CYIL vol. 13 (2022)

TOMÁŠ HOLČAPEK CYIL 13 ȍ2022Ȏ from the ethical viewpoint. According to the relevant guidance issued by the General Medical Council as the statutory regulator for the medical profession in the United Kingdom 27 , decisions about treatment for children must always be in their best interests, weighing the benefits, burdens and risks of treatment for the individual child; a child’s best interests are not always limited to clinical considerations 28 . In addition, if, when considering the benefits, burdens and risks of treatment a physician concludes that, although providing treatment would be likely to prolong life, it would cause pain or other burdens that would outweigh any benefits and the physician reaches a consensus with the child’s parents and healthcare team that it would be in the child’s best interests to withdraw, or not start the treatment, the physician may do so; in case of decisions about clinically assisted nutrition and hydration a second opinion must be sought . 29 If no consensus can be reached after taking appropriate steps (e.g. consultations, mediation etc.), a judicial ruling may be necessary. 30 According to section 1(2) of the (Model) Professional Code for Physicians in Germany 31 , the tasks of physicians include preservation of life, alleviation of suffering and support of the dying. Pursuant to its section 16, physicians must support the dying while preserving their dignity and respecting their wishes; it is forbidden to kill patients upon their request. A summary of relevant principles published by the German Medical Chamber in 2011 32 stipulates that in case of the most severe illnesses affecting minors incapable of making their own decisions, life sustaining treatment may be withheld or withdrawn in agreement with the patient’s parents 33 . In case of a dispute, it is necessary to engage a family court. In the Czech Republic, the Ethical Code of the Czech Medical Chamber states that with respect to the incurably ill and dying, a physician effectively relieves pain, respects human dignity and eases suffering. However, in the face of inevitable and imminently expected death the aim of the physician’s actions should not be prolongation of life at any cost. 34 This wording was deliberately chosen to provide physicians with some space for forming of their own opinion, as it neither expressly commands nor forbids to terminate the life-sustaining treatment in the latter situation. In 2010, a more specific (although non-binding) recommendation was adopted to supplement the main principle. 35 One of its aims is to limit the providing of futile and ineffective treatment in situations where it is possible to reasonably assume based on medical assessment that the benefit of initiating or continuing the relevant treatment method with regard to the patient’s health condition does not outweigh the risk of complications, pain, discomfort and 28 Ibid., paragraph 92. 29 Ibid., paragraph 106. 30 Ibid., paragraph 108. 31 (Muster-)Berufsordnung für die in Deutschland tätigen Ärztinnen und Ärzte , adopted by the German Medical Chamber ( Bundesärztekammer ) in 1997, as subsequently amended. 32 Grundsätze der Bundesärztekammer zur ärztlichen Sterbebegleitung , published by the German Medical Chamber ( Bundesärztekammer ) in 2011. 33 Ibid., part V. 34 Ethical Code of the Czech Medical Chamber, section 2(7). The Code was adopted in 1996, with subsequent minor amendments. 35 Recommendation of the Board of Directors of the Czech Medical Chamber no. 1/2010 on the procedure for deciding to change intensive care to palliative care in patients in terminal stage who are unable to express their will. 27 Treatment and care towards the end of life: good practice in decision making , adopted in 2010, as subsequently amended.

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