2012Marek Vcha

Eutanzieeu = dobr, sprvn; thanatos = smrt"Pasivn eutanzie" = zastaven (kausln) lby s vdomm myslem zpsobit pacientovi smrtaktivn eutanzie = vdom akt s myslem ukonit ivot pacienta na pacientovu vlastn dostrozdl mezi "aktivn" a "pasivn" spov v tom, e u aktivn eutanzie is nco aktivn udlno s myslem ukonen ivota pacienta; u pasivn eutanzie, je nco neudlno, to co by jinak mohlo prodlouit ivot pacientv.existuje rozdl mezi letting die a killing

Eutanzie= mysln zabit nemocnho na jeho vlastn dosteutanzie je aktivn in, udln neho. Nen to tedy ustoupen od aktivity (nepodn lku)eutanzie je zleitost chtnou ze strany nemocnch. Eutanzie tedy nen zabjen pacient vkomatu, ani zabjen novorozenceutanzie je vmyslu jednajcho. Podle principu dvojho efektu tedy nen eutanzi tlumen bolesti opity

EuthanasiaDutch definition of euthanasia=the intentional termination of the life of a patient at his request by someone other than the patient= mysln ukonen ivota pacienta na jeho dost nkm jinm ne je pacient

Eutanzieaktivnaktivn in lkae na aktivn dost pacientanonvoluntrn eutanzie (nonvoluntary euthanasia)pacient nen schopen artikulovat, lka provede euthanasiiinvoluntrn eutanzie (involuntary euthanasia)which ignores the individuals autonomous rights and could potentially bring about the death of unwilling victim, is not easily distinguished from murder. (Edge, R.S., Groves, J.R. (2006) Ethics of Health Care. A Guide for Clinical Practice 3rd. ed.Thomson Delma learning, NY. p. 235)=pacient je schopen komunikovat (tce rann vojk je zastelen "aby se netrpil" etc.)pasivndoing nothingpassive voluntarylka sice nedl nic, ale s myslem smrti pacienta (nkdy tko rozliit od active euthanasia)

Eutanzieaktivnaktivn in lkae na aktivn dost pacientanonvoluntrn eutanzie (nonvoluntary euthanasia)pacient nen schopen artikulovat, lka provede euthanasiiinvoluntrn eutanzie (involuntary euthanasia)ignoruje autonomii a prva postienho a potenciln me zpsobit usmrcen nevinn obti nemus bt odliiteln od vrady (Edge, R.S., Groves, J.R. (2006) Ethics of Health Care. A Guide for Clinical Practice 3rd. ed.Thomson Delma learning, NY. p. 235)=pacient je schopen komunikovat (tce rann vojk je zastelen "aby se netrpil" etc.)pasivnnedln niehopasivn voluntrn (passive voluntary)lka sice nedl nic, ale s myslem usmrtit pacienta (nkdy tko rozliit od active euthanasia)

Eutanziedvodem oteven diskuse je nae schopnost bojovat proti konkrtnm nemocem ale neschopnost zabrnit strnut

Pasivn eutanzietermn se dnes ji neuvnikdo nic nenamt proti ustoupen smrti, udrovn ivota pacienta umle a za kadou cenuje rozdl mezi letting die a killingLeon Kass: je vak obrovsk mravn rozdl mezi podzenm se smrti, kdy nadeel jej as a kdy jsme ji vi n bezmocn na stran jedn a myslnm zabit a ji v dob umrn nebo jin.

Asistovan sebevradaAsistovan suicidium je definovno jako akt mysln sebevrady sasistenc jinho lovka, kter vdom poskytuje znalosti, prostedky nebo oboj. (Special Senate Committee on Euthanasia and Assisted Suicide, 1995, cit. vDickens et al. 2009)"the act of intentionally killing oneself with the assistance of another who deliberately provides the knowledge, means, or both."

Letting die= enabling nature to take its coursethe disease, not the doctor,has killed the patientbut there is a difference between:withdrawing machines and medications from the patientwithholding or withdrawing artificial nutrition and hydration

PONECHN ZEMT "LETTING DIE"= umonn prod, aby postupovala svm tempemexistuje ale rozdl mezi:odstrann podprnch pstroj a ukonen podvn medikamentodstrann nebo nenasazen umlho vyivovn a hydratace

Dvody oteven diskuseDveaktivn ivot nemoc a umrn smrtDnesaktivn ivot nemoc a umrn smrtDky medicn dnes mme sice o nco del aktivn ivot, ale proporcionln mnohem del obdob nemoc, pobytu v nemocnicch a umrn

The Greeks...The Greeks had no concept of the sanctity of life. They practised abortion on a wide scale. They practised infanticide also. Babies born with congenital defects were often simply left to die. That is how the story of Oedipus begins.They had no qualms, either, about euthanasia. It is astonishing how lightly the Greeks took the idea of suicide. It was, for the Stoics, Cynics, Sceptics and Epicureans, a perfectly legitimate assertion of human freedom. If life was distressing, end it.Epictetus, the former slave who became a Stoic philosopher, is reputed to have said that leaving life is no more consequential than leaving a smoky room.It is even said that Zeno, the first Stoic, tripped, broke his toe, and promptly committed suicide.Sacks, J., (2011) The Great Partnership. God, Science and the Search for Meaning. Hodder & Stoughton, London.p.152

EKOV...nemli dn koncept posvtnosti ivota. V irok me provdli potraty. Provdli rovn infanticidy. Novorozenci s vrozenmi vadami byli ponechni, aby zemeli. Takto zan i pbh Oidipa. podobn nemli rozpaky ani co se te eutanzie. je udivujc, jak snadno pijali ideu sebevrady. Pro Stoiky, Cyniky, Skeptiky a Epikurejce se jednalo o zcela legitimn uskutenn lidsk svobody. pokud je ivot nepjemn, ukoni jej. Epictetus, bval otrok, kter se pozdji stal stoickm filosofem, proslul vrokem, dle kterho opustit ivot nem dn vt nsledky ne opustit zakouenou mstnost. k se dokonce, e Zeno, prvn Stoik zakopl, zlomil si prst na noze a v zpt spchal sebevradu. Sacks, J., (2011) The Great Partnership. God, Science and the Search for Meaning. Hodder & Stoughton, London.p.152

... and the Contemporary Westthe contemporary West is headed in this direction, with abortion legalised, a strong movement for voluntary euthanasia and assisted suicide, and a number of ehticists including Peter Singer of Harvard arguing for the permissibility of infanticide.Sacks, J., (2011) The Great Partnership. God, Science and the Search for Meaning. Hodder & Stoughton, London.p.152

... A SOUASN ZPADsmuje stejnm smrem, s legalizovanmi potraty, silnm hnutm za legalizaci eutanzie a asistovan sebevrady a uritm potem etik, v ele s Peterem Singerem z Harvardu, kte usiluj za legalizaci infanticid. Sacks, J., (2011) The Great Partnership. God, Science and the Search for Meaning. Hodder & Stoughton, London.p.152

Eutanzie a antit myslitelpojem eutanzie ve starm ecku skuten znamenal dobrou smrt ekov hovoili o dobr smrti spe vsouvislosti stm, e umrajc umral vyrovnan, vklidu a sebekontrole. Nkdy bylo mono ztohoto dvodu i ivot ukrtit. Nebyla zde souvislost svradouPythagorejci: ivot je dan bohy a pozemsk existence lovka je vbolesti a teba i tkou smrt vsouvislosti za minul hchy. Bohov m budou posuzovat za tento ivot, jeho mysln zkrcen je tedy vnm pestupkem. Socrates: Asklepius, bh lkastv jist nechce protahovat ivoty, kter u nejsou k dnmu dobru a lkai a nechaj zemt ty. Kte jsou nemocn a znien a nevyliteln due udlaj konec samy sob

Eutanzie a antit myslitelSocrates: strach ze smrti je nemoudrbu po smrti nen nic, a pak se nen teba btnebo se setkme s pteli, a pak je mono se titnic neme ukodit lovku dobrmu, ani v ivot, ani po smrti.

Filosof a bsnk Theognis pe, e vzhledem k tomu, e nikdo nev, jak dlouho bude t, je tk rozhodnout se, zda m lovk penze stdat, i utrcet.

Eutanzie a antit myslitelPlaton: pi bezprostedn neodvratn smrti je mono zvolit dvj odchod ze ivota. Pozdji ve hodnotu lovka ksttu: utilitaristicky uvauje, e lovk stkou chorobou je neuiten pro sebe a je bemenem pro stt.Aristoteles: lovk mus zstat produktivn co nejdle. Nejde vbec o nboenstv. Eutanzie je zavrenhodn, protoe zbavuje stt svch len a protoe to je nejvy poin zbablosti. Tk smrt je morlnm testem lovka. lovk se m smrti postavit chrabe.Stoikov: eutanzie me bt za dvou podmnek: - motivace mus bt adekvtn, a ve mus bt zveno i vzhledem kostatnm lidem. Jde tedy o to, aby se nejednalo o impulsivn tk od povinnost ivota.

Eutanzie a antit myslitelepikurejci: due se po smrti rozpadne spolu s tlem (kdy jsme my, nen smrt, kdy je smrt, nejsme my)nen teba se bt zhrob, nebo dn nennen teba se bt smrti jako znien, nebo kdy pijde, my ji nebudeme. Epikuros:

Smrt nic neznamen, nebo pokud existujeme, smrt zde nen, a kdy smrt pijde, potom ji neexistujeme my. Smrti se tedy nemus obvat ani iv ani mrtv, nebo pro prv zde smrt nen, a druz ji nejsou.

EutanzieHolandsko od 1994On April 10, 2001, the Dutch Parliament approved the "Termination of Life on Request and Assisted Suicide (Review Procedures) Act."(41) It amended sections of the criminal code, specifically stating that the offenses of euthanasia and assisted suicide are not punishable if they have been "committed by a physician who has met the requirements of due care" that are described in the act and if they have informed the municipal "autopsist" in accordance with the Burial and Cremation Act.Belgie od 2002Austrlie Severn teritorium 1995 1997, pak zruenoOregon od 1998, Washington 2008, Montana 2009, Vermont 2013Luxembourg od 2008

EUTANZIEeu = dobr, sprvn; thanatos = smrtHolandsko od 199410. dubna 2001 holandsk parlament schvlil zkon "Ukonen ivota na dost pacienta a asistovanou sebevradou" ("Termination of Life on Request and Assisted Suicide (Review Procedures) Act.") Izkon pozmuje sekce trestnho prva konstatujce e pein eutanzie a asistovan sebevrady nebude trestn, pokud byl "proveden lkaem, kter naplnil poadavky dn pe" ("committed by a physician who has met the requirements of due care"), kter jsou v zkon popsny a po proveden informoval mstskho zstupce provdjcho pitvy (municipal "autopsist") v souladu se zkonem o pohebnictv (the Burial and Cremation Act).Belgie od 2002Austrlie Severn teritorium 1995 1997, pak zruenoOregon od 1998, Washington 2008, Montana 2009, Vermont 2013Luxembourg od 2008

Msta, kde je eutanzie i AS legln

Eutanzie1969: Jan Hendrik van der Berg vknize Medische macht en medische ethiek (Lkask moc a lkask etika) navrhuje, aby lkai pijali nsledky technickch vymoenost a byli ochotni sv trpc a umrajc a ty, kte ij ji jen ve vegetativnm stavu zabt.1971: dcera lkaka aplikuje sv matce, inkontinentn, na vozku vpeovatelskm domov, morfinovou injekci snsledkem zabt. Matka zemela po nkolika minutch. 1973 byla odsouzena kjednotdennmu podmnnmu trestu.

Medische macht en medische ethiekHippocratic oaththe physician must preserve human life, save it and prolong it, where and whenever possibletoday, with all the medical possibilities:the physician must preserve human life, save it and prolong it, wherever it is sensible and meaningful to do so.should the physician consider it no longer sensible to proceed, then he should be permitted to end patients life. This can be done in two ways:through ceasing all life-sustaining measuresthrough actively terminating the life of the patientSohn, W., Zenz, M., (eds) (2001) Euthanasia in Europe. Schattauer. Stuttgart, New York. p.138

MEDISCHE MACHT EN MEDISCHE ETHIEKHippokratova psahalka mus peovat o lidsk ivot, chrnit jej a prodluovat jej, kdekoli a kdykoli je to mondnes, se vemi lkaskmi vymoenostmi:lka mus peovat o lidsk ivot, chrnit jej a prodluovat jej, kdekoli je to moudr a smyslupln. v ppad, e lka shled, e dal prodluovn ivota pacienta ji nen moudr a smyslupln, mlo by mu bt dovoleno ukonit pacientv ivot. Toto me provst dvma zpsoby:odstrannm vech prostedk, ktermi je zachovvn pacientv ivotaktivnm ukonenm ivota pacientaSohn, W., Zenz, M., (eds) (2001) Euthanasia in Europe. Schattauer. Stuttgart, New York. p.138

The Netherlands In 1973 Dr. Gertruida Postma, who gave her dying mother a lethal injection, received light sentence in the Netherlands. The case and its resulting controversy launched the euthanasia movement in that country.

NIZOZEMPPAD POSTMA V roce 1973 Dr. Gertruida Postma, kter sv matce aplikovala smrtc injekci, dostv mrn a podmnn trest. tato kazuistika a nsledn kontroverze byly rozntkou, kter v Nizozem nastartovaly hnut pro eutanzii

Postma CaseLeeuwarden 1973Dr. Postma was sentenced to only one week in prisonthis remarkably mild sentence was based on the fact, thatthe physicians mother was incurably illshe experienced her suffering as unbearableshe was already in dying phasethe ending of life was done on her own expressed wish

PPAD POSTMALeeuwarden 1973Dr. Postma byla odsouzena pouze k tdennmu vzen (s ron podmnkou)tento pozoruhodn mrn trest za vradu byl odvadnn tmito fakty:lkaina matka byla nevyliteln nemocnmatka sv utrpen klasifikovala jako nesnesitelnmatka se ji nachzela ve fzi umrnukonen ivota bylo provedeno na jej vslovn pn

Eutanzieod t doby se eutanzie provdrozevraj se nky mezi legislativou a praxproto v roce 1982 vznikaj tzv. Rotterdamsk kritria

Rotterdamsk kritria1982Pacient mus bt kompetentn a dost mus bt zcela dobrovoln a myslnPacientova dost mus bt dobe uven, jasn a opakovanPacient mus nesnesiteln trpt (ne nutn fyzicky) a eutanzie mus bt posledn monost. Jin monosti ulehit situaci nemocnmu ji byly vyzkoueny a shledny neinnmi.Eutanzii mus provdt jedin lkaLka mus ve konzultovat sjinm nezvislm lkaem, kter ji m zkuenost vtto oblasti.

Rotterdamsk kritria1982kritika: kritria se nedodrujvan der Wal in 1990: interval mezi prvn dost o eutanzii a provedenm eutanzie13% ppad ne vce ne jeden den35% ppad ne vce ne jeden tdenvjimen ne vce ne nkolik hodinVan der Wal G. Euthanasia and Assisted Suicide.Medisch Contact1991; 46: 212-214.

Eutanzie1988 odhaduje se, e ron takto umr cca 6 000 osob

Eutanzie1990: rada Krlovsk lkask asociace se shoduje na postupu povinnho hlen:lka provdjc eutanzii a asistovan suicidium nepod hlen o pirozen smrti, nbr informuje mstnho lkaskho revizora pomoc vyplnnho rozshlho dotaznkumstn revizor pod hlen okresnmu prvnmu zstupcitento rozhodne, zda ppad ped ksoudnmu trestnmu sthn i nikoliv.Vyhovl-li lka stanovenm podmnkm, pak trestn nebude.

Remmelinkova zprva1991Remmelink Committee (3 physicians and 3 lawyers)zkoumaj se vechny mrt v Holandsku za rok 1990 (128 786 mrt)2,300 (1,8%) ppad eutanzie na vlastn dost400 (0,3%) ppad asistovanho suicidia1,000 (0,8%) ukonen ivota without specific request;

The Netherlands1973 Voluntary Euthanasia societies formed in the Netherlands 1982 A Rotterdam court states conditions under which aiding suicide and administering Voluntary Euthanasia will not lead to prosecution in the Netherlands 1984 The Supreme Court of the Netherlands declares that V.E. is acceptable subject to ten clearly defined conditions 1990 Notification procedure agreed between the Royal Dutch Medical Association and the Ministry of Justice 1994 Amendments under the Burial Act incorporate the notification procedure, giving the latter formal legal status

NIZOZEM1973 vznik Spolenost pro voluntrn eutanzii1982 Rotterdamsk kritria. Rotterdamsk soud konstatuje, e proveden eutanzie nebo asistovn pi sebevrad nebude vst k trestnmu sthn, pokud lka dodrel Rotterdamsk kritria. 1984 Nejvy soud konstatuje, e voluntrn eutanzie je akceptovateln pi dodren uritch pravidel1990 Probh notifikan procedura mezi Krlovskou holandskou lkaskou asociac (the Royal Dutch Medical Association) a Ministerstvem spravedlnosti. 1994 Jsou notifikovny dodatky k zkonu o pohebnictv, m je tmto dodatkm dn prvn status

Ppad Schoonheim, 198216. ervna 1982 provedl lka Dr. Schoonheim eutanzii sv 95-let pacientce. Pacientka mla zlomen krek stehenn kosti, odmtala operaci a vdla, e ji nebude moci ani vstt a chodit, ani sedt a e ze svho lka ji nevstane. Dochzelo rovn kzhorovn zraku a sluchu, mentln vak byla vnaprosto vpodku.

Ppad Schoonheim, 1982Pi jasnm vdom opakovan dala Dr. Schoonheim o eutanzii. 16. ervna znovu d o eutanzii vptomnosti svho syna, snachy a asistenta Dr. Schoonheima. Dr. Schoonheim provedl eutanzii za pouit dvou injekc; prvn suspvac ltkou a po nkolika minutch druhou se svalovm relaxantem. Tent den Dr. Schoonheim o celm ppadu informoval policii. Vroce 1983 probh soud. Nejvy soud vzal vpotaz zejmna situaci nesnesitelnho utrpen, vetn monosti ztrty osobn dstojnosti vbrzk budoucnosti a riziko, e by vbudoucnu pacientka ji nemohla zemt dstojnm zpsobem. Vzhledem ktmto a dalm bodm obhajoby, Nejvy soud zprosti Dr. Schoonheima obvinn. Jednalo se o prvn ppad vdjinch Nizozem, kdy byl lka po proveden eutanzie osvobozen

Remmelink report

Remmelinkova zprva1991zkoumaj se vechny mrt v Holandsku za rok 1990 (128 786 mrt)8,750 pacient u kterch byla peruena i nenasazena ivot udrujc lba bez dosti pacienta bu sten s myslem ukonit ivot pacienta (4,750) nebo s explicitnm myslem ukonit ivot pacienta (4,000) 8,100 ppad pedvkovn morfiem sten s myslem ukonit ivot pacienta (6,750) nebo s explicitnm myslem ukonit ivot pacienta (1,350) 5,800 ppad peruen nebo nenasazen lby na explicitn dost pacienta s stenm myslem ukrcen ivota (4,292) nebo s explicitnm myslem ukrcen ivota (1,508)

Remmelinkova zprva1991zkoumaj se vechny mrt v Holandsku za rok 1990 (128 786 mrt)nastalo tedy celkem 23,350 ppad zkrcen ivota skutkem nebo opomenutm (by act or omission) co je vce 38% vech mrt za dan rok a 54% ze vech neakutnch mrtdky tomu, e ve uveden kategorie se rzn prolnaj, nelze stanovit pesn sla

without specific requestmnoz z nich nebyli schopn mluvitnkte vak byli schopn komunikovat

lovk v, nebo si spe mysl, e v, jak je to s druhm a co je mu ku prospchu. To ani tak nesouvis se suvernnm opomjenm druhho jako s tichm pedpokladem, e vichni jsou stejn.(Jung, C.G., (1998) Vbor zdla II., Archetypy a nevdom, Brno: Nakladatelstv Tome Janeka, str.8)

BEZ EXPLICITN DOSTImnoz z nich nebyli schopn mluvitnkte vak byli schopn komunikovat

lovk v, nebo si spe mysl, e v, jak je to s druhm a co je mu ku prospchu. To ani tak nesouvis se suvernnm opomjenm druhho jako s tichm pedpokladem, e vichni jsou stejn.(Jung, C.G., (1998) Vbor zdla II., Archetypy a nevdom, Brno: Nakladatelstv Tome Janeka, str.8)

without specific requestin 1990, besides the 2 300 cases of voluntary euthanasia and 400 cases of physician-assisted suicide per year, there were over 1 000 cases of active nonvoluntary euthanasia performed without the patients knowledge or consent, including roughly 140 cases (14 percent) in which the patients were mentally totally competent.(Kass, R.L., (2002) Life, Liberty and the Defense of Dignity. Encounter Books. New York, London. p. 201)Maas van der, P.J. et al., Euthanasia and Other Medical Decisions Concerning the End of Life (New York: Elseveir Science Inc., 1992)

BEZ EXPLICITN DOSTIv roce 1990, krom 2 300 ppad voluntrn eutanzie a 400 ppad asistovan sebevrady zde bylo kolem 1000 ppad aktivn nonvoluntrn eutanzie proveden bez toho, ani by pacient o vci vdl i s ukonenm ivota souhlasil, vetn piblin 140 ppad (14%), ve kterch byli pacienti mentln zcela kompetentn(Kass, R.L., (2002) Life, Liberty and the Defense of Dignity. Encounter Books. New York, London. p. 201)Maas van der, P.J. et al., Euthanasia and Other Medical Decisions Concerning the End of Life (New York: Elseveir Science Inc., 1992)

without specific requestje rozdl mezi otzkamiwhat would the patient want in this circumstances?what do you want for the patient?

without specific requestje rozdl mezi otzkamico vnm pacient za tchto okolnost jako nejlep?co vnm lka pro pacienta jako nejlep?

Netherlands

Netherlands

Souasn situace v Holandskuvsledky dvou studi

19952000eutanzie2,2% - 2,3%2,2% - 2,6%asistovan suicidium0,2% - 0,4%0,1% - 0,2%bez explicitn dosti0,7%0,6% - 0,7%

2008 v Holandsku2146 eutanzie152 asistovan sebevrada33 kombinace oboucelkov 2331rok 2009: 2636

(nap v Heuvel van den W.J.A., Legislation of euthanasia: the Dutch case. Paliatia. Journal of palliative care. Vol. 3 n.1 January 2010)

NetherlandThe most important reasons for the request for euthanasia were futile suffering (29%), avoidance of humiliation (24%) unbearable suffering (18%). Although pain was among the reasons in 40% of cases, only in 5% of cases was pain mentioned as the most important reason.Van der Wal G, van Eijk JThM, Leenen HJJ, Spreeuwenberg C. Euthanasia and assisted suicide. II. Do Dutch family doctors act prudently? Family Practice 1992;9:135-40.

NizozemNejdleitj dvody dosti o eztanzii jsou:zbyten utrpen (futile suffering) (29%), snaha vyhnout se ponen (24%) nesnesiteln utrpen (18%). Akoli bolest byla zmiovna ve 40% ppad, pouze v 5% vech ppad byla zmiovna jako nejdleitj dvod dosti Van der Wal G, van Eijk JThM, Leenen HJJ, Spreeuwenberg C. Euthanasia and assisted suicide. II. Do Dutch family doctors act prudently? Family Practice 1992;9:135-40.

Brongersma CaseEdward Brongersma, an 86-year-old former senator in the Dutch parliament, committed suicide with the assistance of a doctor, simply because he was elderly and tired of life. The doctor who assisted him was initially acquitted, but the Dutch Ministry of Justice appealed against on the ground that what he did was outside the existing rules. Nevertheless, since the court recognised that the doctor had acted out of compassion, it did not impose any penalty.Singer, P., (2003) Voluntary Euthanasia: A Utilitarian Perspective. Bioethics 17, nos. 5-6 : 526-41

Ppad Brongersma1998: Edward Brongersma, 86ti let bval sentor holandskho parlamentu spchal sebevradu s asistenc lkae, protoe se ctil star a unaven ivotem. Lka, kter asistoval u sebevrady byl zpotku zprotn viny, avak holandsk Ministerstvo spravedlnosti se proti rozsudku odvolalo s poznmkou, e co lka uinil bylo mimo vymezen pravidla. Soud ovem vzal v potaz, e lka jednal z dvodu soucitu s pacientem a neuloil dn trest. Singer, P., (2003) Voluntary Euthanasia: A Utilitarian Perspective. Bioethics 17, nos. 5-6 : 526-41

Slippery slopeChabot Case1993: Dr. Boudewijn Chabot provided assistance in dying to a 50-year-old woman who was severely depressed, but suffered from no physical illnesspsychiatr napomh sv pacientce zemt. Pacientce se rozpadlo manelstv a zemel j syn. Pacientka odmt lbu deprese. Psychiatr nekonzultuje s jinm lkaem, je obvinn z vrady ale nsledn osvobozen.

Ppad Chabot

1993: Dr. Boudewijn Chabot poskytl asistanci v sebevrad 50ti let en, kter byla v tkch depresch, avak netrpla dnou fyzickou nemocpsychiatr napomh sv pacientce zemt. Pacientce se rozpadlo manelstv a zemel j syn. Pacientka odmt lbu deprese. Psychiatr nekonzultuje s jinm lkaem, je obvinn z vrady ale nsledn osvobozen.

Slippery slopeEutanzie dt v HolandskuBBC 23. ledna 2005:od roku 1997 piznvaj holandt lkai zabit 22 dt milosrdnou smrt akoli je eutanzie dt v Holandsku ilegln, dn z lka nebyl obvinn. Studie byla uveejnna v Dutch Journal of Medicine, autoi chtj povzbudit lkae ke sdlovn pravdy bez obav z perzekuce ppady se tkaly dt se spina bifida

Slippery slopeEutanzie dt v HolandskuBBC 23. ledna 2005Ve studii se uvd, e lkai nebudou alovn po splnn ty podmnek:lkask tm a nezvisl lkai mus souhlasitnen nadje na zlepen stavu a bolest neme bt tlumenarodie dvaj souhlasivot mus bt ukonen korektnm zpsobemstudie odhaduje, e kad rok je lkai zabito 15 20 dt

Eutanzie mladistvchdti 12 15 let mohou o eutanzii podat, ta ale bude provedena jen se souhlasem rodimladistv 16 17 let mohou podat, rodie ale mus bt ptomni na vech diskusch

Eutanzie v Holandsku1993 schvlen zkona o eutanzii1994 zkon nabv platnostisekce 293: kdokoliv vezme jinmu na jeho vlastn a vnou dost ivot, bude potrestn odntm svobody maximln na 12 let nebo pokutou pt kategoriesekce 294: kad, kdo uven podncuje jinho ke spchn suicidia, asistuje mu pitom nebo mu ktomu poskytne prostedky a suicidium se uskuten, bude potrestn odntm svobody maximln na 3 roky nebo pokutou tvrt kategorie

The NetherlandsOn April 1st 2002, euthanasia became legal in The Netherlands, rather than being technically illegal but not punishable in circumstances of force majeure (necessity).Key points in the new law include the following:incompetent patients can be killed if they have written a statement in advance requesting euthanasia.teenagers aged 16-18 may receive euthanasia, not necessarily with the agreement of a parent or guardian.

Nizozem, 20021. dubna 2002 se eutanzie stv vNizozem legln. Do tto chvle byla technicky ilegln ale netrestan. Mezi klov momenty novho zkona pat:nekompetentn pacienti mohou bt zabiti, pokud zanechali dve vysloven pn dajc eutanzii.

Nizozem, 2002teenagerm ve vkovm rozmez 16 18 let me bt provedena eutanzie, a to nikoli nezbytn se souhlasem rodi nebo zkonnho zstupceteenagerm ve vkovm rozmez 12 16 let me bt provedena eutanzie pouze se souhlasem rodi nebo zkonnho zstupcelkai mus bt pesvdeni, e utrpen pacienta je trval a nesnesitelnvechny ppady mus bt po smrti pacienta peeteny

Nizozem, 2002Aby lka podle novho zkona mohl provst eutanzii, mus bt splnny nsledujc podmnky:1. Pacient mus dat o eutanzii svobodn a opakovan, po pelivm zven2. Lka me tto dosti vyhovt pouze pokud je pacient terminln nemocen, bez ance na uzdraven a ve vnch bolestech3. Ped provedenm eutanzie mus lka ve konzultovat sjinm lkaem a po proveden mus podat zprvu koronerovi.

The NetherlandsOn April 1st 2002, euthanasia became legal in The Netherlands, rather than being technically illegal but not punishable in circumstances of force majeure (necessity).Key points in the new law include the following:incompetent patients can be killed if they have written a statement in advance requesting euthanasia.teenagers aged 16-18 may receive euthanasia, not necessarily with the agreement of a parent or guardian.

The Netherlandschildren 12-16 years old may receive euthanasia with the agreement of a parent or guardian.the doctor must hold the conviction that the patients suffering is lasting and unbearable. all cases will be reviewed after the death of the patient.the law does not prohibit doctors from administering euthanasia to nonresidents.

The Netherlands 2002in order for the physician to assist with the euthanasia, the following must occurethe patient must request the assistance freely and frequently, after careful considerationthe physician may act on the request only if the patient is terminally ill, with no hope of improvement and in severe painthe physician must consult with another physician and file a report with the coroner

The Netherlands 2002the standard process is to give a large dose of barbiturates to produce comaand then an injection of curare, which stops respiration and heart rate

Nizozem 2002standardn proces je aplikovat pacientovi velkou dvku barbiturt, m se navod komapotom injikovat medikament na bzi kurare, kter zastav dchn a innost srdce

The Netherlands 2002types of patient availing themselves for euthanasia option:women and men are equal in requesting euthanasiathe average age for men is sixty-three and for women sixty-sixrequests are rare in people over age seventy-five and even rarer for those over age eighty-five

Nizozem 2002typy pacient, dajc o eutanzii:eny a mui daj o eutanzii procentuln stejn prmrn vk mu v dob dosti je 63 let, prmrn vk en 66 letdosti o eutanzii jsou velmi vzcn u oban nad 75 let a jet vzcnj u oban nad 85 let

The Netherlands 2002The Dutch Patients Association:We feel our lives are threatened. We realize that we cost the community a lot. Many people think we are useless, often we notice that we are being talked into desiring death. We will find it extremely dangerous and frightening if the new medical legislation includes euthanasia.

Dutch policy of tolerance: gedogengedogen meansa policy of pragmatic tolerancedeclaring in advance that under specific conditions people do not need to fear criminal prosecution of certain illegal actionsthis is done only when policy makers think that not prosecutinog certain illegal actions has particular social advantages over prosecuting them.forms of gedogen are seen in the Dutch policy with regard to euthanasia, prostitution and drugs

Situace v Oregonuasistovan suicidium legalizovno od 1998. Od t doby takto umraj piblin dva pacienti za msc. Tento mal poet je zpsoben psnmi pravidly:

Situace v Oregonupacient mus bt rezidentem sttu Oregonpacient mus bt star 18 letpacient mus dat o eutanzii dvakrt stn a jednou psemnmezi prvn a posledn z tchto dost mus uplynout nejmn 15 dnpacient mus bt terminln nemocn a oekvan doba ivota mus bt men ne 6 mscprognza mus bt potvrzena nezvislm konsiliemoba lkai se mus shodnout, e pacient je schopen uinit takto zvan rozhodnutoba lkai se mus shodnout,e pacient nen pod vlivem lk, kter by mohly ovlivnit jeho rozhodnutpacient si mus sm aplikovat letln medikaci

Oregon from 1998the patient mustbe a capable adultbe an Oregon residenthave a terminal illness, with less than six month to live (!!)voluntarily request a prescription for lethal drugsthe request must be made both orally and in writing

To request a prescription for lethal medications, the DWDA requires that a patient must be: An adult (18 years of age or older), A resident of Oregon, Capable (defined as able to make and communicate health care decisions), and Diagnosed with a terminal illness that will lead to death within six months.

Patients meeting these requirements are eligible to request a prescription for lethal medication from a licensed Oregon physician. To receive a prescription for lethal medication, the following steps must be fulfilled: The patient must make two oral requests to his or her physician, separated by at least 15 days. The patient must provide a written request to his or her physician, signed in the presence of two witnesses. The prescribing physician and a consulting physician must confirm the diagnosis and prognosis. The prescribing physician and a consulting physician must determine whether the patient is capable. If either physician believes the patient's judgment is impaired by a psychiatric or psychological disorder, the patient must be referred for a psychological examination. The prescribing physician must inform the patient of feasible alternatives to DWDA, including comfort care, hospice care, and pain control. The prescribing physician must request, but may not require, the patient to notify his or her next-of-kin of the prescription request.

Oregonadatel mus bt:1. Plnolet (18 let a star)2. Resident sttu Oregon3. Svprvn (zde ve smyslu, e je schopen tvoit a komunikovat rozhodnut tkajc se lkask pe)4. Mt terminln diagnzu a oekvanou dobu ivota mn ne 6 msc5. Pacient mus o asistovanou sebevradu dat nejmn dvakrt stn, mezi obma dostmi mus bt minimln 14 dn

6. Pacient mus o asistovanou sebevradu dat t psemn, dost mus bt podepsna vptomnosti dvou svdk7. Lka, kter bude asistovat a konzultujc lka mus oba potvrdit diagnzu a prognzu terminln nemoci soekvanou dlkou ivota men ne est msc8. Lka, kter bude asistovat a konzultujc lka mus urit, zda pacient je kompetentn.9. Pokud jeden ztchto lka m podezen, e pacientovo rozhodnut je narueno psychiatrickou nebo psychologickou nemoc, pacient mus podstoupit psychologick vyeten.10. Lka, kter bude asistovat mus pacienta informovat o dostupnch alternativch kasistovan sebevrad, vetn komfortn pe, hospicovho zazen a kontroly bolesti.11. Lka, kter bude asistovat mus podat, avak nikoli vyadovat, aby pacient uvdomil svho nejbliho pbuznho o sv dosti o asistovanou sebevradu (Pierce and Randels 2010)

Situace v Oregonuasi 30% pacient, kte zahajuj proces vedouc k eutanzii umr dve ne k eutanzii me bt pikroeno19% pacient, kte dostali pstup k letln medikaci se nakonec rozhoduj ji nepout45% pacient, kterm byla poskytnuta kvalitn paliativn pe se nakonec rozhoduj proti eutanziidalm dvodem malho potu asisitovanch suicidi je postoj lka: jen ptina z nich by byla ochotna pedepsat letln medikaci

Oregonbetween 1998 and 2007, 341 patients died after ingesting a lethal dose of prescribed medication under Oregons DWDAJanuary 2011:Pierce, J., Randels, G., (2010) Contemporary Bioethics. Oxford University Press, NY, Oxford. p. 125

Oregonmezi lety 1998 a 2007 zemelo celkem 341 pacient pot, co poili letln dvku medikament ve shod se zkonem DWDA (Death With Dignity Act)Leden 2011:Pierce, J., Randels, G., (2010) Contemporary Bioethics. Oxford University Press, NY, Oxford. p. 125

Oregon January, 2010

Zdroj:http://public.health.oregon.gov/ProviderPartnerResources/Evaluationresearch/deathwithdignityact/Pages/index.aspx

Switzerlandpermits assisted suicide without requiring that the person be terminally illallows foreigners to receive assistance in what is sometimes called "suicide tourism"

SwitzerlandThe Swiss medical profession does not condone physician participation in suicide; the practice occurs outside of the medical contextAny citizen may assist someone else to commit suicide, as long as he or she does not act out of selfish motives (e.g. desire to inherit money sooner), but assisted suicide is often coordinated by nonprofit organizations dedicated to the practice.In their role as citizen rather than as physician, doctors may provide assistance, and many of them do write prescriptions for lethal medication.

http://zpravy.idnes.cz/jak-funguje-klinika-smrti-zabijeme-vas-az-najdeme-doktora-pzr-/zahranicni.aspx?c=A090824_135356_zahranicni_klu

Kevorkian casejune 1990 Janet Adkins ended her life with the assistance of Dr. Jack Kevorkianby the end of June 1998, Kevorkian had participated in over fifty similar events using his suicide machines

Kevorkian CaseKey dates in Kevorkians assisted suicide campaignJune 4, 1990 Janet Adkins, 54, of Portland, Oregon, becomes the first person to use a suicide machine developed by Kevorkian. Murder charges against him are dropped when a judge rules Michigan has no law against assisted suicide.November 1991 Michigan suspends Kevorkians medical license.May 2, 1994 Kevorkian is acquitted of assisted suicide.March 8, 1996 Kevorkian is acquitted of two assisted suicides.May 14, 1996 Kevorkian is acquitted of two assisted suicides. A judge had dismissed murder charges against him in the same deaths.

Kevorkian CaseJune 1997 Kevorkian is accused of assisted suicide. The judge declares a mistrial.September 17, 1998 Kevorkian videotapes the injection death of Thomas Youk, shown two months later on CBS 60 Minutes.November 25, 1998 Kevorkian is charged with murder, assisted suicide and delivery of a controlled substance in Youks death. The assisted suicide charge is later dropped.March 26, 1999 Kevorkian is convicted of second degree murder and delivery of a controlled substance. He faces up to life in prison.April 13, 1999 Kevorkian is sentenced to 10 to 25 years in prison for second degree murder and three to seven years for delivery of a controlled substance.Kevorkian showed no emotion as the judge handed down his sentence. He was taken out of the courtroom in handcuffs.

Kevorkian Sentenced to Prison(1999)In 1999, pathologist Dr. Jack Kevorkian was sentenced to a 10 to 25 year prison term for giving a lethal injection to Thomas Youk whose death was shown on the 60 Minutes television program. in 2006 he was released

Filosofy by zajmalo, jak byla realizovna aktivn dost...?

Veobecn zmatekNvrh zkona, na kterm sentorka spolupracovala s Liberln reformn stranou, legalizuje asistovanou sebevradu, ale umouje i eutanazii, tedy monost, e lka usmrt tce nemocnho pacienta, kter je napklad v komatu. Pro tuto variantu vak zkon stanov velmi psn podmnky. Pacient s eutanazi napklad mus souhlasit pedtm, ne se do tkho stavu dostane.

Letting die= enabling nature to take its coursebut there is a difference between:withdrawing machines and medications from the patientwithholding or withdrawing artificial nutrition and hydration

A QuestionWhat is the difference between administering a large dose of morphine for reducing physical painand using that same dosage in response to a person saying, I want to end this?

An Answerthe physical pain occurs against the will of the patient, and the morphine is therefore a therapeutic responsethe statement I want to end this is, however, an expression of the individuals will

Model zkaznka Model zkaznka lka jen pasivn vykon pacientovu zakzku, podobn jako automechanik i kadenk. Prvoadm principem je pacientova autonomie. Lka psob pouze jako informtor, jeho vlastn postoje a hodnoty nejsou dleit.

Smluvn modelSmluvn model lka diskutuje s pacientem o spolench hodnotch, oba jsou autonomn a svobodn, a mon sdl i stejn nzor na asistovan suicidium nebo eutanzii. Tet strana (nap.stt) nem prvo do dialogu zasahovat.lka s pacientem vytvo vlastn text, kter nemus mt nic spolenho s obecnou morlkoupojmy jako dobro a zlo nejsou dleit

Diskuse o eutanziiExistuje v ivot lovka bod, od kterho dle ji nem cenu t dl?utilitarismus: ano, takovto bod existuje. Nastane ve chvli, kdy nelibosti pev nad libostmi. utrpen je vdycky negativn a musme se jej vysthat za kadou cenujudaismus, kesanstv, islm: takovto bod neexistuje. ivot lovka je cesta a stle se na n umei kdy je teba bojovat proti bolesti, utrpen jako takov nemus bt vdy a vude vnmno jako negativn. Skrze utrpen se mnohmu naume.

Diskuse o eutanziipacienta ztotoujeme s jeho nemoczajmaj ns parametry jako teplota, krevn obraz atd. Jsou-li tyto hodnoty mimo normu, sname se je vrtit zpt do mantinelpokud se to zda, pacient je povaovn za vylenho

Bolestfyzickemocionlnsociln spiritulnlogotherapy:a task not yet completedwork not yet done

odtud i tyi poteby nemocnhobiologickpsychologicksocilnspirituln

priorita poteb se v prbhu nemoci mn. (Svatoov, M., (2008) Hospice a umn doprovzet. 6. vyd. Pro APHPP vydalo Karmelitnsk nakladatelstv. Kosteln Vyd, str. 19)

Quality end of life careaccording to The Committee on Care at the End of Life of the US Institute of Medicine, National Academy of Sciencesoverall quality of lifephysical well-being and functioningpsychosocial well-being and functioningspiritual well-beingpatient perception of carefamily well-being and perception

tired of livingJurisprudence from 1994 states that the extent of the suffering is determined by the way in which it is experienced, and should be abstracted from the cause. However, jurisprudence from 2002 adds to this that the cause must be medical: if a patient is suffering from the consequences of old age and requests EAS because (s)he is tired of living, but does not suffer from a severe disease, the physician is not allowed to grant such a request

tired of livingOne of the reasons for this, as given by the Supreme Court, is that a physician is a medical expert, and can therefore judge the extent of unbearable and hopeless suffering of a patient with a medically defined disease, but is not an expert in dealing with patients who are tired of living

tired of livingovem v Holandsku je provedena eutanzie v cca 400 ppadech ron prv z dvodu unavenosti ivotem.Rurup ML, Muller MT, Onwuteaka-Philipsen BD, et al. Requests for euthanasia or physician-assisted suicide from older persons who do not have a severe disease: an interview study. Psychological Medicine, in press.

Dvody dosti o eutanziistrach z protahovanho umrnstrach z pli dlouhho itstrach ze ztrty kontroly nad seboustrach z toho, e se stanu zt finann, psychickou i sociln pro ostatn

Diskusedve: ivot lovka je pou, cesta odnkud nkamPro ivot modernho lovka je naopak typick epizodinost a nekonsekventnost. ivotn projekt se rozpad na kaleidoskop samostatnch epizod, je nejsou propojeny ani kauzln, ani logicky. Postmodern lovk ji nen clevdom poutnk, ale zevloun, tulk, turista a hr. Tyto dve marginln role se stvaj zkladnmi charakteristikami jeho ivota. Tak vmorlce opustil lovk vechny systematicky pojat morln systmy a rozhoduje se ppad od ppadu na zklad aktulnho uven, a jet vce efektu. (imek, palek: Filosofick zklady lkask etiky,Grada Publishing, a.s. Avicenum 2003 p. 21)- ivot jako klip na MTV

Austriaeuthanasia is prohibited by lawthe protection of human life from conception to death (22 ABGB) is also a civil lawIt is strongly opposed by a large part of the Austrian population that abortion under defined circumstances is not prosecuted any more (12 weeks, qualified staff and obligatory counseling).Besides the religious refusal (more than 70 % of the population being Roman Catholic) there is also the recent history of the murders during the Nazi regime that causes caution when discussing these matters.