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The R ight to refuse a medical treatment

The R ight to refuse a medical treatment. Lenira Dias FD-UNL 18.04.2013. The Medical R elation. Equal base vs paternalistic base ; The new generation rights and the bioethical princples related to them : Pinciple of Autonomy ; Right to self- determination ;

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The R ight to refuse a medical treatment

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  1. TheRight to refuse a medical treatment Lenira Dias FD-UNL 18.04.2013

  2. The Medical Relation • Equal base vspaternalistic base; • Thenewgenerationrightsandthebioethicalprincplesrelated to them: • PincipleofAutonomy; • Right to self-determination; • Right to Information; • PrincipleofEquality.

  3. Patient’s rights As a person: As a partof a contract: Life; Fisicaland moral integrity(dignity); Personalidentity; Free developmentofpersonality; Freedom of speech and belief; Freedom of conscience and religion; Privateautonomy; Social security; Education; Work; Confidentiality; Information; Self-determination(to acept, refuse or stop a currenttreatment); Chooseanydoctor to treathim/her; equality in access to health care.

  4. TheDuty to giveinformations as a condition to a validconsentandtheConsent as thecondition for a validinterventiononthe patient’s sphere DutyofinformationValidConsent Patient´sconsent Legitim medical treatment

  5. Therefusalof a treatmentandthe patient’s autonomy • Relevantquestions: • Does thepatienthave a legitimright to refuse a medical treatmentthatcouldbetheonlyway to savehis/herlife? Conflictofrights. • Afterthe refuse, does thedoctorhavethedutyofrespectingthe patient’s willor can heperformthetreatmentevenagainstit? Conflictofduties.

  6. Problemsraised As to thefirstquestion: • Right to self-determinationonhealthissuesandRight to die withdignityVSRight to lifeandhealthprotection.

  7. As to thesecondquestion: • Doctor’sdutyofprotectingandcuringthepatientVS hisduty to respectthe patient’s personalsphereorautonomy.

  8. Groundsofrefusal • Moral; • Cientific; • Personal; • Religious.

  9. ConflictofRights • PrincipleofHarmonizationwayofbalancingthe (fundamental) rights in conflict.

  10. ConflictofDuties • Religiouspointofview; • Moral (social) pointofview; • Penal pointofview.

  11. Conflictofduties • Examplesofpractical cases ofrefusalof a medical treatment: • RefusalofbloodtransfusionbytheJeová’switness; • Refusalof a DNA test; • Refusalof a cesareansectionorcesarianoperation; • Refusalofchemotherapy (andotherinvasivetherapeutics); • Refusalofalimentation; • Refusalofvaccine; • Refusalof a tuberculosistreatment.

  12. Religiouspointofview TheJeová’sWitnesssituation Theright to religionHealthprotection and to belief (art.41º (art.64º ofthe ofthe Portuguese Portuguese Constitution) Constitution) Autonomy (art.26º) Life (art.23º)

  13. Moral pointofview TheCancersituation Right to die peacefullyRight to becured (art.1º, 13º, 37º) (art.64º=) Dignity (art.1º) Life (art.23º)

  14. Penal pointofview • Conflictbetweenthedutyofrespectingthepatient’spersonalsphereandwillandthedutyofsavinghis/herlifeart.36ºofthe Portuguese PC. • Refusalof a treatmentEndofthedutyofprotection= art.156ºofthe PC = Thedoctorshallnot realize thetreatment. • Refusalof a treatmentMaintenanceofsuchduty= 131º + 10º ( homicidebydefault).

  15. Arrangements for medical refusal • WrittenwillPrevious; • VerballyexpressedwillCurrent; • Presumedwillcurrentbutconsideringpreviousor actual informationsprovidedbythefamilypacientiscurrentlyunconciousoristemporarilyincapableofmakingdecisions.

  16. Conclusions • Right to life VS Personalbeliefs. • PreviousConsent VS Arbitrarytreatments. • Duty to treat VS Dutyofrespect.

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