmivi kontroli, aramed analizis procesSi

CarTuli profesionalebis momzadebac.

CM(2003)130 63

kvleva paliatiur mzrunvelobaSi

132. ramdenadac kvlevis mTavar mizans warmoadgens (an unda warmoad-

gendes) pacientze mzrunvelobis xarisxis gaumjobeseba, calke

Tavis miZRvnis nacvlad, aRniSnul sakiTxs xarisxTan mimarTebaSi

ganvixilavT.

133. adreul wlebSi, kvleva paliatiuri medicinisa da mzrunvelobis

ganviTarebis umTavres da prioritetul nawils warmoadgenda.

paliatiuri medicina iseve unda iyos damyarebuli mtkicebule-

bebze, rogorc medicinis sxva sferoebi.

134. kvlevis Sedegebis safuZvelze mniSvnelovani progresi iqna miR-

weuli tkivilisa da simptomebis marTvis sferoSi. kvleva aseve

swrafad viTardeba medicinisa da jandacvis samsaxurebis sxva

sferoebSi, Tumca mimdinare da momavali problemebi jer kidev

saWiroeben Semdgom Seswavlas. paliatiuri mzrunvelobis praq-

tikis umetesi nawili dafuZnebulia epizodur da/an istoriul

faqtebze da ara mecnierul meTodebsa da mtkicebulebebze. miux-

edavad imisa, rom komitetis mizans ar warmoadgens mkurna-

lobaSi SemoqmedebiTi midgomisa da aratradiciuli meTodebis

gamoyenebis mniSvnelobis daknineba, igi miiCnevs, rom saWiroa

masStaburi kvlevebis Catareba, raTa moxdes realurad sasarge-

blos usargeblosagan gamorCeva.

135. paliatiur mzrunvelobaSi kvlevis SedarebiTi simwire SeiZleba

aixsnas mravali faqtoriT, maT Soris imiTac, rom SezRudulia

kvleviTi muSaoba am jgufis pacientebSi. Cven unda ganvixiloT

paliatiuri mzrunvelobis kvlevasTan dakavSirebuli lojisti-

kuri, demografiuli, akademiuri faqtorebi da specifikuri

eTikuri problemebi.

136. pacientebis SerCeva da aRniSnul kvlevaSi maTi CarTva sakmaod

rTulia paliatiuri mzrunvelobis realuri bunebidan gamomdi-

nare. ramdenadac kvleva tardeba hospisebsa da stacionarul

ganyofilebebSi, maTi mcire moculoba aferxebs kvlevas. ufro

CM(2003)13064

metic, pacientebi, romelTa mdgomareobis stabiluroba kvlevaSi

monawileobis miRebis saSualebas iZleva, aRniSnul

dawesebulebebSi mxolod mcire droiT rCebian, xolo is pacien-

tebi, romelTa mdgomareoba moiTxovs ufro xangrZlivi droiT

iq darCenas, imdenad mZimea, rom bevr maTgans ar SeuZlia im

damatebiTi tvirTis atana, rac kvlevas axlavs Tan. yovelive

aRniSnulis Sedegad, mxolod zogierT pacients SeuZlia miiRos

monawileoba Sesabamisi kvlevis CatarebaSi drois saWiro

monakveTSi.

137. zemoTaRniSnulTan erTad, arsebobs specifikuri klinikuri faq-

torebi, romlebic kidev ufro arTuleben kvlevas am sferoSi.

pacientebi umTavresad asakovani adamianebi arian, romelTa mdgo-

mareoba garTulebulia ramodenime organos dazianebiT, rasac

Tan axlavs Tanmdevi simptomebi. daavadeba aris progresirebadi,

simptomebi ki swrafad cvalebadi, gansakuTrebiT terminalur

stadiaSi; sasicocxlo vada SezRudulia da mravali medikamen-

tis gamoyeneba Cveulebriv movlenas warmoadgens.

138. aRniSnuli sxvadasxva faqtorebi moiTxoven kvlevis srulyofil

meTodologias, romlis sqema maqsimalurad iqneba miznebze mor-

gebuli. sqema SeiZleba iyos rogorc xarisxobrivi, aseve raode-

nobrivi. paliatiur mzrunvelobaSi fsiqosocialuri da emociu-

ri sakiTxebis mniSvnelobidan gamomdinare, umetesad misaRebia

xarisxobrivi midgoma. sabednierod kvlevis xarisxobrivi

meTodebi samedicino mecnierebaSi sul ufro metad aRiarebuli

xdeba. Tumca, meTodologiuri codna ar aris sakmarisi aseTi

seriozuli problemis gadaWrisaTvis.

139. bevr qveyanaSi paliatiuri medicina da mzrunveloba ar aris

gamoyofili calke disciplinad, aramed miCneulia mkurnalobis

filosofiad, sadac aqcenti keTdeba adamianis pirovnebaze. mci-

rea kavSirebi akademiur organizaciebTan, dabalia am organiza-

ciebis mier paliatiuri mzrunvelobis, iseve rogorc jandacvis

sxva sferoebis prioritetulobis aRiareba. swored am mizezis

gamo erovnuli kvleviTi fondebis umetesoba paliatiur mzrun-

CM(2003)130 65

velobas an ar miiCnevs kvlevis cakle sferod, an ar aRiarebs

mis prioritetulobas da Sesabamisad naklebadmisawvdoms xdis

dafinansebas.

140. paliatiur medicinaSi kvlevis Semaferxebel sxva SesaZlo bari-

erebs warmoadgens: Sefasebis erTiani meTodikebis nakleboba da

aseTi meTodikebis arasakmarisad gamoyeneba. paliatiuri medici-

nis arazusti gansazRvreba; yuradRebis nakleboba farmakologi-

uri kompaniebis mxridan, garda misi iseTi zogierTi momgebiani

seqtorebisa, rogoricaa analgezia; koordinaciis nakleboba

paliatiuri mzrunvelobis kvlevis sferoSi momuSave centrebs

Soris.

141. Catarebuli iqna kvleva terminaluri pacientebis gamokiTxvis

eTikur sakiTxebTan dakavSirebiT, gansakuTrebiT pacientTa im

jgufis mimarT, romelTac ar aqvT SesaZlebloba miiRon monawi-

leoba gadawyvetilebis miRebaSi (SemecnebiTi darRvevebis

maRali maCvenebeli) da/an ganacxadon Tavisufali da informire-

buli Tanxmoba. (damokidebuleba im dawesebulebaze, sadac isini

mzrunvelobas iReben, grZnobebisa da madlierebis Sesaxeb).

(Grande and Todd 2000; Hardy 1997; Kaasa and De Conno 2001). Tumca,umetesoba aRniSnul problemebs ar ganixilavs mxolod palia-

tiuri medicinis problemad da miiCnevs, rom isini medicinis

sxva sferoebSic gvxvdeba. (heriatria, intensiuri mkurnaloba da

sxv) Sedegad, ar arsebobs paliatiuri pacientebis calke kate-

goriad gamoyofis aucilebloba da maT mimarT helsinkis

aRiarebuli eTikuri kodeqsisagan gansxvavebuli eTikuri norme-

bis gamoyeneba. (Crigger 2000). paliatiuri mzrunvelobis sferoSikvlevebi unda Seesabamebodes klinikuri kvlevis sferoSi

miRebul yvela eTikur normebs da aRiarebuli unda iqnas regio-

nuli da instituciuri eTikuri komitetis mier.

142. gansakuTrebuli yuradReba unda mieqces kvleviTi proeqtis im

riskebisa da upiratesobebis Sefasebas, romelic SeiZleba gansx-

vavdebodes daavadebis progresirebis sxvadasxva stadiaze.

mzrunvelobis amocanebi icvleba terminalur stadiaze, rodesac

CM(2003)13066

sicocxlis gaxangrZlivebasTan SedarebiT upiratesoba sicocx-

lis xarisxs eniWeba. aseT SemTxvevaSi gansakuTrebuli mniSvne-

loba aqvs iseTi faqtorebis gaTvaliswinebas, romelTac umete-

sad ar aqvT biologiuri safuZveli, mag. rogoricaa pacien-

tebisaTvis daniSnulebis modificireba.

143. miuxedvad evropis paliatiuri medicinis asociaciis (EAPC)mcdelobisa, xeli Seuwyos TanamSromlobas, jer kidev arsebobs

TanamSromlobis nakleboba evropis qveynebSi paliatiuri mzrun-

velobis kvlevis sferoSi momuSave profesionalTa Soris.

pprrooffeessiioonnaallTTaa ddaa vvoolloonnttiioorrTTaa

ggaannaaTTlleebbaa ddaa ttrreenniinnggeebbii

144. paliatiuri mzrunvelobis ganviTarebisaTvis udidesi mniSvne-

loba eniWeba profesionalTa da sazogadoebis ganaTlebas. bevr

qveyanaSi gansazRvrulia ganaTlebis sami done: sawyisi done, ro-

melic unda miiRos jandacvis yvela profesionalma; Sualeduri

done, romelic unda miiRos paliatiur medicinaSi specifikuri

kvalifikaciis miRebis msurvelma profesionalma (paliatiuri

medicinis eqspertis statusis miRebis gareSe) da umaRlesi done

maTTvis, visac surs gaxdes paliatiuri mediciis specialisti.

145. sabaziso sauniversiteto kursi profesionalebisaTvis aris is

pirveli periodi, rodesac studentebi Seiswavlian paliatiur

mzrunvelobas. bevrma profesiulma organizaciam, rogoricaa

gaerTianebuli samefos eqimTa samefo koleji, evropis paliati-

uri mzrunvelobis asociacia, SeimuSava saswavlo programebi

(kurikulumi). miuxedavad simwirisa, eqimTa sabazo sauniversite-

to gamocdileba naTlad miuTiTebs, rom gamarTlebulia studen-

tebisaTvis paliatiuri mzrunvelobis aspeqtebis sawvleba.

naklebad aris cnobili informacia saeqTno da sxva arasamedici-

no profesiebis studentebisaTvis sabaziso saswavlo programe-

bis efeqturobisa da ganxorcielebadobis Sesaxeb.

CM(2003)130 67

146. paliatiuri mzrunvelobis saswavlo programebSi mniSvnelovani

adgili ukavia im eTikur dilemebs, romelTa gadawyveta uwevT

rogorc profesional, aseve araprofesional momvlelebs. aseT

programebSi gansakuTrebuli yuradReba eqceva studentTa mier

pirovnuli Rirebulebebis gacnobierebas, mag. sicocxlis

dasrulebasTan dakavSirebul sakiTxebTan da im gavlenasTan

mimarTebaSi, rasac igi axdens mzrunvelobaze. aRniSnul

sakiTxebTan dakavSirebiT gansakuTrebiT misasalmebelia gulax-

diloba.

147. ganaTlebasTan dakavSirebul mniSvnelovan fsiqologiur aspeq-

tebs warmoadgens usiamovno ambis miwodeba, iseTi fsiqologiu-

ri darRvevebis diagnozireba da mkurnaloba, rogoricaa wuxi-

li, depresia da SfoTva. aseve saswavlo programis mniSvnelovan

nawils warmoadgens pacientis SemecnebiT unarSi cvlilebis

aRiareba. igive exeba pacientisa da misi ojaxis daxmarebis

saWiroebas.

148. ganaTlebis mniSvnelovan sakiTxs warmoadgens iseTi socialuri

aspeqtebi, rogoricaa pacientisa da misi ojaxis sacxovrebeli

pirobebi, socialuri da praqtikuli daxmarebis arseboba an

ararseboba.

149. paliatiur mzrunvelobaSi ganaTlebis yvelaze mniSvnelovan

tipiur sakiTxebs sulieri da kulturuli aspeqtebi warmoad-

gens. studentebma unda iswavlon pacientebisaTvis sicocxlis

bolo periodSi am sakiTxebis mniSvneloba, gaigon maTi

saWiroebebi da gauwion adekvaturi daxmareba.

150. aRiarebs ra dadgenil moTxovnebs, gunduri muSaobis SesaZ-

leblobebsa da SezRudvebs, saswavlo programis organizaciuli

aspeqtebi ukavSirdeba jandacvis sistemisa da arsebuli palia-

tiuri samsaxurebis Sesaxeb codnas. sauniversiteto saswavlo

programa moicavs yvela zemoTCamoTvlil aspeqts. maTi umrav-

lesoba SeiZleba CarTuli iqnas samedicino saswavleblebis sxva

mimdinare programebSi.

CM(2003)13068

151. mraval qveyanaSi paliatiuri medicina CarTulia uwyveti samedi-

cino ganaTlebis (usg) programis sawyis doneze. zogierTi erov-

nuli asociaciebi uzrunvelyofen an mxars uWeren zogadi praq-

tikis eqimebis ganaTlebis aseT kursebs.

152. usg programebis garda zogierTma qveyanam ganaviTara ufro

maRali donis ganaTleba, magram mxolod araspecialistebisaTvis

(Sualeduri done). aseT magaliTs warmoadgens uelsis universi-

tetis mier SemuSavebuli paliatiuri mzrunvelobis distanciu-

ri saswavlo kursi da holandiis zogad praqtikosTa kolejis

mier SemuSavebuli eqspert zogad praqtikosTa satreningo

kursi. aseTi saxis kursebis mizania monawileebs saSualeba mis-

ces gaxdnen paliatiuri mzrunvelobis eqspertebi da amavdrou-

lad saqmianoba ganagrZon ZiriTadi specialobiT. umaRlesi donis

sauniversiteto ganaTlebis kidev erTi magaliTia belgiaSi,

Libre de Bruxelles –is universitetis mier aRiarebuli Sida-sauni-versiteto diplomi. aqcenti keTdeba mzrunvelobis uwyvetoba-

ze, mkurnalobasa da paliatiur mzrunvelobas Soris dogmatu-

ri sazRvrebis gavlebis gareSe.

153. ufro maRal doneze, arsebobs paliatiuri mzrunvelobis saswav-

lo programebi, romlebic ZiriTadad SemuSavebulia evropis im

qveynebSi, sadac paliatiuri mzrunveloba damoukidebel specia-

lobad aris aRiarebuli.

kkoommuunniikkaacciiaa

154. kargi sakomunikacio unar-Cvevebi paliatiuri mzrunvelobis um-

Tavresi nawilia da ar aris specifikurad damaxasiaTebeli pali-

atiuri mzrunvelobisaTvis. Civili arasaTanado mzrunvelobis

Sesaxeb ufro xSirad gamowveulia araefeqturi komunikaciiT da

ara mkurnalobis dabali doniT. komunikacia moicavs ufro mets,

vidre ubralod informaciis miwodeba. es aris procesi,

romelSic CarTulia mravali adamiani da romlis amocanebi moi-

cavs informaciis gacvlas, urTierTgagebasa da daxmarebas,

CM(2003)130 69

rTuli da zogjer mtkivneuli sakiTxebis ganxilvas da am sakiT-

xebiT gamowveuli emociuri stresis ganawilebas. sxvaTa wuxi-

lis gaziareba aseve moicavs dros, pasuxismgeblobasa da gulwr-

fel survils. nawilobriv, es exeba pasuxis gacemas, ufro metad

ki tkivilis Semsubuqebasa da pirovnebis gverdiT yofnas maSin,

rodesac pasuxi ar arsebobs. komunikacia ar aris `damatebiTi

momsaxureba~, igi jandacvis sasicocxlo, ganuyofel da aucile-

bel komponents warmoadgens. tradiciulad, bevri sauniversite-

to kursi ar moicavs komunikaciis sakiTxebs. dReisaTvis

aRiarebulia am deficitis arseboba da kurikulumebis umeteso-

baSi yuradReba maxvildeba komunikaciis sakiTxebze.

155. komunikacia ar moicavs mxolod jandacvis profsionalsa da

pacients. is moicavs komunikacias jandacvis profesionalsa da

ojaxs, pacientTa da maT ojaxebs (an pacientisaTvis mniSvnelovan

axloblebs) Soris da kominikacias jandacvis profesionalebs

Soris sxvadasxva dawesebulebaSi. yvela am mxares Soris efeq-

turi da swrafi komunikaciis fasilitacia moiTxovs Semdeg

elementebs:

- jandacvis yvela profesionalis ganaTlebasa da treningebs

komunikaciis unar-Cvevebis sakiTxebze;

- hospisebi da klinikebi unda uzrunvelyofdnen pacientebisa

da maTi ojaxebis piradi SexvedrebisaTvis Sesaferis farTs;

- jandacvis profesionalebs unda qondeT yovelkvireuli gan-

rigi pacientebTan da maT ojaxis wevrebTan, aseve jandacvis

sxva profesionalebTan SexvedrebisaTvis.

- jandacvis profesionalebisaTvis misawvdomi unda iyos

Tanamedrove teqnologiebi.

CM(2003)13070

komunikacia pacientebsa da jandacvis profesionalebs Soris

156. avadmyofobis tipiuri procesis ganmavlobaSi pacients jandac-

vis mraval profesionalTan uxdeba Sexvedra. yoveli aseTi

Sexvedra iZleva komunikaciis SesaZleblobas. komunikaciis nawi-

li xdeba metyvelebiT, umetesi nawili ki araverbaluria. zoga-

dad, pacientebi moiTxoven gulaxdil, misawvdom da Tanmimdev-

rul informacias maTi daavadebisa da SesaZlo garTulebebis

Sesaxeb. arcTu iSviaTad, jandacvis profesionalebi da ojaxis

wevrebi pacientisaTvis imedis SenarCunebis mizniT mas araswor

informacias awvdian. aseTi `keTili ganzraxvis strategiam~

SesaZloa gamoiwvios sirTuleebi, ramdenadac daavadeba progre-

sirebs. cudi axali ambavi yovelTvis cudi ambavia, Tumca misi

miwodebis meTodebi da is, Tu ramdenad grZnobs pacienti

mxardaWerasa da gagebas, mniSvnelovnad ganapirobebs mis

Seguebas axal realobasTan.

CM(2003)130 71

Photo: Maciej Kluziak, Poland

157. ufro metic, arsebobs mkafio emociuri, fsiqologiuri SezRud-

vebi, Tu ra doziT SeiZleba iqnas miwodebuli SemaSfoTebeli

informacia erTi saubris dros: cudi ambis gagebiT miRebuli

emociuri dartymis gamo, Semdgomi informacia Cveulebriv veRar

aRiqmeba. amitom informaciis danawevreba, pacientisa da misi

ojaxisaTvis cudi ambis gasaazreblad drois micema, umTavres

momentad aris aRiarebuli. dadasturebulia cudi axali ambis

gamxelis arsebuli safexureobrivi etiketis (mag. Buckman in 3)efeqturoba.

158. rogorc wesi, pacientebs daavadebis, mkurnalobisa da prognozis

Sesaxeb aseTi saxis informacia unda miewodos mgrZnobiare,

TanadgomiTi da gulaxdili formiT. pacientis damoukidebloba-

sa da RirsebasTan mimarTebaSi sasicocxlo mniSvneloba aqvs

misTvis aucilebeli informaciis miwodebas, raTa man SeZlos

informirebuli arCevanis gakeTeba. aRniSnul procesze SeiZleba

garkveuli gavlenaiqonios kulturulma garemom im gagebiT, rom

zogierTma pacientma, aniWebs ra informaciis sisrules nakleb

mniSvnelobas, SesaZloa mniSvnelovani gadawyvetilebis miReba

sxvas miandos.

159. paliatiur mzrunvelobaSi komunikacias gansakuTrebiT Semecne-

biTi darRvevebi arTulebs. amdenad SemecnebiTi darRvevebis

SesaZlo cvalebadobis mxedvelobaSi miReba da misi xarisxis

Sefaseba metad mniSvnelovania.

komunikacia pacientsa da ojaxis wevrebs Soris

160. paliatiuri mzrunvelobis dawesebulebebSi pacientebi da maTi

ojaxis wevrebi xSirad stresis qveS imyofebian. arcTu iSviaTad,

mxareebs Soris komunikacia Zalian mcirea, Tuki is saerTod

arsebobs. aseT SemTxvevebSi xSiria gaugebrobisa da wyenis momen-

tebi. pirovnebas SeiZleba miaCndes, rom mzrunvelobis tvirTi

arasamarTliania. SesaZloa amotivtivdes Zveli jibri da Suri,

ramac situaciaze kontrolis dakargva gamoiwvios.

CM(2003)13072

161. jandacvis profesionalebs ekisrebaT aseTi fenomenis gamovle-

nisa da sapasuxo reaqciis gamoxatvis movaleoba. ukidures Sem-

TxvevaSi maT unda moaxdinon informaciis gaziarebis faqtis

modelireba, raTa pirovnebebs SeeZloT iyvnen gulaxdilni

TavisTavTan da sxvebTan sakuTar grZnobebsa da emocebTan

mimarTebaSi. erT saojaxo Sexvedras SeuZlia Secvalos da

gadaarCinos iseTi situaciac ki, romelic sxva SemTxvevaSi swra-

fad gadaizrdeboda sibrazis, simwarisa da wyenis nazavSi.

162. yuradReba unda daeTmos bavSvebisa da mozardTa gansakuTrebul

saWiroebebs. mWidro ojaxur situaciebSi, bavSvebi xSirad gariy-

uli arian procesidan Tumca keTili ganzraxviT, magram araswo-

ri mcdelobiT `daicvan~ isini. iseve rogorc ufrosebs, bavSvebs

sWirdebaT, rom maTi esmodeT, ugebdnen da qondeT SesaZlebloba

CarTuli iyvnen mimdinare procesebSi.

komunikacia jandacvis profesionalebs Soris

163. erT pacientze mzrunvelobaSi SesaZloa sxvadsaxva sferosa da

dawesebulebaSi momuSave jandacvis profesionalebi monawile-

obdnen. Sesabamisad, aucilebelia informaciis swrafi da adekva-

turi gacvla. drois simciris garda komunikaciis problemas

warmoadgens movaleobaTa ganawileba, mzrunvelobis sxvadasxva

filosofiisa da barierebis arseboba. iseve rogorc ojaxSi,

saqme ar exeba mxolod informaciis gacvlas. aucilebelia

sxvaTa Sexedulebebis gaziareba, gansakuTrebiT maSin, rodesac

mkurnalobis strategiebis Sesaxeb gansxvavebuli mosazrebebi

arsebobs. aseT SemTxvevebSi, urTierTgagebis, poziciis Sejere-

bisa da pacientisaTvis saukeTeso servisis SeTavazebis SesaZleb-

lobas faqtTan dakavSirebuli azrTa gacvla iZleva. rekomende-

bulia azrTa Ria urTierTgacvla gareSe fasilitatoris monawi-

leobiT. Semdgomi informaciisaTvis ix. Semdegi Tavi.

CM(2003)130 73

gguunnddeebbii,, gguunndduurrii mmuuSSaaoobbaa ddaa ddaaggeeggmmvvaa

164. daavadebis Sorswasuli formis mqone pacientebisa da maTi ojax-

is wevrebis xSirad garTulebuli problemebis gaTvaliswinebiT

zogadi da specializebuli mzrunveloba umetes SemTxvevaSi

unda xorcieldebodes interdisciplinuri gundis mier, romlis

mizania mzrunvelobis uzrunvelyofa interdisciplinuri, gun-

duri midgomiT, fizikuri, fsiqologiuri, socialuri da suli-

eri mxardaWerisa da Sesabamisi unar-Cvevebis SejerebiT. es ar

aris mxolod paliatiuri mzrunvelobisaTvis damaxasiaTebeli

specifikuri sakiTxi: kompleqsuri mzrunvelobis yvela forma,

rogorc mwvave, aseve qronikul SemTxvevebSi, moiTxovs multi-

disciplinur gundur muSaobas. Tumca paliatiur mzrunvelobaSi

gundur muSaobas ramodenime gansakuTrebuli maxasiaTebeli aqvs:

araprofesionalTa, moxaliseTa (volontiorTa) da ojaxis wevre-

bis CarTva; momvlelebze zrunvis saWiroeba; sulieri da emoci-

uri sakiTxebis mniSvneloba. (Cummings 1998) miuxedavad imisa,

rom mtkicebuleba jer kidev arasrulia, arsebobs maCveneblebi,

romlebic paliatiur mzrunvelobaSi pacientisaTvis gunduri

muSaobis upiratesobas adastureben.

165. gundis moculoba moqnilia da SesaZloa icvlebodes pacientis

saWiroebebidan gamomdinare. ase mag. gundis minimaluri Semadgen-

lobaSi Sedian ojaxis eqimi da ubnis eqTani, magram Cveulebriv,

gundSi aseve Sedian socialuri muSakebi, fsiqologebi da moxa-

liseebi (volontiorebi). udavoa, rom yvela aRniSnul profesio-

nalsa da volontiorebs SesaZlebloba unda qondeT monawileo-

ba miiRon gadawyvetilebis miRebis procesSi. Tumca jer kidev

sakamaToa sakiTxi, iTvlebian Tu ara ojaxis wevrebi gundis wev-

rebad. is faqti, rom ojaxis wevrebi umetes SemTxvevaSi

xangrZlivad arian CarTuli mzrunvelobaSi, amis sasrgeblod

metyvelebs, xolo is, rom isini aseve warmoadgenen `zrunvis

obieqts~, sapirispiros amtkicebs.

166. xSirad keTdeba gansxvaveba interdisciplinur da multidisci-

plinur gundebs Soris. pirveli nakleb mniSvnelobas aniWebs

CM(2003)13074

profesiul gansaxvavebulobas, vidre ukanaskneli _ ZiriTadad

mzrunvelobas uzrunvelyofs mTeli gundi, ise rom davalebebi

yovelTvis ar aris ganawilebuli profesiebis mixedviT. inter-

disciplinur gundSi lideroba damokidebulia arsebul amocana-

ze da ara profesiul ierarqiaze, rogorc es multidisciplinu-

ri gundis dros xdeba. zogierTi avtori mkafio upiratesobas

aniWebs interdisciplinur gunds. komitets am sakiTxTan

dakavSirebiT ar gaaCnia erTiani rekomendacia da miaCnia, rom

gundis tipis Sesaxeb gadawyvetileba miRebuli unda iqnas adgi-

lobrivi situaciisa da gadasawyveti problemis safuZvelze.

167. miuxedavad imisa, rom ar Catarebula aranairi kvleva eqimis

xelmZRvanelobiT momuSave da sxva gundebs Soris gansxvavebis

gamosavlenad, komitets miaCnia, rom specialuri gundis erT

wevrs mainc unda qondes gavlili treningi da iyos paliatiuri

mzrunvelobis aRiarebuli specialisti.

168. aRiarebulia ra pacientebisaTvis gundis sxvadasxva wevris mier

erTi da igive informaciis miwodebis aucilebelebloba, komuni-

kacia gunduri muSaobis mniSvnelovan aspeqtis warmoadgens. gun-

debi SeimuSaveben komunikaciis gamWvirvale arxebs ise, rom

uzrunvelyofili iqnas gundis yvela wevris mier mzrunvelobis

procesSi wvlilis Setanis SesaZlebloba da am procesis mimdi-

nareobis Sesaxeb maTi drouli informireba.

mzrunvelobis dagegmva da winaswari direqtivebi

169. paliatiuri mzrunvelobis xarisxi mniSvnelovnad umjobesdeba

maSin, rodesac misi winaswari dagegmva xdeba. (Cummings 1998)mzrunvelobis gegmaSi miTiTebulia ara marto mniSvnelovani da

mosalodneli simptomebi, aramed arsebuli da SesaZlo fsiqo-

logiuri da sulieri problemebi. Tu es keTdeba sistematiurad

da uwyvetad, SesaZlebelia arasasurveli krizisisa da saavad-

myofoSi gadayvanis Tavidan acileba.

170. mzrunvelobis winaswari dagegmva Cveulebriv moicavs winaswar

CM(2003)130 75

direqtivebs sicocxlis bolo periodTan dakavSirebul samedi-

cino xasiaTis gadawyvetilebebTan: usargeblo mkurnalobis

Sewyveta, sicocxlis xangrZlivobis Semamcirebeli tkivilisa da

simptomTa marTva, sicocxlis bolos tkivilgayuCeba; pacientis

mier sakiTxis wamoWris SemTxvevaSi, eqimebi mzad unda iyvnen gan-

marton TavianTi mosazrebebi eqimis daxmarebiT gardacvalebis

Sesaxeb (daxmareba TviTmkvlelobaSi, eftanazia). detaluri ganx-

ilvisa da sakiTxTan dakavSirebiT evropis sabWos rekomendaci-

ebisaTvis, mkiTxveli unda gaecnos evropis sabWos 1999 wlis 21

maisis #8421 dokuments adamianis uflebebis, terminaluri da

momakvdavi pacientebis Rirsebis dacvis Sesaxeb.

171. warmodgenili memorandumis konteqstSi sakmarisia xazi gaesvas,

rom miuxedavad eqimebs Soris amgvari gadawyvetilebis eTikuri

Sefasebis sxvadasxvaobisa, arsebobs erTi saerTo mosazreba, rom

profesional mzrunvelebs unda SeeZloT pacientTan Ria dialo-

gis warmoeba. (Quill 1996) aseTi gaxsnili dialogi zogierT

SemTxvevaSi Tavidan agvacilebs eqimis daxmarebiT sikvdilis

moTxovnas. mniSvnelovania eqims miRebuli qondes Sesaferisi

ganaTleba sicocxlis bolos pacientze mzrunvelobis eTikur

dilemebTan dakavSirebiT, raTa man SeZlos gaiazros da

Sesaferisi wesiT pacientsa da misi ojaxis wevrebTan ganixilos

kargad Camoyalibebuli mosazreba. eTikuri dilemebi gansakuTre-

biT maSin warmoiSveba, rodesac pacients jiutad surs sikvdi-

li, Tumca paliatiuri mzrunvelobis SesaZleblobebi jer kidev

ar aris amowuruli. ufro xSirad ki dilemebi aRmocendeba ma-

Sin, rodesac paliatiuri mzrunveloba, mag. morfinis maRali do-

zebiT tkivilis marTva, iwvevs an SesaZloa gamoiwvios sicocx-

lis xangrZlivobis Semcirebis (an gangrZobis) efeqti.

172. marTvis gegmebis SemuSavebasa da monitoringSi pacientisa da

misi ojaxis wevrebis CarTvas aSkara eTikuri upiratesoba aqvs.

garda amisa arsebobs mtkicebulebebi, rom aRniSnuls dadebiTi

wvlili Seaqvs mzrunvelobis xarisxis gaumjobesebaSi.

173. profesionalebi da araprofesionalebi paliatiur mzrunvelobas

CM(2003)13076

sxvadasxva TanafardobiT afaseben rogorc sasargeblosa da

aucilebels. arc is aris gasakviri, rom literaturaSi

gansakuTrebuli yuradReba eqceva iseT Temas, rogoricaa ̀ mzrun-

veloba mzrunvelebze~. Tumca okupaciuri janmrTelobis

TvalsazrisiT ar arsebobs Camoyalibebuli mtkicebuleba, Tu

mzrunvelobis romeli modelia saukeTeso. eWvgareSea, rom

mzrunvelebi raime formiT unda iRebdnen yuradRebas. mzrunve-

lTa gadaRlis Tavidan asacileblad maTi mZime tvirTis sakiTxi

sistematiurad unda iqnas ganxiluli gundis Sekrebaze. aRniS-

nuli exeba ara marto ojaxis wevrebs, aramed maTac, visTvisac

mzrunveloba aris profesionaluri da sistematiuri saqmianoba.

ojaxis daxmarebisa da krizisuli situaciebis Tavidan asacile-

blad sasargeblo iqneba ojaxuri Sexvedrebi pacientisa da

erTi-ori profesionali mzrunvelis monawileobiT.

174. qamingsi aRwers gunduri muSaobis mniSvnelovan, Tumca xSirad

miviwyebul aspeqtebs: (Cummings 1998) gundebs, gansakuTrebiT ki

paliatiuri mzrunvelobis gundebs gaaCniaT iseTive sasicocxlo

cikli, rogorc yvela individs: pirveli faza - idealisturi

enTuziazmi, romelsac TanamSromloba da qarizmatuli lidero-

ba axasiaTebs; meore faza - marTvis komponentebis gaZliereba,

sadac iniciatorebi awydebian gundSi sakuTari adgilis

gaazrebasTan dakavSirebul sirTuleebs da mesame faza - rode-

sac arsebobs idealizmisa da pragmatizmis kombinacia.

volontiorebi

175. warmodgenil memorandumSi sasargeblo iqneboda gansakuTrebuli

yuradRebis gamaxvileba volontiorebze, mzrunvelTa im katego-

riaze, romelic garkveulwilad specifikuria paliatiuri

mzrunvelobisaTvis. volontiorebs paliatiur mzrunvelobaSi

mniSvnelovani, Tumca xSir SemTxvevaSi arasaTanadod dafasebuli

roli eniWebaT. maT SeuZliaT pacients SesTavazon ̀ mosmenis mza-

dyofna~. ar gaaCniaT ra profesionaluri movaleobebi, isini Tavs

srulad uZRvnian pacientebs, romelTac xSirad esaWiroebaT

CM(2003)130 77

sakuTari tanjvis vinmesTvis gaziareba. mesame piris arseboba,

(romlis ndobac advilia) pacients saSualebas aZlevs Tavi

SeigrZnos da aRiqvas sxvebTan Tanabar pirobebSi myof, jer kidev

sazogadoebis wevrad.

176. volontiorTa sxva mniSvnelovani amocana SeiZleba iyos ojaxis

wevrebis droebiT gamoTavisufleba avadmyofze mzrunvelobisa-

gan (rac xSirad amcirebs maTSi danaSaulis grZnobas), maTi emo-

ciebis gaziareba, xolo pacientis gardacvalebis SemTxvevaSi

maTi daxmareba da sazrunavis Semsubuqeba.

177. SeuZliaT ra damxmare pirebis CarTva mzrunvelobis procesSi,

volontiorebs mniSvnelovani funqcia eniWebaT profesionali

mzrunvelebisaTvis. isini profesionalebs saSualebas aZleven

gamonaxon dro sxva saqmianobisaTvisac. profesional mzrunve-

lebs volontiorebis daxmarebiT aseve SeuZliaT pacientisagan

axali informaciis miReba.

178. saimedo partniorobisaTvis unda xdebodes volontiorebis mom-

zadeba, monitoringi da asociaciis mier maTi damtkiceba. ar aris

sakmarisi mxolod daxmarebis survili, mniSvnelovania gul-

dasmiT SerCeuli personalis momzadeba.

179. volontiori damxmareebi qmnian koordinatoris pasuxisxmgeb-

lobiT momuSave gunds, romelic mzrunvelebsa da volontior

damxmareTa Soris damakavSirebeli rgolis fuqcias asrulebs.

maTze zedamxedveloba warmoebs damxmare jgufis konteqstSi.

180. volontiorTa asociaciebi uzrunvelyofen saavadmyofoebSi

volontiorTa saWiro struqturis Camoyalibebas. aseve didia

maTi mniSvneloba binaze movlis pirobebSi volontiorTa daxma-

rebis organizebisaTvis.

181. interdisciplinur gundSi, volontiorebi ar ikaveben sxvis

adgils; SeaqvT ra sakuTari gansakuTrebuli wvlili gundis

muSaobaSi, isini avseben sxvaTa muSaobas da ar iWrebian maT

CM(2003)13078

funqciebSi. mkafiod unda iyos gansazRvruli maTi roli da amo-

canebi. jandacvis am araprofesionalTa gverdiT profesionali

mzrunvelebi da administratorebi Tavs maqsimalurad komfor-

tulad unda grZnobdnen.

182. belgiaSi, 1991 wlis samefo dadgenilebiT nebadarTuli iqna pali-

atiuri mzrunvelobis asociaciebisa da am sferoSi momuSave

sxvadasxva organizaciebis finansuri daxmareba.

183. im asakSi, rodesac sikvdilis Temas tabu edeba, profesional

mzrunvelebTan erTad gansakuTrebuli simboluri mniSvneloba

eniWeba volontior damxmareebs. maTi pirovnuli movaleobebis

garda, isini momakvdavi adamianis garemo sazogadoebas warmoad-

genen.

mmZZiimmee ddaannaakkaarrggii

184. daxmareba axloblis gardacvalebiT gamowveuli mZime danakargis

SemTxvevaSi, specialur literaturaSi paliatiuri mzrunvelo-

bis programebis erT-erT mTavr sakiTxad aris miCneuli. rogorc

samsaxuri, igi misawvdomi unda iyos yvela im dawesebulebaSi,

sadac paliatiuri mzrunveloba xorcieldeba: specialuri pali-

atiuri mzrunvelobis dawesebulebebi, klinikebi da saTemo saa-

vadmyofoebi, binaze movlis pirobebSi. amas ori mizezi aqvs.

erTis mxriv, mZime danakargis SegrZneba Cveulebriv pacientis

gardacvalebamde gacilebiT adre iwyeba, radgan daavadebis pali-

atiuri faza pacientisa da misi ojaxis wevrebisaTvis danakar-

gis mzard SegrZnebas warmoadgens. meores mxriv, paliatiuri

mzrunvelobis profesionalebi ojaxs ganixilaven rogorc

`mzrunvelobis obieqts~, ris logikur aucilebel

gagrZelebasac warmoadgens ojaxTan urTierToba pacientis gar-

dacvalebis Semdgom. (Doyle, Hanks and MacDonald 1998)

185. mZime danakargis SemTxvevaSi damxmare samsaxuris mizania mxari

CM(2003)130 79

dauWiros pacientebsa da maTi ojaxis wevrebs, raTa gaumklavd-

nen avadmyofobisa da gardacvalebis periodSi axloblis

dakargviT gamowveul mraval problemas. aseTi samsaxurebi unda

efuZnebodnen mraval faqtors, maT Soris: individualur

Sefasebas, mwuxarebis siZlieres, problemasTan gamklavebis

unars da TiToeuli ojaxis specifikur saWiroebebs. mZime dana-

kargis SemTxvevaSi daxmarebis efeqturoba dadasturebulia pro-

fesionaluri samsaxurebisa da profesionalTa mxardaWeriT

ganxorcielebuli volontioruli samsaxurebis muSaobaze Cata-

rebul mraval kvlevaSi. aRniSnuli kvlevebis analizis safuZ-

velze parqisi akeTebs daskvnas, rom mZime danakargis SemTxvevaSi

damxmare samsaxurebs SeuZliaT danakargiT gamowveuli fsiqia-

triuli da fsiqosomaturi darRvevebis riskis Semcireba.

(Parkes 1980)

186. mwuxarebis da mZime danakargis sakiTxebze zrunva paliatiuri

mzrunvelobis mTeli procesis ganmavlobaSi uwyvetad unda xor-

cieldebodes. ojaxis wevri Tavs gacilebiT advilad arTmevs

mwuxarebas, Tu igi grZnobs, rom misTvis axlobeli adamiani

iRebs karg mzrunvelobas, aqvs SesaZlebloba gamoxatos sakuTa-

ri wuxili da miiRos daxmareba. Sesabamisad, maT, visac serio-

zuli eWvi SeaqvT mzrunvelobis srulyofilebaSi, mwuxarebis

gamoxatvis ufro garTulebuli da xanrgZlivi reaqcia axasi-

aTebT.

187. ojaxis mxardaWera moicavs avadmyofobisa da mZime danakargiT

gamowveul periodebSi daxmarebas. faqtiurad, daxmarebis es ori

forma mWidrod aris dakavSirebuli erTmaneTTan: axlobeli ada-

mianis gardacvalebamde yovelive gancdili, pirovnebas momavalSi

mwuxarebasTan gamklavebaSi exmareba. axloblis dakargvisaTvis

mzadeba ukve aris mwuxarebis procesis nawili. daxmarebis gawe-

va SeiZleba xdebodes axloblis gadacvalebamde, gardacvalebis

procesSi da mis Semdgom. es aris erTiani, sruli procesi da

SeiZleba grZeldebodes ramodenime saaTi an Tve. profesional

mzrunvelebs sxvadasxva gziT SeuZliaT daxmarebis aRmoCena: maT

SeuZliaT daexmaron ojaxis wevrebs sakuTari grZobebis ufri

CM(2003)13080

mkafiod gansazRvrasa da gamoxatvaSi. (ambivalenturoba, danaSa-

ulis SegrZneba, frustracia da a.S.) amgvari moqmedebiT gunds

SeuZlia gadauWreli an konfliqturi situaciebis ganmuxtva.

mzrunvelobis gundebi aseve mniSvnelovan rols asruleben gar-

dacvlilis survilebTan dakavSirebuli formaluri mxareebisa

da dakrZalvis sakiTxebis organizebaSi.

188. axloblis gardacvalebis Semdgomi periodis winaswari gaazreba

da misTvis mzadeba, mZime danakargis procesis winaTgrZnobad

SeiZleba iqnas miCneuli.

189. emociebis moTokva kidev ufro arTulebs mwuxarebas, maTi dau-

faravi gamoxatva ki am process aadvilebs. amisaTvis ki mTavaria

Sesabamisi droisa da adgilis SeTavazeba.

190. mwuxarebis procesSi axloblebisaTvis didi mniSvneloba aqvs im

garemos, romelsac mas Seuqmnis gundi da romelic gahyveba

momavalSi. mZime danakargi xSirad axloblebSi sicarielis

SegrZnebas tovebs. adamiani Tavs martosulad, izolirebulad

grZnobs da ar SeuZlia axal situaciasTan Segueba. ojaxis wev-

rebisa da megobrebis daxmareba arasakmarisia; socialur struq-

turebs daxmarebis aRmoCena ar ZaluZT. paliatiuri samsaxuris

mier SemoTavazebul specialur samsaxurs SeuZlia Seavsos es

bzari mzrunvelobis axali formebiT: xsovnisadmi miZRvnili

ceremonia, korespodenciis warmoeba, satelefono daxmareba,

individualuri saubrebi da damxmare jgufebi. mZime danakargis

SemTxvevaSi, damxmare samsaxuri gansakuTrebiT yuradRebiT unda

iyos bavSvebisa da mozardebis mimarT, romelTac mwuxarebis

ufrosebisagan gansxvavebuli aRqma da Segueba axasiaTebT. aseve

mniSvneloba eniWeba kulturul gansxvavebulobas.

191. mZime danakargis SemTxvevaSi damxmare samsaxurebis muSaobis

efeqturobis damadasturebeli meToduri mtkicebuleba arasak-

marisia. aRniSnuli samsaxurebis marTvasa da koordinacias axde-

nen Sesaferisi rangisa da kvalifikaciis mqone profesionalebi.

specialurad momzadebuli volontiorebi, romelTac miRebuli

CM(2003)130 81

aqvT codna mZime danakargis SemTxvevaSi daxmarebis sakiTxebSi,

aseve muSaoben profesionalTa xelmZRvanelobiT.

mZime danakargis SemTxvevaSi damxmarebis done

192. mZime danakargis SemTxvevaSi daxmarebis sami done SeiZleba

gamoiyos (Worden 1999)

ppiirrvveellii ddoonnee - mZime danakargis SemTxvevaSi ZiriTadi daxmareba,

romelsac profesionalTa xelmZRvanelobiT axorcieleben maRal

doneze momzadebuli personali da volontiorebi. es ar aris kon-

sultireba, Tumca momzadebuli volontiorebi aseve gamoiyeneben

Sesabamis sakonsultacio unar-Cvevebsac. aRniSnuli gansakuTrebiT

Rirebulia maTTvis, vinc moklebulia socialur daxmarebas da Tavs

daxmarebis potenciuri wyaroebidan izolirebulad grZnobs. daxma-

rebis aRniSnuli done akmayofilebs maT umravlesobas, visac mZime

danakargis SemTxvevaSi daxmareba esaWiroeba.

mmeeoorree ddoonnee - sakonsultacio daxmareba, romelsac secialur pali-

atiur samsaxurebTan an TemTan arsebuli Sesabamisi kvalifikaciis

mqone personali axorcielebs. aseTi konsultaciebi gansakuTrebiT

mniSvnelovania maTTvis, visi mdgomareobac garTulebulia damate-

biTi stresiTa da mwuxarebasTan gamklavebis araadekvaturi damoki-

debulebiT.

mmeessaammee ddoonnee - moicavs ufro intensiur fsiqoTerapias, rodesac

saWiro xdeba specialistisaTvis mimarTva. aseTi saWiroeba SeiZleba

aRmocendes im situaciebSi, rodesac danakargi disfunqciuri qcevis

Rrma Sreebs an ufro Rrma emocionalur kriziss iwvevs.

193. zemoTaRniSnuli samive done gulisxmobs riskis Sefasebas,

romelic gamoiyeneba pirovnebasTan an ojaxTan saubris dros,

yovel konkretul SemTxvevaSi mzrunvelobis yvelaze Sesaferisi

donis gansazRvrisaTvis.

CM(2003)13082

ggaannmmaarrtteebbiiTTii lleeqqssiikkoonnii::

zzrruunnvvaa mmzzrruunnvveelleebbzzee - paliatiuri mzrunvelobis aqtivoba, rome-

lic ukavSirdeba momakvdavi pirovnebis movlasTan dakavSirebul

sirTuleebsa da barierebs. aseve moicavs daxmarebas mZime danakar-

gis (axloblis dakargviT gamowveuli) SemTxvevaSi.

mmzzrruunnvveelloobbiiss ggeeggmmaa - paliatiuri mzrunvelobis gundis mier paci-

entisa da misi ojaxis wevrebis monawileobiT Sedgenili da regu-

larulad ganaxlebadi dokumenti, sadac aRniSnulia pacientisa da

misi ojaxis saWiroebebi da arCevani, mdgomareobis prognozireba,

procesSi CarTul profesionalTa da araprofesionalTa amocanebi;

mzrunvelobis gegma aris winmswrebi da mimarTulia krizisuli

situaciebis prevenciaze.

CM(2003)130 83

Photo: Mihai Eröss, Romania

ddRRiiss mmzzrruunnvveelloobbiiss ddaawweesseebbuulleebbeebbii -- Cveulebriv funqcionireben

specialuri paliatiuri mzrunvelobis stacionarebis bazaze, sadac

pacientebi Tavsdebian kviraSi erTi an ramodenime dRiT. SeTavaze-

buli momsaxureba SeiZleba iyos sxvadasxva xasiaTis: samedicino

(sisxlis gadasxma, tkivilisa da simptomTa marTva, a.S.), socialuri

(Sxapi/abazana), sareabilitacio (fizio/okupaciuri Terapia), gan-

tvirTviTi (masaJi) an damxmare (yuradRebis gadamtani: xelovneba,

xelsaqme). aRniSnuli momsaxurebis mizans aseve warmoadgens Ziri-

Tadi momvlelisaTvis mcire drois gamoTavisufleba.

oojjaaxxii -- paliatiuri mzrunvelobis konteqstSi, ojaxi moicavs paci-

entze mzrunvelobaSi monawile yvela axlobels. xSirad ojaxi

ganixileba rogorc ̀ mzrunvelobis erTeuli~. SesaZloa es mosazre-

ba ar iyos zedmiwevniT gamarTlebuli, (pacienti yovelTvis aris da

unda rCebodes yuradRebis centrSi) Tumca igi xazs usvavs ojaxis

rogorc mzrunvelis, aseve zrunvis obieqtis mniSvnelobas.

ffuuWWii aaqqttiivvoobbaa - warmoadgens yvelaze xSir sakamaTo sakiTxs preven-

ciis, diagnostikisa da mkurnalobis im samedicino CarevebTan

mimarTebaSi, romelTac aranairi sargebloba ar moaqvT pacientisaT-

vis. is ukavSirdeba “acharnement thërapeutique” (Terapiuli mZvinvare-ba) frangul gagebas, romelic ZiriTadad gamoiyeneba kuraciuli an

sicocxlis gamaxangrZlivebeli mkurnalobis dros.

hhoossppiissuurrii mmzzrruunnvveelloobbaa -- ar arsebobs pospisuri mzrunvelobis

erTi, yvelasaTvis misaRebi ganmarteba. Tavdapirvelad, koncefcia

mimarTuli iyo jandacvis zogadi sistemisagan gansxvavebuli mzrun-

velobis formaze, sadac samuSaos udidesi nawili sruldeboda

volontiorTa mier da aqcenti keTdeboda komfortsa da suliere-

baze. dResdReobiT, mraval qveyanaSi pospisuri mzrunveloba palia-

tiuri mzrunvelobis sinonims warmoadgens.

hhoossppiissii -- SeiZleba niSnavdes dawesebulebas an binaze movlis sam-

saxurs. zogjer gansxvaveba keTdeba maRali da dabali mzrunvelo-

bis donis hospisebs Soris.

CM(2003)13084

mmzzrruunnvveelloobbiiss iinnddiivviidduuaalluurrii ggeeggmmaa - ix. `mzrunvelobis gegma~

iinntteerrddiisscciipplliinnuurrii - gunduri muSaoba, rodesac mzrunvelobas

uzrunvelyofs erTiani, mTliani gundi. multidisciplinuri gundis

muSaobis stilisagan gansxvavebiT, sazRvrebi disciplinebsa da maT

kompetenciebs Soris naklebad mniSvnelovnad aris miCneuli.

mmuullttiiddiisscciipplliinnuurrii - gundSi erTze meti profesiis warmomadgen-

lebis arseboba. multidisciplinuri gundi SeiZleba Sedgebodes

eqimebis, eqTnebisa da jandacvis sxvadasxva sferos muSakebisagan;

igi SeiZleba muSaobdes interdisciplinuri an multidisciplinuri

stiliT.

ppaalliiaattiiuurrii mmzzrruunnvveelloobbiiss eerroovvnnuullii//rreeggiioonnuullii ggeeggmmaa -- politikis

SemmuSaveblebis, profesionalTa da pacienTa mier SemuSavebuli st-

rategia, romlis mizansa da ZiriTad ideas paliatiuri mzrunvelo-

bis masStaburobis, Tanasworobisa da xarisxis (efeqturobisa da

dakmayofilebis) uzrunvelyofa warmoadgens. racionaluri gegmis

saerTo elementebi moicavs Semdeg aspeqtebs: Sefasebis saWiroeba;

mkafio miznebis gansazRvra; specifikuri momsaxurebis ganxorciele-

ba; ZiriTadi/tradiciuli momsaxureba (upiratesad Sorswasuli daa-

vadebis mqone pacientTa mzrunvelobaze mimarTuli da Temze dafuZ-

nebuli); ganaTleba da treningi; opioidTa misawvdomobis populari-

zacia; specifikuri sakanonmdeblo baza; standartebis SemuSaveba da

Sedegebis sistematiuri Sefaseba.

ppaalliiaattiiuurrii mmzzrruunnvveelloobbaa -- arsebobs paliatiuri mzrunvelobis

ramodenime ganmarteba. warmodgenil rekomendaciebsa da ganmartebiT

memorandumSi gamoyenebulia janmo-s mier 1990 wels formulirebu-

li da 2002 wels koreqtirebuli ganmarteba: Sorswasuli, progre-

sirebadi daavadebis mqone pacientebze aqtiuri, srulyofili zrun-

va. umTavresi xdeba tkivilisa da sxva simptomebis, fsiqologiuri,

socialuri da sulieri problemebis kontroli. paliatiuri mzrun-

velobis mizania pacientebisa da maTi ojaxis wevrebis sicocxlis

xarisxis gaumjobeseba.

CM(2003)130 85

ppaalliiaattiiuurrii mmeeddiicciinnaa -- warmoadgens specifikur samedicino mzrunve-

lobas aqtiuri, progresirebadi da Sorswasuli daavadebis mqone im

pacientebze, romelTa sasicocxlo prognozi SezRudulia da mzrun-

velobis aqcenti keTdeba sicocxlis xarisxze.

ssiiccooccxxlliiss xxaarriissxxii -- paliatiuri mzrunvelobis umTavres mizans

sicocxlis optimaluri xarisxi warmoadgens, Tumca am koncefcias

efemeruli xasiaTi aqvs da Sorswasuli daavadebis mqone pacien-

tebSi misi gazomva rTulia. daavadebis modificirebaze mimarTul

mkurnalobaSi SemuSavebuli ganzomilebebi paliatiur medicinasTan

mimarTebaSi ver gamoiyeneba, gansakuTrebiT, rodesac saqme sicocx-

lis bolos sulierebis sakiTxebisadmi yuradRebas exeba. paliatiu-

ri mzrunvelobisaTvis misaRebia pacientTa prioritetebze damyare-

buli sicocxlis xarisxis Sefaseba.

rreeaabbiilliittaacciiaa - Sorswasuli daavadebis mqone pacientebSi funqciu-

ri mdgomareobis maqsimaluri gaumjobeseba, raTa maT SesaZlebloba

qondeT SeinarCunon aqtiuroba da sicocxlis optimaluri xarisxi.

aRniSnulma SesaZloa fizio da okupaciuri Terapevtebis muSaoba

moiTxovos.

ddrrooeebbiiTTii mmzzrruunnvveelloobbaa - mzrunvelobis forma, romelic ojaxis wev-

rebs aZlevs pacientis movlisagan droebiTi Sesvenebis saSualebas:

aRniSnuli SeiZleba saWiro gaxdes sxvadasxva SemTxvevaSi, mag. das-

venebis dReebsa da Svebulebis dros, mkurnalobis saWiroebis dros

da a.S. droebiTi mzrunveloba SeiZleba xorcieldebodes

saavadmyofoebSi, moxucebulTa saxlebSi an hospisebSi. zogjer

droebiTi, dRis mzrunvelobis da samedicino procedurebisaTvis

hospitalizaciis formebs Soris sazRvrebi mkafio ar aris.

ssppeecciiaalliizzeebbuullii ppaalliiaattiiuurrii mmzzrruunnvveelloobbiiss ssaammssaaxxuurreebbii - samsaxure-

bi, romelTa mTavar specializacias warmoadgens paliatiuri

mzrunveloba, romelsac Sesabamisi ganaTlebisa da gamocdilebis

mqone paliatiuri mzrunvelobis profesionalebis xelmZRvanelobiT

uzrunvelyofs interdisciplinuri gundi.

CM(2003)13086

ssuulliieerrii mmzzrruunnvveelloobbaa - aqcents akeTebs cxovrebis arsze, im egzi-

stencialur da religiur sakiTxebze, romlebic xSirad uCndeba

pacientebsa da ojaxis wevrebs. igi exeba rogorc morwmune, aseve

ara religiur pacientebsa da maTi ojaxis wevrebs, rogorc gardac-

valebamde, ase gardacvalebis Semdgom.

tteerrmmiinnaalluurrii zzrruunnvvaa - paliatiuri mzrunvelobis kontiniumi. Cve-

ulebriv mimarTulia pacientTa mdgomareobis marTvaze sicocxlis

bolo saaTebsa an dReebSi.

vvoolloonnttiioorreebbii - mzrunvelebi, romelnic sakuTari drois nawils

uangarod uTmoben maTTvis ucnob pacientebze mzrunvelobas.

Cveulebriv maT ganaTlebasa da muSaobas koordinacias uweven

volontioruli organizaciebi. jandacvis profesionalebi aseve

SesaZloa iyvnen volontiorebi.

CM(2003)130 87

CM(2003)13088

CM(2003)130 89

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CM(2003)130 91

eevvrrooppiiss ssaabbWWooss aannggaarriiSSii ppaalliiaattiiuurrii mmzzrruunnvveelloobbiiss

oorrggaanniizzeebbiiss SSeessaaxxeebb

2003 wlis 12 noembers ministrTa komitetis mier oficialurad iqna miRebuli

evropis sabWos paliatiuri mzrunvelobis organizebis eqspertTa komitetis

angariSi, romelic mravali qveynis monawileTa mWidro TanamSromlobis Sedegs

warmoadgens. TandarTul memorandumTan erTad saboloo saxiT warmodgenili

rekomendaciebi gansazRvraven wevr saxelmwifoebSi paliatiuri mzrunvelobis

uzrunvelyofis standartebs.

konkretulad, wevri saxelmwifoebi SeTanxmdnen SeimuSaon paliatiuri

mzrunvelobis SeTanxmebuli da yovlismomcveli erovnuli politikisaTvis auci-

lebeli moqmedebis, sakanonmdeblo da sxva zomebi. angariSSi paliatiuri mzrun-

veloba jandacvis samsaxurebis sasicocxlo Semadgenel nawilad aris

aRiarebuli. nebismier pirovnebas, romelsac paliatiuri mzrunveloba esaWiroeba,

unda SeeZlos miiRos igi yvelanairi biurokratiuli Seferxebis gareSe im

dawesebulebaSi, romelic maqsimalurad Seesabameba mis individualur

saWiroebebsa da arCevans. angariSSi xazgasmiT aris aRniSnuli ganaTlebis, tre-

ningebisa da kvlevis struqturuli programebis saWiroeba.

warmodgenili angariSis miRebis gadawyvetileba, warmoadgens wevri saxelmwi-

foebis mzadyofnas ganaviTaron maqsimalurad maRali standartebis paliatiuri

mzrunveloba. mis warmatebas gansazRvravs is, Tu ramdenad ganvaviTarebT da

davnergavT 45 wevr qveyanaSi paliatiuri mzrunvelobis im programebs, romelTac

realurad SeuZliaT yoveli individualuri pacientisa da ojaxis wevrebis

saWiroebaTa dakmayofileba,

angariSis miRebisas, wevri qveynebi SeTanxmdnen mxari dauWiron paliatiuri

mzrunvelobis saerTaSoriso saagentoebis qselur muSaobas da xeli Seuwyon war-

modgenili rekomendaciebis aqtiur, mizanmimarTul gavrcelebas. amasTan

dakavSirebiT, aRmosavleT evropis paliatiuri mzrunvelobis aRmosavleTis

(EAPS –East) sakoordinacio centrma, sxva mraval erovnul organizaciasTan

erTad miiRo gadawyvetileba 2004 wlis oqtomberSi rac SeiZleba met qveyanaSi

gauwios popularizacia angariSis ZiriTad principebs. rogorc evropelebi, evro-

pis sabWos rekomendaciebis popularizaciiT Cven SevZlebT erTad SevcvaloT

mdgomareoba Cvens qveynebSi da partnioruli muSaobiT xedva gadavaqcioT realo-

bad. Cven da Tqven SegviZlia SevcvaloT msoflio!

stokholmi, agvisto 2004

karl jon fursti silvia sauteri

(EAPS –East) aRmosavleT evropis paliatiuri mzrunvelobis

aRmosavleTis sakoordinacio centri

Stockholms Sjukhem Foundation112 35 Stockholm, Sweden

www/ eapcest. org

dabeWdilia fond `Ria sazogadoeba saqarTvelo~-s finansuri

mxardaWeriT proeqt `saerTaSoriso standartebis danergva

saqarTveloSi paliatiuri mzrunvelobis sferoSi~-s farglebSi.

Published with financial assistance of Open Society Georgian Foundationwithin the framework of the project "Introducing of International Standardsinto Palliative Care Services in Georgia "

dabeWdilia S.p.s ètiketSi~, q. Tbilisi, 2005 w.

Printed by the Ltd. "Etiketi", Tbilisi, 2005

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ministrTa komitetis rekomendacia REC (2003) 24 evropis ...2003)24-Georgian.pdf · Photo: Làszló Valuska, Hungary danarTi CM (2003) 24 rekomendacia REC (2003)-s danarTi . .