CYIL vol. 9 (2018)

PETR ŠUSTEK CYIL 9 ȍ2018Ȏ The concept of dignity and the concept of autonomy of will are in some contexts contradictory: for example, various understandings of human dignity either support or suppress the autonomy-based arguments in favour of euthanasia or assisted suicide. 15 The concept of dignity is sometimes even considered confusing, redundant, and fully replaceable by respect to the autonomy of will. However, it is not too difficult to understand the inherent connection between the Convention’s core values. The situation at the time of ratification When the Convention was signed by its first parties 21 years ago, not many people in the Czech Republic were aware of the event. Three years later, the Convention was ratified by the Czech Republic, but the awareness was not significantly better. Then-Senator Tomáš Julínek later said that nobody had any clue what influence the Convention could possibly have in the Czech Republic. According to Julínek, one of the decisive reasons to ratify it was the simple fact that it was a human rights document and such documents are popular. 16 In the beginning, nobody – including legal experts – realised how important the Convention really was. The Convention was, in fact, ratified in a situation that was very different from its standards. At the time of the ratification, the Czech health care system was characterised by a significant paternalistic ambience. While paternalistic understanding of the physician- patient relationship used to govern medicine all over the world, the Communist rule in Czechoslovakia preserved the approach even in times it was slowly changing in some of democratic countries. 17 After the fall of the Communist regime in 1989, Czechoslovak medicine was still highly paternalistic, in contrast with a significant shift towards a more equal position of patients in the USA and Western Europe. This tradition of paternalism then survived to the beginning of the third millennium. 18 Paternalism was not merely an approach of health care professionals, it was rather a culture acknowledged by the whole population. Medical ethicist Helena Haškovcová aptly describes one of its aspects as “the medicine of silence”. 19 A physician used to decide the scope 15 On the one hand, many euthanasia lobby groups choose the word dignity to be a part of their names, for example the Swiss organisation Dignitas , the US organisation Death with Dignity National Center , or the United Kingdom organisation Dignity in Dying . On the other hand, the opponents of assisted dying sometimes argue that the killing of a vulnerable suffering person represents a violation of their dignity. See for example ANDERSON, Ryan T. Physician-Assisted Suicide Betrays Human Dignity and Violates Equality Before the Law. The Heritage Foundation. (11 May 2015.) accessed 6 June 2018. 16 A personal memory of the author. 17 For example, in 1972 the American Hospital Association presented a document under the title of Patient’s Bill of Rights which explicitly required the patient’s informed consent (primarily in its Article 3). Available at accessed 6 June 2018. 18 Several changes towards a less paternalistic environment have occurred. For example, the Ministry of Health published the ethical code Patient Rights in 1992. However, the practice remained largely paternalistic. The code is available at accessed 6 June 2018. 19 For example Helena Haškovcová’s presentation titled “Od medicíny mlčení k medicíně souhlasu” [“From the Medicine of Silence to the Medicine of Consent”] at the conference Dvacet let Úmluvy o biomedicíně [Twenty Years of the Convention on Biomedicine] that took place on 2 November 2017 in Prague, organised by the Institute of State and Law of the Czech Academy of Sciences, the Centre of Medical Law of the Faculty of Medicine and the Department of International and European Law of the Faculty of Law, Masaryk University, and the Centre 2.

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