CYIL vol. 13 (2022)

CYIL 13 ȍ2022Ȏ FUTILE MEDICAL CARE: CHILDREN, PARENTS AND COURTS suffering for the patient and does not offer a possibility of a positive effect on the patient’s health condition or saving of their life. 36 It expressly emphasises that human life is finite 37 and that health care should “sustain life, but not prolong dying” 38 . Achieving a temporary correction of the value of some of the physiological functions or their partial parameters without affecting the overall course of the disease cannot be considered a beneficial effect when considering the abovementioned benefit-risk balance. 39 According to the Recommendation, a treatment that cannot stop the progress of the disease, restore the patient’s health or avert their death is not indicated and should not be commenced; if it already has been commenced, it should be terminated (including discontinuation of pharmacological circulatory support, haemodialysis or ventilation support). 40 Performing such intervention is not just ineffective, but also professionally unjustified and unethical. Here we can see that the Recommendation goes somewhat beyond the general principles of the Ethical Code, as it expressly discourages the providing of futile care and considers it unethical. Nevertheless, it repeatedly stresses that this kind of decision cannot be confused with euthanasia. 41 With respect to children, an additional non-binding opinion was issued by the Section of Child Palliative Care of the Czech Society for Palliative Medicine of the Czech Medical Society of J. E. Purkyně in 2019. 42 It asserts that maintaining and prolonging the life of a paediatric patient with no regard to the suffering and pain that comes with it can be just as wrong as a failure to ensure adequate access to health care . 43 The Opinion prefers “ineffective” to “futile” in description of the treatment, as the decision on (dis)continuation of certain treatment is generally based on its effectiveness in relation to therapeutic aims. In case of minors capable of expressing their will, the Opinion attaches importance to a reasonable wish not to maintain the low quality of life the treatment offers. In case of minors who lack such capacity, the decisive criterion should be whether it can be reasonably assumed that the patient would not wish to live with the offered quality of life. 44 Even artificial nutrition or hydration may be considered ineffective treatment and withdrawn; such withdrawal does not constitute euthanasia. According to the Opinion, in case of disagreement between doctors and the patient’s parents regarding the (in)effectiveness of care, urgent treatment should only be provided if the doctors believe that it could bring real benefit to the patient. If the matter is not urgent, any such disagreement should be resolved by a court. 45

36 Ibid., Article 2 d). 37 Ibid., Article 4 a). 38 Ibid., Article 4 c). 39 Ibid., Article 4 f ). 40 Ibid., Article 3 e) and f ). 41 Ibid., Articles 2 f ), 3 g) and 4 j).

42 KREJČÍKOVÁ, H., HŘÍDEL, J. Stanovisko k poskytování život udržující léčby dětským pacientům [Opinion on the Provision of Life-Sustaining Treatment to Minor Patients]. Sekce dětské paliativní péče České společnosti paliativní medicíny České lékařské společnosti J. E. Purkyně [Section of Child Palliative Care of the Czech Society for Palliative Medicine of the Czech Medical Society of J. E. Purkyně] , 2019. 43 Ibid., p. 1. 44 Ibid., pp. 3–4. 45 Ibid., p. 6.

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