In Romania, care for terminally ill patients is usually provided by the family⁹⁴. Hospitals do not make provision for patients beyond the curable stages of disease. As a result, patients are discharged home into the care of family members with little support. Around 90 per cent of patients die at home, 15 per cent receive narcotic drugs, and 50 per cent are considered to suffer unrelieved pain⁹⁵. Their situation is described by Mariana Pernea:

‘The patients were [angry]…because they are [sent] home without any advice or indication of drugs which might be taken…because the family was not able to cope with this because most of them were and are active people working, without sufficient time to take care of a patient [who] is maybe immobilised…’⁹⁶

The difficulties encountered by the patient and their family are further described by Daniela Mosoiu:

‘I think in Romania it’s different: usually, even if they keep the patients a longer time in the hospital, you know, when it comes to the end usually they are going home. And the problems they are usually facing are usually [being] at home without anybody to visit them, so without any symptom control with a very stressed family which has to undertake all the care, and with no support.’⁹⁷

A paper by Mosoiu, Andrews and Perrolls (2000) highlights some of the cultural and ethical issues which must be taken account of in the development of palliative care in Romania. They write:

‘Romanian society has traditionally been one in which family ties are very strong. The extended family often lives in close proximity. For this reason, home care seems to be more appropriate. Approximately 80% of Romanians belong to the Romanian Orthodox Church. In the Orthodox tradition there are special rituals surrounding death and bereavement that are concerned with the outward show of grief and remembering the dead. In rural areas, where death is seen as a natural process in communities are stronger, (sic) these traditions are better preserved. Conversely, in urban society the subject of death is seen as somewhat ‘taboo’. It continues to be common practice for health care professionals to inform the family of the diagnosis and prognosis before discussing this with the patient, and in some cases the patient is not even told of their condition. However, experience has suggested that many patients suspect their diagnosis and welcome the opportunity to discuss it.’⁹⁸

The moral and ethical dilemmas related to telling the person who is facing death about their prognosis are highlighted in this excerpt from an interview with Daniela Mosoiu:

‘…the big problem is communication problem, because in our culture it’s traditional, you know, not to talk with the patient about the diagnosis and about the prognosis, so that was a big challenge for me at the beginning, because I was taught ‘Don’t tell to the patient, tell to the family’, and then [there] is this other philosophy about the patient has the right to know.’⁹⁹