Czech Doctors’ Chamber issues guidelines on treatment of terminally ill patients

Deciding when to stop treating terminally ill patients is an extremely sensitive issue and until now, doctors have had to make this decision alone and justify it to the patient’s relatives. Now the Czech Doctors’ Chamber has issued a set of guidelines which should help them decide when further treatment is futile. However the move has evoked criticism, with critics pointing out that such guidelines can be abused.

Although the new guidelines regarding care for terminally ill patients are not legally binding, they are being described by doctors as a revolution in Czech health care. It is the first official document of its kind and it has been prompted by the Czech Society of Anaesthesiology and Intensive Care Medicine, who wanted doctors to have something to fall back on in the event of a legal problem.

Milan Kubek
Above all, the guidelines define effective and ineffective treatment based on the premise that the life of every patient is terminal and a person should live it as well as possible. Milan Kubek is the head of the Czech Doctors’ Chamber.

“Our guidelines should prevent patients from getting what we call ‘futile treatment’ which cannot prolong their life or lead to their recovery. Such patients should receive palliative care but they shouldn’t be burdened for example by further surgeries if there is no chance that this could improve their life. We want patients to receive treatment that is optimal for them. They should not be exposed to suffering, when the treatment makes no sense.”

While most doctors welcome the initiative of the Doctors’ Chamber, patients remain more cautious. Josef Mrázek, the vice-president of the Czech Association of Patients, argues that the guidelines will take the responsibility of the decision away from the doctors.

“Mr Kubek argued that the guidelines would help inexperienced doctors to decide whether to terminate treatment, but we think that this decision should always be in the hands of an experienced doctor. Secondly, there were cases recently when a doctor decided that a patient was dead and it later turned out that the person was still alive. And thirdly, it is always better to treat someone longer than necessary than later questioning whether doctors did all they could. This is important especially for the relatives.”

The Doctors’ Chamber has stressed that the guidelines are merely a set of recommendations and should not in any event lead to a withdrawal of treatment if the patient shows a will to fight. They concern mainly patients in a coma or patients with multiple organ failure but even in such cases, doctors should take into consideration a patient’s previous wishes. Besides, they say, withdrawing intensive treatment does not imply withdrawing treatment as such – a patient would get treatment to relieve their pain and discomfort, without prolonging their suffering. This has led some critics to argue that the new guidelines can be regarded as a first step to euthanasia, but Milan Kubek of the Czech Doctors’ Chamber strongly disagrees.

“Euthanasia is illegal and the Czech Doctors’ Chamber doesn’t agree with it. In my view a patient’s wish to die is the result of ineffective palliative care and a lack of hospices in this country. Our guidelines cannot be seen as paving the way to euthanasia. On the contrary, they enforce the right of patients to proper care.”