CYIL vol. 11 (2020)

CYIL 11 (2020)

PREVIOUSLY EXPRESSED WISHES IN THE CZECH REPUBLIC …

PREVIOUSLY EXPRESSED WISHES IN THE CZECH REPUBLIC – THE RIGHT WAY TO FULFILL THE INTERNATIONAL OBLIGATION? Josef Salač 1 Abstract: The concept of previously expressed wishes was introduced to Czech law by the Convention on Human Rights and Biomedicine, but its detailed legal regulation was enacted more than a decade later in Act on Health Services. The said regulation sets relatively strict formal criteria. If they are fulfilled, however, the patient’s will is widely protected. The paper identifies controversial questions related to the regulation of previously expressed wishes where legal uncertainty persists. These issues should be resolved by both the doctrine and, even more importantly, the legal practice. Resumé: Institut dříve vyslovených přání byl do českého práva přinesen Úmluvou o lid- ských právech a biomedicíně, ale konkrétní právní úpravy se dočkal až s účinností záko- na o zdravotních službách o více než deset let později. Předmětná úprava zavádí poměrně přísná formální kritéria, za jejichž splnění je však pacientova vůle široce chráněna. Článek identifikuje sporné oblasti regulace dříve vyslovených přání, ve kterých přetrvává právní nejistota a které by měly být právní teorií a zejména praxí vyjasněny. Key words: previously expressed wishes, advance directives, health law, Convention on Human Rights and Biomedicine, Czech law About the Author: doc. JUDr. Josef Salač, Ph.D. , is an Associate Professor at the Faculty of Law, Charles University (Prague), the head of its Centre for Medical Law, and a member of the Department of Civil Law. Introduction Generally speaking, previously expressed wishes (also known as advance directives , living will , 2 or other terms; hereinafter also “PEWs”) are directives regarding medical procedures in specific future circumstances that are issued for the case the person would lose her or his capacity to make relevant decisions 3 . PEWs usually consist in imposing a negative obligation not to carry out specific procedures. While they can forbid any intervention (including the life-saving ones), they cannot validly oblige the provider of health services to perform any action that would not be in accordance with the professional standards 4 . A typical situation for which previously expressed wishes might be formulated is progressive dementia 5 , cardiac 1 This paper was written with the support of the research program Progres Q04. 2 See for example BEAUCHAMP, Tom L., CHILDRESS, James F. Principles of Biomedical Ethics. 7 th ed. Oxford University Press, Oxford 2013, pp. 188-189. 3 See for example ibid., p. 189, or MATĚJEK, Jaromír. Dříve projevená přání. Výhody a rizika [Previously Expressed Wishes. Benefits and Risks]. Galén, Praha 2012, p. 15. 4 See MACH, Jan, BURIÁNEK, Aleš, ZÁLESKÁ, Dagmar, MÁCA, Miloš, VRÁBLOVÁ, Barbora. Zákon o zdra- votních službách a podmínkách jejich poskytování. Zákon o specifických zdravotních službách. Praktický komentář [Act on Health Services and Conditions of their Provision. Act on Specific Health Services. Practical Commentary]. Wolters Kluwer, Praha 2018, p. 156. 5 Progressive senile dementia is even mentioned as an example of a situation covered by Article 9 of the Convention on Human Rights and Biomedicine in its Explanatory Report, point 61.

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