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
eevvrrooppiiss ssaabbWWoo
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
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 `eqadaga~ 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, `ar 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 (`ar 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 (`ar 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. `anderZi 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)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 `etiketSi~, q. Tbilisi, 2005 w.
Printed by the Ltd. "Etiketi", Tbilisi, 2005