Health ministry draws up proposal allowing patients to end treatment

The Czech Ministry of Health is treading on delicate ground. It is working on a proposal that would set out the scenario where patients could determine in advance when their treatment should be discontinued. The proposal is still being worked on but could be ready to go before the government within a few months.

The proposal being worked on by the Ministry of Health has sparked headlines about euthanasia, but that is taking things more than a step too far. Euthanasia is illegal in the Czech Republic and would continue to be so even if this proposal is passed.

The proposal being discussed would actually allow patients to specify in advance when doctors should end their treatment. In some cases discontinuation of treatment might lead to death but this is not a charter for euthanasia.

Michal Sojka is spokesman for the Czech Doctors’ Chamber. He explains where discussions have got so far.

Michal Sojka

“The proposal is about respecting the patient’s previously written request about ending treatment. It is about the patient’s decision about treatment, not about euthanasia. Euthanasia is the active ending of life.”

For Czech doctors the distinction between respecting a patient’s wishes to end treatment and their wishes for medical help to end their lives is crucial. The chamber is open to talks about the former but is still firmly opposed to the latter.

Discussions at the moment cover the exact rules under which instructions for ending treatment should be set out. Under one scenario these instructions would have the character of a legal document signed when the individual was still fully conscious and could be valid for up to five years. Doctors still have some quibbles about the precise formulation of the instructions.

To some extent, these instructions are proceeding further down a path already laid out by doctors themselves. Last year doctors mapped out guidelines where intensive treatment, such as surgery, should be discontinued but treatment relieving the patients’ suffering should continue.

Many of these cases clearly fall into the category where there is no longer any hope that surgery, chemotherapy or far reaching drug treatments will have any effect for the better. These guidelines were talked about at the time as a revolution in Czech healthcare but again, stop well short of euthanasia.

The latest discussions do however come at a time when more thought is being given to how the country cares for the terminally ill. For instance, moves are being discussed that would allow health insurance to cover the costs of stays in hospices. Currently hospices are thin on the ground in the Czech Republic which has a chronic shortage of such facilities. Often the stark choice is between a hospital bed in a facility offering medical care that is not required and staying at home without the basic supervision needed.