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INDICE Situación
en España:
Constitución
Código Penal
Código Médico
Jurisprudencia
Cataluña
Opina el experto Europa
Consejo de Europa
Parlamento Europeo
Holanda
Bélgica
Francia Estados
Unidos
Oregón
Nueva York
Michigan (Dr. Kevorkian) Sudamérica
Uruguay
Colombia Otros
países
Suiza
Australia
Indice temático
Los menores en los Países Bajos
Comité
Consultivo de Etica Francés
El
procedimiento de notificación neerlandés
El
procedimiento suizo
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DOCUMENTACION
El Senado belga
respalda la eutanasia
HOLANDA. Procedimiento de notificación de la
muerte.
CONSEJO DE EUROPA. Recomendación sobre
protección de los derechos humanos y la dignidad de los enfermos
terminales.
PARLAMENTO
EUROPEO. Resolución sobre el respeto de los derechos humanos.
AUSTRALIA. Ley sobre derechos de los pacientes terminales del
Territorio Norte.
OREGÓN. Ley del Estado de Oregón sobre muerte digna (Death
with Dignity Act).
Pablo Parrón. Madrid.
La reciente aprobación en los Países Bajos de un proyecto de ley
en la Camara Baja que autoriza la eutanasia activa ha reavivado un debate
que no es ajeno al Derecho Sanitario.
Aun cuando de la lectura de los párrafos que siguen pudiera parecer que la eutanasia, sino legalmente al menos de facto, es aceptada en mayor o menor medida en muchas partes del mundo, la realidad es que sigue siendo ampliamente rechazada por las normativas de casi todos los países y organismos internacionales. A pesar de ello y al margen de los textos legales, existen encuestas y estudios que revelan que la eutanasia, aun prohibida, se practica
de forma velada en algunos centros hospitalarios.
Ni son tantos los
países en los que se ha intentado legalizar la eutanasia como pudiera parecer tras la lectura de las líneas que siguen, ni son tan pocas las prácticas eutanásicas
que se llevan a cabo, la mayoría de ellas al margen de la ley.
Con carácter previo al examen de la situación mundial de la
controvertida cuestión, conviene recordar que la discusión actual se centra
en la eutanasia activa y en la pasiva, en las que tanto una acción como
una omisión intencionadas tienen como objetivo acabar con la vida de
una persona.
Artificios legales
Del análisis realizado, se deduce que en todos los países objeto de
estudio -incluso en Holanda- la eutanasia sigue siendo una figura
delictiva tipificada en los respectivos códigos penales, si bien en
Holanda y Uruguay existen artificios legales para difuminar la
responsabilidad penal.
Tal es el caso de
Holanda, en el que un procedimiento de notificación supervisado por un
comité regional de bioética permite desde 1990 sortear la
incriminación penal a los médicos que la practican.
En Uruguay, si un
médico es demandado, el juez puede incluso dictaminar el perdón
judicial previsto en el Código Penal si el médico interviene a
petición del enfermo terminal.
En cualquier caso,
la experiencia de la legalización o permisividad de la eutanasia en
algunos países determina una notable falta de control de los
implicados, los objetivos, las causas y los afectados.
Situación legal en España
En España, la Organización Médica Colegial
(OMC) siempre se ha pronunciado totalmente en contra de
la eutanasia.
Con la aprobación del vigente Código de Etica y Deontología Médica en la Asamblea General celebrada el 25 de septiembre de 1999, la OMC mantiene
su postura en el artículo 27.3 que dice literalmente que "el médico nunca provocará intencionadamente la muerte de ningún paciente, ni siquiera en caso de petición expresa por parte de
éste".
En 1998, los máximos responsables de la OMC
reunidos en Navarra, aprobaron la denominada Declaración de Pamplona (ver
Actualidad del Derecho Sanitario nº 40, junio 1998, pág. 333), en la que mostraban su abierto rechazo a la eutanasia y defendían la calidad
de la asistencia hasta el momento de la muerte.
Cooperación al suicidio
El Código Penal español aprobado en 1995 también tipifica la eutanasia como
delito -aunque sin mencionarla- y lo incluye en el tipo atenuado del delito de cooperación al suicidio.
La propia redacción del artículo 143.4, que contiene el expresado tipo penal, supone una relajación con respecto a la situación precedente.
Dice textualmente: "El que causare o cooperare activamente con actos necesarios y directos a la muerte de otro, por la petición expresa, seria e inequívoca de éste, en el caso de que la víctima sufriera una enfermedad grave que conduciría necesariamente a su muerte, o que produjera graves padecimientos permanentes y difíciles de soportar, será castigado con la pena inferior en uno o dos grados a las señaladas en los números 2 y 3 de este artículo".
Acción punible
Esta misma idea fue expuesta por Fermín Morales
Prats, catedrático de Derecho Penal, durante la celebración del V Congreso de la Asociación Española de Derecho Sanitario, al indicar que la respuesta del Código Penal a la eutanasia "continúa estableciendo una prohibición para determinadas formas de participación en el suicidio ajeno, pero al proceder a la desincriminación de las modalidades de participación menos intensas (complicidad simple en un suicidio ajeno) viene a reconocer un relativo margen al derecho a la disponibilidad de la propia vida, opción político criminal que se acentúa al observar el tratamiento otorgado a la eutanasia".
También ha indicado este autor que el artículo 143.4 del Código Penal sanciona la eutanasia activa directa consentida -aquélla en la que se ejecutan actos directos para provocar la muerte- como constitutiva de un tipo atenuado con respecto al auxilio al homicidio genérico.
Este tipo penal se refiere a un sujeto que padece una enfermedad grave, permanente y difícil de soportar, y que está en fase terminal. El precepto exige que medie una petición expresa, seria e inequívoca, es decir, no basta para que se dé el tipo atenuado con la anuencia o el consentimiento genérico del sujeto de renuncia a su propia vida, según Morales.
Es preciso un consentimiento escrito que no suscite dudas sobre la veracidad de la decisión del enfermo. En este sentido, el testamento vital no sería suficiente cuando la víctima se halla en estado de inconsciencia, sino sólo en caso de que la petición sea consciente y actualizada. También ha reconocido que el nuevo marco legal obliga a reconsiderar la prolongación irracional de la vida, pues puede colisionar con el principio constitucional de dignidad de la persona, "sin que pueda descartarse que tales supuestos puedan reputarse como tratos inhumanos y degradantes".
Debate en Cataluña
Es preciso hacer una mención especial al debate planteado en
Cataluña donde en el mes de abril de 2000 el Parlamento
autonómico ha llegado a votar una propuesta para modificar el Código Penal en el sentido de que se despenalice la eutanasia, que finalmente no pasó los correspondientes trámites parlamentarios por falta del apoyo necesario (68 votos frente a 66, después de que en una primera votación con voto secreto se produjera un empate).
El Código de Deontología aprobado por la Asamblea General del Consejo de Médicos de Cataluña el 16 de junio de 1997, en vigor desde el 1 de enero de 1998, expresa que "el objetivo de la atención a las personas en situación de enfermedad terminal no es acortar ni alargar su vida, sino promover su máxima calidad posible. El tratamiento de la situación de agonía debe adaptarse a los objetivos de confort, sin pretender alargar innecesariamente ni acortar deliberadamente. En los casos de muerte cerebral, el médico deberá suprimir los medios que mantienen una apariencia de vida a no ser que sean necesarios para un transplante previo" (art. 58).
La eutanasia en la jurisprudencia
Apenas existe jurisprudencia existe sobre eutanasia en España, y cuando
algún tribunal ha juzgado el problema ha aplicado estrictamente la normativa vigente, como no podría ser de otra manera, lo que les ha llevado a recordar que tanto el Código Penal vigente como su antecesor sancionan inequívocamente la asistencia al
suicidio (ver en este
sentido la sentencia de la Audiencia Provincial de la Coruña en Actualidad
del Derecho Sanitario nº 28, mayo 1997, pág. 253).
La propia Constitución
reconoce en su artículo 15 el derecho a la vida y a la integridad física y moral, sin que del mismo pueda deducirse un derecho a disponer sobre la propia vida.
En este sentido, el ordenamiento jurídico español no parece admitir bajo ninguna circunstancia la eutanasia.
La situación holandesa
En el ámbito Europeo, que no exclusivamente de la Unión Europea, el debate sobre la eutanasia también ha dado lugar a diversas normas y recomendaciones por parte de los Estados y organismos supranacionales.
El caso más notable lo encontramos en los
Países
Bajos, donde recientemente se ha aprobado una propuesta de ley de legalización de la eutanasia que, si bien aun está pendiente de aprobación por el Senado y, dada la mayoría con que cuentan los partidarios del proyecto, probablemente verá la luz
el próximo año.
Aunque probablemente se trate del primer país del mundo que promulgue una ley, en sentido
estricto con este contenido, no debe olvidarse que desde 1990 existía un procedimiento de notificación que en la práctica
supone una aceptación de la eutanasia bajo ciertos presupuestos.
De hecho, el texto, denominado
"Control de la eutanasia solicitada y asistencia a la muerte
voluntaria", no hace más que sancionar una práctica que ya estaba tolerada y apoyada en 25 años de jurisprudencia holandesa. En el proyecto anunciado, que conserva los rasgos básicos del antiguo procedimiento de notificación, los requisitos precisos para que un médico pueda dar curso a la petición de eutanasia de un paciente son tres:
- Que el enfermo tenga un sufrimiento insoportable sin que perspectiva de mejora alguna.
- Que le haya expresado al médico repetidamente su voluntad de morir
- Que el médico pida la opinión de otro colega. Además la opinión del médico estará sometida al control de comisiones regionales especializadas, quienes juzgarán si el diagnóstico es correcto.
Menores de edad
Además, la propuesta neerlandesa ha ido mucho más lejos de lo que en un principio se pudiera pensar ya que también reconoce el derecho de los enfermos de 16 y 17 años a decidir independientemente sobre su vida, sin el consentimiento de sus progenitores, aunque su opinión se tomará en consideración. Los enfermos de entre 12 y 16 años también podrán acogerse a la ley de eutanasia pero en este caso, necesitarán la aprobación de sus progenitores o tutor.
El
procedimiento de
notificación neerlandés
funciona del siguiente modo:
El médico debe
notificar todo caso de muerte no natural al forense municipal. En el
caso de la eutanasia o del auxilio al suicidio, el médico redacta un
informe partiendo de un modelo preestablecido (anexo I).
El
forense redacta un informe en el que establece la muerte no natural del
paciente y envía ambos informes, el del médico y el suyo, al fiscal. A
su vez, también envía el informe del médico a la Comisión Regional
de Comprobación de la Eutanasia.
La
comisión comprueba si la actuación del médico cumple los criterios de
cuidado y envía su dictamen al Ministerio Fiscal, al inspector regional
de sanidad y al médico en cuestión, que puede solicitar una explicación
de palabra. Independientemente de lo que haga el Ministerio Fiscal, el
inspector regional de sanidad puede someter el asunto al órgano
disciplinario médico.
Si
la comisión dictamina que el médico ha actuado con el cuidado y el
esmero profesional exigibles, normalmente el Ministerio Fiscal decidirá
no someter el caso a juicio, a menos que haya motivos fundados para el
procesamiento. Si la comisión dictamina que el médico no ha actuado
con el cuidado y el esmero profesional exigibles, el Ministerio Fiscal
consulta al ministro de justicia antes de incoar el procesamiento.
El
procedimiento de notificación se creó en 1990 porque tanto los médicos
como los fiscales necesitaban directrices sobre la actuación de los médicos
que aplicaban la eutanasia. En 1994 se estableció el procedimiento de
notificación en un decreto legislativo. En 1996, se llevó a cabo una
investigación de ámbito nacional sobre el estado de la cuestión de
las actuaciones médicas de terminación de la vida.
De la mencionada
investigación se desprendió que tanto los médicos como los forenses y
los fiscales abogan por que el Ministerio Fiscal realice un control
anterior a la comprobación de cuidado, que no se lleve a cabo en la
esfera del derecho penal o que, al menos, pierda parte de ese carácter.
Desde el 1 de noviembre de 1998 hay cinco comisiones regionales de
comprobación, de las que forman parte un experto médico, uno jurídico
y un experto en ética. A estos miembros los nombran conjuntamente el
ministro de justicia y el de sanidad.
Otros países de Europa
En Bélgica la legalización de la eutanasia también está siendo ampliamente debatida, hasta el punto de que el gobierno de coalición formado por liberales, socialistas y verdes está estudiando la adopción de una normativa que descriminalice algunas prácticas de eutanasia.
En
Francia, el debate sobre la eutanasia está bastante restringido, de acuerdo con su estricta legislación en este campo. Baste señalar como ejemplo que en ningún país es ilegal informar sobre cómo suicidarse, siempre que la información no se dirija consciente y específicamente a una persona que tenga la intención de quitarse la vida. Pues bien, en Francia el proporcionar esta información sí es ilegal.
No obstante en marzo del año 2000 se conoció un informe de la más alta instancia francesa sobre cuestiones éticas, el
Comité Consultivo Nacional de Etica para las Ciencias de la Vida y de la
Salud, en el que se aconseja que en ciertas circunstancias excepcionales, como los casos en que no se controla el dolor a pesar de los medios disponibles, pueda practicarse la eutanasia. El informe se elaboró tras 18 meses de consultas con juristas, médicos y enfermeros de varios países europeos.
Otro caso llamativo, del que sin embargo se habla menos, quizá por no pertenecer al grupo de los 15 países que conforman la Unión Europea, es el de
Suiza, la pequeña confederación de Estados situada en el centro de Europa. En el cantón de Zurich, se celebró un referéndum el 27 de septiembre de 1977 a fin de legalizar la eutanasia. El referéndum tuvo éxito, pero fue rechazado por el Consejo Nacional Federal el 6 de marzo de 1979. De acuerdo con los datos ofrecidos por EXIT, la Asociación Suiza para la Muerte Humana (Swiss Association for Human Dying), cuyo presidente es el profesor Meinrad Schaer, antiguo vicedirector de la Oficina Federal Suiza de Salud Pública, en este Estado la ley permitiría practicar la asistencia al suicidio.
De hecho, EXIT lo viene haciendo desde 1982 aplicando un procedimiento que básicamente consiste en que un médico de la asociación visita al enfermo y comprueba que tiene al menos 18 años, es residente en Suiza, no tiene alteradas sus facultades mentales, padece sufrimientos de salud intolerables y no hay circunstancias o terceras personas que influyan en su decisión.
Si se entiende que se reúnen los requisitos, un equipo compuesto por un abogado, un psiquiatra y un médico toman la decisión y, en su caso, asisten el suicidio solicitado. Inmediatamente se llama a la policía para que se investiguen las circunstancias de la muerte y si se ha violado la ley. Desde que se fundó la asociación en 1982 ningún colaborador ha sido enjuiciado por su participación en un suicidio asistido, y sólo en 1996 hubo 119 intervenciones que llevaron a la muerte del paciente.
El Consejo de Europa
El Consejo de Europa viene manteniendo una postura constante en contra de la eutanasia activa. En junio de 1999, la Asamblea Parlamentaria aprobó una
Recomendación (1418/1999) a los 41 Estados miembros, entre los que figura España, sobre protección de los enfermos en la etapa final de su vida
(anexo II). El texto aboga por la definición de los cuidados paliativos como un derecho subjetivo y una prestación más de la asistencia sanitaria. Por otra parte, subraya que el deseo de morir no genera un derecho legal del paciente ni una justificación jurídica para que un tercero practique la eutanasia.
El Parlamento Europeo
Por su parte el Parlamento Europeo observa la misma línea oficial del Consejo de Europa. El 21 de mayo de 1996 aprobó una resolución en la que rechazaba de plano las propuestas de algunos políticos y científicos que respaldan la eutanasia para los pacientes en coma y los neonatos con graves minusvalías. La eurocámara rechaza de forma enérgica la tesis de un grupo de científicos que niegan un derecho ilimitado a la vida de las personas con graves dolencias físicas y psíquicas, los pacientes en coma y los recién nacidos con dificultades para sobrevivir.
La resolución responde a afirmaciones de políticos sobre que las enfermedades físicas y degenerativas suponen una carga económica y social considerable. Contiene una petición a la Comisión de las Comunidades Europeas para que renuncie, en su Programa de Investigación sobre Biología Médica y Salud, a declaraciones sobre el elevado coste de la ayuda y sostenimiento de las personas desahuciadas.
El Parlamento Europeo considera que deben rechazarse las teorías sobre la vida indigna, basándose en que contraría La Declaración Universal de los Derechos Humanos. Los eurodiputados han hecho hincapié en su sólida convicción de que el derecho a la vida es inherente a toda persona, independientemente de su salud. El Grupo del Partido Europeo de los Liberales, Demócratas y Reformistas (ELDR) no participó en la votación de la resolución por considerar que se trata de una cuestión demasiado importante como para abordarse en un debate sobre cuestiones urgentes, sin haberse elaborado un informe previo.
En otra resolución, publicada en el
Diario Oficial de las Comunidades Europeas C 320 de
28.10.1996, relativa al respeto de los derechos humanos en la Unión Europea, el Parlamento Europeo también afirma con rotundidad que
"el derecho a la vida entraña el derecho a la atención sanitaria y requiere la prohibición de la eutanasia" (anexo III).
Regulación en otros países
En el resto del mundo el caso más paradigmático lo encontramos en
Australia, donde en 1994 el Territorio del Norte aprobó el Acta de Derechos de los Enfermos Terminales, que legalizaba la eutanasia (anexo IV). A pesar de ello, en marzo de 1997 la ley fue revocada tras una controvertida votación en que hubo 38 votos a favor de revocar la norma frente a 34 votos a favor de su mantenimiento.
La ley establecía el derecho a solicitar la eutanasia a toda persona mayor de 18 años que demostrase que era un enfermo terminal, que no había tratamiento para su dolencia y que estaba en pleno uso de sus facultades mentales. También se exigía la firma de tres médicos, entre ellos un psiquiatra, y se defendía la voluntariedad del médico a practicar la eutanasia.
En Estados Unidos la controversia ha adquirido cierta relevancia en algunos Estados. Concretamente el Tribunal Federal de Apelaciones de
Nueva York, competente también para Vermont y Connecticut, autorizó en 1996 la eutanasia médica, aunque posteriormente, el Tribunal Supremo suspendió las sentencias del Tribunal Federal.
El caso del “Doctor Muerte”
También es destacable en Estados Unidos el caso del Dr. Kevorkian
-también conocido como "Doctor muerte"-, que diseñó una máquina que contenía infusiones de barbitúricos, relajantes musculares y cloruro de potasio que, al ser activada por el mismo paciente, producía la muerte sin ningún tipo de dolor o molestia, en el lapso de seis minutos.
Una de sus primeras pacientes fue la señora Janeth Adkins, quien a los cincuenta y cuatro años de edad y tras recibir la noticia de una enfermedad incurable , decidió poner fin a sus días con la máquina del doctor Kevorkian, eximiéndolo por escrito de toda responsabilidad.
El caso fue juzgado en la Corte del Estado de Michigan, que exoneró de cualquier cargo criminal al inventor. De cualquier modo, después de 9 años bajo la sombra de la duda en los que el Dr. Kevorkian fue declarado inocente en tres ocasiones y en una cuarta el caso fue sobreseído, llegó una condena de 25 años por homicidio y otra de entre 3 y 10 años por administrar fármacos y ejercer la medicina sin permiso.
Oregón y la Death with Dignity Act
No puede dejar de hacerse mención al caso del Estado de Oregón cuyas leyes permiten que un enfermo terminal pueda acceder al suicidio asistido ingiriendo un medicamento letal prescrito por un médico. Esta posibilidad se contempla desde la aprobación de la
Death with Dignity Act en 1997 (anexo V) que exige como requisitos que quienes se acojan a la misma sean enfermos terminales con un pronóstico de seis meses de vida que no padezcan ninguna alteración mental y lo soliciten por escrito en varias ocasiones. Hasta ahora 43 pacientes han fallecido usando este método.
Situación en Sudamérica
El Código Penal de Uruguay de 1934 (Ley 9414, de 29 de junio de 1934) ofrece una respuesta jurídica peculiar para el problema de la eutanasia. Esta peculiaridad no radica en el hecho de ser el único país latinoamericano que ha adoptado una solución como la que a continuación se expone, ya que también los códigos penales de
Perú, de 1924 (art. 157) y Colombia, de 1936 (art. 364), adoptaron soluciones semejantes, sino en el hecho de que, a diferencia de estos últimos, se ha mantenido hasta nuestros días.
El artículo 310 del vigente Código Penal de Uruguay tipifica como delito de homicidio la acción de quien "con intención de matar, diere muerte a alguna persona". La pena de entre veinte meses de prisión a doce años de penitenciaria prevista para el homicidio sería en principio perfectamente aplicable al médico que practica una eutanasia. Sin embargo, el código uruguayo también prevé varias "causas de impunidad" entre las que se encuentra el "homicidio piadoso".
Efectivamente, el artículo 37 prescribe que "los jueces tienen la facultad de exonerar de castigo al sujeto de antecedentes honorables, autor de un homicidio piadoso, efectuado por móviles de piedad, mediante súplicas reiteradas de la víctima". Este artículo consolida la doctrina del "perdón judicial" aplicable al médico que asista a un enfermo terminal a superar voluntariamente la frontera de la vida. En la práctica, el perdón judicial es una especie de indulto que puede producir efectos muy similares a los de la legalización propiamente dicha.
En Colombia, la Corte Constitucional autorizó en 1997 la eutanasia voluntaria para pacientes terminales que la pidan. El Congreso puede regular los términos en los que se aplica pero no oponerse a ella.
ANEXO I
PAISES BAJOS
MODELO DE INFORME PARA EL MÉDICO QUE TRATA AL PACIENTE, EN RELACIÓN CON LA NOTIFICACIÓN AL FORENSE MUNICIPAL DEL FALLECIMIENTO DE UNA PERSONA COMO CONSECUENCIA DE LA APLICACIÓN DE PRÁCTICAS DESTINADAS A LA TERMINACIÓN DE LA VIDA A PETICIÓN DEL PACIENTE O DE AUXILIO AL SUICIDIO.
Para notificar al forense municipal una muerte no natural como consecuencia de la aplicación de prácticas destinadas a la terminación de la vida a petición del paciente o de auxilio al suicidio, el médico que trata al paciente facilitará un informe al forense municipal, que deberá redactarse según el modelo propuesto:
NB: se ruega que motive las respuestas a las preguntas formuladas.
Al responder las preguntas, puede ofrecer información suplementaria por medio de anexos. Si no es suficiente el espacio facilitado para la contestación de las preguntas, también puede adjuntar los anexos necesarios. No se olvide de indicar en los anexos a qué pregunta se refieren los mismos.
Datos del médico:
Apellido:
Iniciales:
Sexo: H / M
Profesión:
- Médico de familia
- Médico de casa de convalecencia
- Especialista (nombre de la especialidad)
En su caso, nombre de la institución:
Dirección del trabajo:
Código postal / Ciudad:
Datos del fallecido
Apellido:
Iniciales:
Sexo: H / M
Fecha de fallecimiento:
Lugar de fallecimiento (municipio):
I.- Historial de la enfermedad.
1. ¿Qué enfermedad(es) padecía el paciente y desde cuándo?
2. ¿Qué terapias médicas se probaron?
3. ¿Era todavía posible la curación del paciente?
4. ¿En qué consistía el padecimiento del paciente?
5a. ¿Existían todavía posibilidades de aliviar el padecimiento del paciente?
5b. En caso de respuesta afirmativa, ¿cuál era la actitud del paciente respecto a esas alternativas?
6. ¿Dentro de qué plazo se calcula que podía esperarse el fallecimiento de no haberse procedido a la terminación de la vida a petición del paciente?
II.- Petición de terminación de la vida o de auxilio al suicidio.
7a. ¿Cuándo solicitó el paciente la terminación de la vida o el auxilio al suicidio?
7b. ¿Cuándo reiteró el paciente esta petición?
8. ¿En presencia de quién expresó el paciente esta petición?
9a. ¿Existe una declaración de voluntad por escrito?
9b. En caso afirmativo, ¿de qué fecha? (por favor, adjunte esta declaración al informe)
9c. En caso de respuesta negativa, ¿cuál es la razón?
10. ¿Existen indicaciones de que la petición del paciente fue expresada bajo presión o influencia de otras personas?
11. ¿Existía alguna razón para dudar que el paciente, en el momento de expresar su petición, tenía plena consciencia del alcance de su petición y de su situación física?
NB: Las actuaciones de terminación de la vida con respecto a pacientes cuyos padecimientos tengan un origen primariamente psíquico, así como con respecto a pacientes cuya capacidad de expresar una petición bien meditada pueda haber sido perturbada, por ejemplo como consecuencia de una depresión o de una demencia en desarrollo, deben notificarse según el procedimiento para los casos de terminación de la vida en ausencia de petición expresa del paciente. La notificación de actuaciones de terminación de la vida con respecto a pacientes menores de edad también deberá efectuarse de acuerdo con ese procedimiento.
12a. ¿Se ha consultado acerca de la terminación de la vida con el personal de enfermería o con el personal sanitario al cuidado del paciente?
12b. En caso afirmativo, ¿con quién y cuáles fueron sus opiniones?
12c. En caso negativo, ¿por qué no?
13a. ¿Se ha consultado acerca de la terminación de la vida con los parientes del paciente?
13b. En caso afirmativo, ¿con quién y cuáles fueron sus opiniones?
13c. En caso negativo, ¿por qué no?
III.- Consulta.
14. ¿A qué médico(s) se ha consultado?
15a. ¿Cuál era su profesión? (médico de familia / especialista / psiquiatra / otros, a saber:)
15b. ¿Era(n) éste(éstos) también médicos que trataban al paciente?
15c. ¿Cuál es su relación con usted?
16a. ¿Cuándo vio/vieron el(los) médico(s) consultado(s) al paciente?
16b. En el caso de que el(los) médico(s) consultado(s) no hayan visto al paciente, ¿por qué no?
NB: Debe adjuntar al presente informe el informe escrito del(los) médico(s)
consultado(s) relativo a su opinión acerca del padecimiento insoportable del paciente y de la ausencia de esperanzas de mejora, así como sobre el hecho de que la petición del paciente haya sido expresa y bien meditada. En el caso de que el(los) médico(s)
consultado(s) no hayan consignado su opinión por escrito: ¿cuál era su opinión acerca de los aspectos anteriormente mencionados?
IV.- Realización de la terminación de la vida a petición del paciente o del Auxilio al suicidio.
18a. ¿Se trataba de:
- Terminación de la vida a petición del paciente (siga con la pregunta 18b).
o de
- Auxilio al suicidio?
18b. ¿Quién se encargó de hecho de llevar a cabo la terminación de la vida a petición del paciente?
19. ¿Con qué medios o de qué forma tuvo lugar la terminación de la vida?
20. ¿Recabó información acerca del método a aplicar y, en su caso, a quién?
21. ¿Qué personas, aparte de usted, estaban presentes en el momento de la terminación de la vida?
V.- COMENTARIOS.
22. ¿Existen otros aspectos de los cuales quiere informar a la comisión de comprobación y que no ha podido incluir en las respuestas de las preguntas precedentes?
Fecha:
Nombre:
Firma:
ANEXO II
CONSEJO DE EUROPA. RECOMENDACIÓN DE LA ASAMBLEA PARLAMENTARIA
SOBRE LA PROTECCION DE LOS DERECHOS HUMANOS Y LA DIGNIDAD DE LOS ENFERMOS TERMINALES
Recommendation 1418 (1999)1
Protection of the human rights and dignity of the terminally ill and the dying (Extract from the Official Gazette of the Council of Europe -June 1999).
1. The vocation of the Council of Europe is to protect the dignity of all human beings and the rights which stem therefrom.
2. Medical progress, which now makes it possible to cure many previously incurable or fatal diseases, the improvement of medical techniques and the development of resuscitation techniques, which make it possible to prolong a person's survival, to defer the moment of death. As a result the quality of life of the dying is often neglected, and their loneliness and suffering ignored, as is that of their families and care-givers.
3. In 1976, in its Resolution 613, the Assembly declared that it was "convinced that what dying patients most want is to die in peace and dignity, if possible with the comfort and support of their family and friends", and added in its Recommendation 779 (1976) that "the prolongation of life should not in itself constitute the exclusive aim of medical practice, which must be concerned equally with the relief of suffering".
4. Since then, the Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine has formed important principles and paved the way without explicitly referring to the specific requirements of the terminally ill or dying.
5. The obligation to respect and to protect the dignity of a terminally ill or dying person derives from the inviolability of human dignity in all stages of life. This respect and protection find their expression in the provision of an appropriate environment, enabling a human being to die in dignity.
6. This task has to be carried out especially for the benefit of the most vulnerable members of society, a fact demonstrated by the many experiences of suffering in the past and the present. Just as a human being begins his or her life in weakness and dependency, he or she needs protection and support when dying.
7. Fundamental rights deriving from the dignity of the terminally ill or dying person are threatened today by a variety of factors:
i. insufficient access to palliative care and good pain management;
ii. often lacking treatment of physical suffering and a failure to take into account psychological, social and spiritual needs;
iii. artificial prolongation of the dying process by either using disproportionate medical measures or by continuing treatment without a patient's consent;
iv. the lack of continuing education and psychological support for health-care professionals working in palliative medicine;
v. insufficient care and support for relatives and friends of terminally ill or dying patients, which otherwise could alleviate human suffering in its various dimensions;
vi. patients' fear of losing their autonomy and becoming a burden to, and totally dependent upon, their relatives or institutions;
vii. the lack or inadequacy of a social as well as institutional environment in which someone may take leave of his or her relatives and friends peacefully;
viii. insufficient allocation of funds and resources for the care and support of the terminally ill or dying;
ix. the social discrimination inherent in weakness, dying and death.
8. The Assembly calls upon member states to provide in domestic law the necessary legal and social protection against these specific dangers and fears which a terminally ill or dying person may be faced with in domestic law, and in particular against:
i. dying exposed to unbearable symptoms (for example, pain, suffocation, etc.);
ii. prolongation of the dying process of a terminally ill or dying person against his or her will;
iii. dying alone and neglected;
iv. dying under the fear of being a social burden;
v. limitation of life-sustaining treatment due to economic reasons;
vi. insufficient provision of funds and resources for adequate supportive care of the terminally ill or dying.
9. The Assembly therefore recommends that the Committee of Ministers encourage the member states of the Council of Europe to respect and protect the dignity of terminally ill or dying persons in all respects:
a. by recognising and protecting a terminally ill or dying person's right to comprehensive palliative care, while taking the necessary measures:
i. to ensure that palliative care is recognised as a legal entitlement of the individual in all member states;
ii. to provide equitable access to appropriate palliative care for all terminally ill or dying persons;
iii. to ensure that relatives and friends are encouraged to accompany the terminally ill or dying and are professionally supported in their endeavours. If family and/or private networks prove to be either insufficient or overstretched, alternative or supplementary forms of professional medical care are to be provided;
iv. to provide for ambulant hospice teams and networks, to ensure that palliative care is available at home, wherever ambulant care for the terminally ill or dying may be feasible;
v. to ensure co-operation between all those involved in the care of a terminally ill or dying person;
vi. to ensure the development and implementation of quality standards for the care of the terminally ill or dying;
vii. to ensure that, unless the patient chooses otherwise, a terminally ill or dying person will receive adequate pain relief and palliative care, even if this treatment as a side-effect may contribute to the shortening of the individual's life;
viii. to ensure that health professionals are trained and guided to provide medical, nursing and psychological care for any terminally ill or dying person in co-ordinated teamwork, according to the highest standards possible;
ix. to set up and further develop centres of research, teaching and training in the fields of palliative medicine and care as well as in interdisciplinary thanatology;
x. to ensure that specialised palliative care units as well as hospices are established at least in larger hospitals, from which palliative medicine and care can evolve as an integral part of any medical treatment;
xi. to ensure that palliative medicine and care are firmly established in public awareness as an important goal of medicine;
b. by protecting the terminally ill or dying person's right to self-determination, while taking the necessary measures:
i. to give effect to a terminally ill or dying person's right to truthful and comprehensive, yet compassionately delivered information on his or her health condition while respecting an individual's wish not to be informed;
ii. to enable any terminally ill or dying person to consult doctors other than his or her usual doctor;
iii. to ensure that no terminally ill or dying person is treated against his or her will while ensuring that he or she is neither influenced nor pressured by another person. Furthermore, safeguards are to be envisaged to ensure that their wishes are not formed under economic pressure;
iv. to ensure that a currently incapacitated terminally ill or dying person's advance directive or living will refusing specific medical treatments is observed. Furthermore, to ensure that criteria of validity as to the scope of instructions given in advance, as well as the nomination of proxies and the extent of their authority are defined; and to ensure that surrogate decisions by proxies based on advance personal statements of will or assumptions of will are only to be taken if the will of the person concerned has not been expressed directly in the situation or if there is no recognisable will. In this context, there must always be a clear connection to statements that were made by the person in question close in time to the decision
-making situation, more precisely at the time when he or she is dying, and in an appropriate situation without exertion of pressure or mental disability. To ensure that surrogate decisions that rely on general value judgements present in society should not be admissible and that, in case of doubt, the decision must always be for life and the prolongation of life;
v. to ensure that - notwithstanding the physician's ultimate therapeutic responsibility - the expressed wishes of a terminally ill or dying person with regard to particular forms of treatment are taken into account, provided they do not violate human dignity;
vi. to ensure that in situations where an advance directive or living will does not exist, the patient's right to life is not infringed upon. A catalogue of treatments which under no condition may be withheld or withdrawn is to be defined;
c. by upholding the prohibition against intentionally taking the life of terminally ill or dying persons, while:
i. recognising that the right to life, especially with regard to a terminally ill or dying person, is guaranteed by the member states, in accordance with Article 2 of the European Convention on Human Rights which states that "no one shall be deprived of his life intentionally";
ii. recognising that a terminally ill or dying person's wish to die never constitutes any legal claim to die at the hand of another person;
iii. recognising that a terminally ill or dying person's wish to die cannot of itself constitute a legal justification to carry out actions intended to bring about death.
1. Assembly debate on 25 June 1999 (24th Sitting) (see Doc. 8421, report of the Social, Health and Family Affairs Committee, rapporteur: Mrs Gatterer; and Doc. 8454, opinion of the Committee on Legal Affairs and Human Rights, rapporteur: Mr McNamara).
Text adopted by the Assembly on 25 June 1999 (24th Sitting).
ANEXO III
Resolución del Parlamento Europeo sobre el respeto de los derechos humanos en la Unión Europea (1994), DO C 320 de 28.10.1996 y Bol. 9-1996, punto 1.2.1
Aprobación por el Parlamento Europeo, el 8 de abril. El Parlamento hizo hincapié en la importancia de que los derechos humanos se protejan sin reserva en la Unión para que ésta sea creíble cuando exige que se respeten en el resto del mundo. Reafirmó su deseo de que la Comunidad se adhiera al Convenio Europeo para la Protección de los Derechos Humanos e instó a los Estados miembros de la Unión Europea a que, en el marco de la Conferencia Intergubernamental, introduzcan en el Derecho comunitario las modificaciones necesarias para facilitar dicha adhesión. Pidió, asimismo, que la Unión integre plenamente en el Tratado una declaración europea de los derechos fundamentales, en la que se expongan y consagren los derechos individuales que incluyen los derechos económicos, sociales, culturales y ecológicos.
El Parlamento pidió a los Estados miembros cuya legislación mantiene la pena de muerte que la supriman definitivamente.
Afirmó, por otra parte, que el derecho a la vida entraña el derecho a la atención sanitaria y requiere la prohibición de la
eutanasia. El Parlamento condenó que la autoridad policial o el personal de prisiones recurran a la fuerza o a la tortura y que se inflijan condenas o tratos inhumanos, crueles o humillantes a personas detenidas o encarceladas. Reafirmó que la libre circulación de las personas en la Unión debe aplicarse a todos quienes residan legalmente en el territorio de la Unión, sea cual fuere su nacionalidad. El Parlamento recordó su adhesión a los principios generales del Derecho, al principio de la independencia de la autoridad judicial, al principio de non bis in idem y a la presunción de inocencia. Tomó nota, asimismo, del estado lamentable de algunas cárceles europeas, del grave problema que representa el hacinamiento, las condiciones materiales deplorables y la insalubridad general de los establecimientos penitenciarios europeos. Pidió a los Estados miembros que se abstengan de considerar la inmigración sólo desde el punto de vista restrictivo, represivo y policial, que reconozcan la dimensión humana y el carácter positivo que puede representar la inmigración para toda la sociedad e incluyan en sus ordenamientos jurídicos los criterios aplicables a la inmigración legal. El Parlamento condenó todas las formas de racismo, xenofobia y antisemitismo, así como cualquier tipo de discriminación por motivos religiosos, étnicos o culturales y pidió que esta posición figure oficialmente en el Tratado. Afirmó su desaprobación de que la pobreza y la marginación sean causa de limitación de los derechos fundamentales y preconizó la elaboración, a escala comunitaria, de un instrumento jurídico vinculante por el que se establezcan garantías mínimas en materia de ingresos, protección social, acceso a la asistencia sanitaria y al alojamiento, condiciones indispensables para poder vivir con dignidad. El Parlamento recordó que el derecho de cada cual al respeto de su intimidad y domicilio, así como la protección de los datos de carácter personal, representan derechos fundamentales que los Estados tienen la obligación de proteger. Insistió en la conveniencia de que en las políticas comunitarias se incluya el derecho fundamental de los minusválidos a la igualdad de oportunidades y a la no discriminación, e hizo hincapié en el derecho de los ancianos a una vida digna. Pidió que los Estados miembros garanticen la participación real y en condiciones de igualdad de las mujeres en la vida pública e insistió en la necesidad de que adopten las medidas indispensables para luchar contra la violencia sexual y demás violaciones de los derechos de la mujer. En cuanto a los niños se refiere, el Parlamento pidió que la Unión erradique la explotación económica o sexual de los menores e instaure mecanismos de control y protección del respeto de sus derechos elementales (DO C 132 de 28.4.1997).
ANEXO IV
LEY SOBRE DERECHOS DE LOS PACIENTES TERMINALES DEL TERRITORIO NORTE DE AUSTRALIA
(1995. Posteriormente modificada en 1996 y 1997).
NORTHERN TERRITORY OF AUSTRALIA RIGHTS OF THE TERMINALLY ILL ACT 1995
TABLE OF PROVISIONS
Section
PART 1 - PRELIMINARY
1. Short title
2. Commencement
3. Interpretation
PART 2 - REQUEST FOR AND GIVING OF ASSISTANCE
4. Request for assistance to voluntarily terminate life
5. Response of medical practitioner
6. Response of medical practitioner, &c., not to be influenced by extraneous considerations
7. Conditions under which medical practitioner may assist
8. Palliative care
9. Patient who is unable to sign certificate of request
10 Right to rescind request
11. Improper conduct
PART 3 - RECORDS AND REPORTING OF DEATH
12. Medical records to be kept
13. Certification as to death
14. Medical record to be sent to Coroner
15. Coroner may report on operation of Act
PART 4 - MISCELLANEOUS
16. Construction of Act
17. Certificate of request is evidence
18. Effect on construction of wills, contracts and statutes
19. Insurance or annuity policies
20. Immunities
21. Regulations
SCHEDULE
NORTHERN TERRITORY OF AUSTRALIA
AN ACT to confirm the right of a terminally ill person to request assistance from a medically qualified person to voluntarily terminate his or her life in a humane manner; to allow for such assistance to be given in certain circumstances without legal impediment to the person rendering the assistance; to provide procedural protection against the possibility of abuse of the rights recognised by this Act; and for related purposes be it enacted by the Legislative Assembly of the Northern Territory of Australia, with the assent as provided by the Northern Territory (Self-Government) Act 1978 of the Commonwealth, as follows:
PART 1 - PRELIMINARY
1. Short title
This Act may be cited as the Rights of the Terminally Ill Act 1995.
2. Commencement
This Act shall come into operation on a date to be fixed by the Administrator by notice in the Gazette.
3. Interpretation
In this Act, unless the contrary intention appears -
"assist", in relation to the death or proposed death of a patient, includes the prescribing of a substance, the preparation of a substance and the giving of a substance to the patient for self administration, and the administration of a substance to the patient;
"certificate of request" means a certificate in or to the effect of the form in the Schedule that has been completed, signed and witnessed in accordance with this Act;
"health care provider", in relation to a patient, includes a hospital, nursing home or other institution (including those responsible for its management) in which the patient is located for care or attention and any nurse or other person whose duties include or directly or indirectly relate to the care or medical treatment of the patient;
"illness" includes injury or degeneration of mental or physical faculties;
"medical practitioner" means a medical practitioner who has been entitled to practise as a medical practitioner (however described) in a State or a Territory of the Commonwealth for a continuous period of not less than 5 years and who is resident in, and entitled under the Medical Act to practise medicine in, the Territory;
"terminal illness", in relation to a patient, means an illness which, in reasonable medical judgment will, in the normal course, without the application of extraordinary measures or of treatment unacceptable to the patient, result in the death of the patient.
PART 2 - REQUEST FOR AND GIVING OF ASSISTANCE
4. Request for assistance to voluntarily terminate life
A patient who, in the course of a terminal illness, is experiencing pain, suffering and/or distress to an extent unacceptable to the patient, may request the patient's medical practitioner to assist the patient to terminate the patient's life.
5. Response of medical practitioner
A medical practitioner who receives a request referred to in section 4, if satisfied that the conditions of section 7 have been met, but subject to section 8, may assist the patient to terminate the patient's life in accordance with this Act or, for any reason and at any time, refuse to give that assistance.
6. Response of medical practitioner, &c., not to be influenced by extraneous considerations
(1) A person shall not give or promise any reward or advantage (other than a reasonable payment for medical services), or by any means cause or threaten to cause any disadvantage, to a medical practitioner or other person for refusing to assist, or for the purpose of compelling or persuading the medical practitioner or other person to assist or refuse to assist, in the termination of a patient's life under this Act.
Penalty: $10,000.
(2) A person to whom a reward or advantage is promised or given, as referred to in subsection (1), does not have the legal right or capacity to receive or retain the reward or accept or exercise the advantage, whether or not, at the relevant time, he or she was aware of the promise or the intention to give the reward or advantage.
7. Conditions under which medical practitioner may assist
(1) A medical practitioner may assist a patient to end his or her life only if all of the following conditions are met:
(a) the patient has attained the age of 18 years;
(b) the medical practitioner is satisfied, on reasonable grounds, that:
(i) the patient is suffering from an illness that will, in the normal course and without the application of extraordinary measures, result in the death of the patient;
(ii) in reasonable medical judgment, there is no medical measure acceptable to the patient that can reasonably be undertaken in the hope of effecting a cure; and
(iii) any medical treatment reasonably available to the patient is confined to the relief of pain, suffering and/or distress with the object of allowing the patient to die a comfortable death;
(c) a second medical practitioner, who is not a relative or employee of, or a member of the same medical practice as, the first medical practitioner and who holds a diploma of psychological medicine or its equivalent, has examined the patient and has confirmed:
(i) the first medical practitioner's opinion as to the existence and seriousness of the illness;
(ii) that the patient is likely to die as a result of the illness;
(iii) the first medical practitioner's prognosis; and
(iv) that the patient is not suffering from a treatable clinical depression in respect of the illness;
(d) the illness is causing the patient severe pain or suffering;
(e) the medical practitioner has informed the patient of the nature of the illness and its likely course, and the medical treatment, including palliative care, counselling and psychiatric support and extraordinary measures for keeping the patient alive, that might be available to the patient;
(f) after being informed as referred to in paragraph (e), the patient indicates to the medical practitioner that the patient has decided to end his or her life;
(g) the medical practitioner is satisfied that the patient has considered the possible implications of the patient's decision to his or her family;
(h) the medical practitioner is satisfied, on reasonable grounds, that the patient is of sound mind and that the patient's decision to end his or her life has been made freely, voluntarily and after due consideration;
(i) the patient, or a person acting on the patient's behalf in accordance with section 9, has, not earlier than 7 days after the patient has indicated to his or her medical practitioner as referred to in paragraph (f), signed that part of the certificate of request required to be completed by or on behalf of the patient;
(j) the medical practitioner has witnessed the patient's signature on the certificate of request or that of the person who signed on behalf of the patient, and has completed and signed the relevant declaration on the certificate;
(k) the certificate of request has been signed in the presence of the patient and the first medical practitioner by another medical practitioner (who may be the medical practitioner referred to in paragraph (c) or any other medical practitioner) after that medical practitioner has discussed the case with the first medical practitioner and the patient and is satisfied, on reasonable grounds, that the certificate is in order, that the patient is of sound mind and the patient's decision to end his or her life has been made freely, voluntarily and after due consideration, and that the above conditions have been complied with;
(l) where, in accordance with subsection (4), an interpreter is required to be present at the signing of the certificate of request, the certificate of request has been signed by the interpreter confirming the patient's understanding of the request for assistance;
(m) the medical practitioner has no reason to believe that he or she, the countersigning medical practitioner or a close relative or associate of either of them, will gain a financial or other advantage (other than a reasonable payment for medical services) directly or indirectly as a result of the death of the patient;
(n) not less than 48 hours has elapsed since the signing of the completed certificate of request;
(o) at no time before assisting the patient to end his or her life had the patient given to the medical practitioner an indication that it was no longer the patient's wish to end his or her life;
(p) the medical practitioner himself or herself provides the assistance and/or is and remains present while the assistance is given and until the death of the patient.
(2) In assisting a patient under this Act a medical practitioner shall be guided by appropriate medical standards and such guidelines, if any, as are prescribed, and shall consider the appropriate pharmaceutical information about any substance reasonably available for use in the circumstances.
(3) Where a patient's medical practitioner has no special qualifications in the field of palliative care, the information to be provided to the patient on the availability of palliative care shall be given by a medical practitioner (who may be the medical practitioner referred to in subsection (1)(c) or any other medical practitioner) who has such special qualifications in the field of palliative care as are prescribed.
(4) A medical practitioner shall not assist a patient under this Act where the medical practitioner or any other medical practitioner who is required under subsection (1) or (3) to communicate with the patient does not share the same first language as the patient, unless there is present at the time of that communication and at the time the certificate of request is signed by or on behalf of the patient, an interpreter who holds a level 3 accreditation from the National Accreditation Authority for Translators and Interpreters, or such other interpretative qualifications as are prescribed, in the first language of the patient.
8. Palliative care
(1) A medical practitioner shall not assist a patient under this Act if, in his or her opinion and after considering the advice of the medical practitioner referred to in section 7(1)(c), there are palliative care options reasonably available to the patient to alleviate the patient's pain and suffering to levels acceptable to the patient.
(2) Where a patient has requested assistance under this Act and has subsequently been provided with palliative care that brings about the remission of the patient's pain or suffering, the medical practitioner shall not, in pursuance of the patient's original request for assistance, assist the patient under this Act. If subsequently the palliative care ceases to alleviate the patient's pain and suffering to levels acceptable to the patient, the medical practitioner may continue to assist the patient under this Act only if the patient indicates to the medical practitioner the patient's wish to proceed in pursuance of the request.
9. Patient who is unable to sign certificate of request
(1) If a patient who has requested his or her medical practitioner to assist the patient to end the patient's life is physically unable to sign the certificate of request, any person who has attained the age of 18 years, other than the medical practitioner or the medical practitioner referred to in section 7(1)(c), or a person who is likely to receive a financial benefit directly or indirectly as a result of the death of the patient, may, at the patient's request and in the presence of the patient and both the medical practitioner witnesses (and where, in accordance with section 7(4) an interpreter has been used, also in the presence of the interpreter), sign the certificate on behalf of the patient.
(2) A person who signs a certificate of request on behalf of a patient forfeits any financial or other benefit the person would otherwise obtain, directly or indirectly, as a result of the death of the patient.
10. Right to rescind request
(1) Notwithstanding anything in this Act, a patient may rescind a request for assistance under this Act at any time and in any manner.
(2) Where a patient rescinds a request, the patient's medical practitioner shall, as soon as practicable, destroy the certificate of request and note that fact on the patient's medical record.
11. Improper conduct
(1) A person shall not, by deception or improper influence, procure the signing or witnessing of a certificate of request.
Penalty: $20,000 or imprisonment for 4 years.
(2) A person found guilty of an offence against subsection (1) forfeits any financial or other benefit the person would otherwise obtain, directly or indirectly, as a result of the death of the patient, whether or not the death results from assistance given under this Act.
PART 3 - RECORDS AND REPORTING OF DEATH
12. Medical records to be kept
A medical practitioner who, under this Act, assists a patient to terminate the patient's life shall file and, subject to this Act, keep the following as part of the medical record of the patient:
(a) a note of any oral request of the patient for such assistance;
(b) the certificate of request;
(c) a record of the opinion of the patient's medical practitioner as to the patient's state of mind at the time of signing the certificate of request and certification of the medical practitioner's opinion that the patient's decision to end his or her life was made freely, voluntarily and after due consideration;
(d) the report of the medical practitioner referred to in section 7(1)(c);
(e) a note by the patient's medical practitioner -
(i) certifying as to the independence of the medical practitioner referred to in section 7(1)(c) and the residential and period of practice qualifications of the patient's medical practitioner;
(ii) indicating that all requirements under this Act have been met;
(iii) indicating the steps taken to carry out the request for assistance; and
(iv) including a notation of the substance prescribed, and such other information, if any, as is prescribed.
Penalty: $10,000 or imprisonment for 2 years.
13. Certification as to death
(1) A medical practitioner who, under this Act, assists a patient to end the patient's life shall be taken to have attended the patient during the patient's last illness for the purposes of Part IV of the Registration of
Births, Deaths and Marriages Act or any provision in substitution for that Part.
(2) A death as the result of assistance given under this Act shall not, for that reason
only, be taken to be unexpected, unnatural or violent for the purposes of the definition of
"reportable death" in the application of Part 4 of the Coroner's
Act, or be a reportable death by reason only of having occurred during an
anaesthetic.
14. Medical record to be sent to Coroner
(1) As soon as practicable after the death of a patient as the result of assistance given under this
Act, the medical practitioner who gave the assistance shall report the death to a Coroner by sending to the Coroner a copy of the death certificate under the Registration of
Births, Deaths and Marriages Act and so much of the medical record of the patient
(including that required by section 12 to be kept) as relates to the terminal illness and death of the
patient.
(2) As soon as practicable after the end of each financial year the Coroner shall advise the
Attorney-General of the number of patients who died as a result of assistance given under this Act and the
Attorney-General, in such manner or report as he or she thinks
appropriate, shall report the number to the Legislative Assembly.
15. Coroner may report on operation of Act
The Coroner may, at any time and in his or her absolute discretion, report to the
Attorney-General on the operation, or any matter affecting the operation, of this Act and the
Attorney-General shall, within 3 sitting days of the Legislative Assembly after receiving the
report, table a copy of the report in the Assembly.
PART 4 - MISCELLANEOUS
16. Construction of Act
(1) Notwithstanding section 26(3) of the Criminal Code, an action taken in accordance with this Act by a medical practitioner or by a health care provider on the instructions of a medical practitioner does not constitute an offence against Part VI of the Criminal Code or an attempt to commit such an
offence, a conspiracy to commit such an offence, or an offence of aiding,
abetting, counselling or procuring the commission of such an offence.
(2) Assistance given in accordance with this Act by a medical practitioner or by a health care provider on the instructions of a medical practitioner is taken to be medical treatment for the purposes of the
law.
17. Certificate of request is evidence
A document purporting to be a certificate of request is, in any proceedings before a
court, admissible in evidence and is prima facie evidence of the request by the person who purported to sign it or on whose behalf it is purported to have been
signed, for assistance under this Act.
18. Effect on construction of wills, contracts and statutes
(1) Any will, contract or other agreement, whether or not in writing or executed or made before or after the commencement of this
Act, to the extent that it affects whether a person may make or rescind a request for assistance under this
Act, or the giving of such assistance, is not valid.
(2) An obligation owing under a contract, whether made before or after the commencement of this
Act, shall not be conditioned or affected by the making or rescinding of a request for assistance under this Act or the giving of that
assistance.
19. Insurance or annuity policies
The sale, procurement or issuing of any life, health or accident insurance or annuity policy or the rate charged for such a policy shall not be conditioned on or affected by the making or rescinding of a request for assistance under this Act or the giving of that
assistance.
20. Immunities
(1) A person shall not be subject to civil or criminal action or professional disciplinary action for anything done in good faith and without negligence in compliance with this
Act, including being present when a patient takes a substance prescribed for or supplied to the patient as the result of assistance under this Act to end the patient's
life.
(2) A professional organisation or association or health care provider shall not subject a person to censure, discipline,
suspension, loss of licence, certificate or other authority to practise, loss of
privilege, loss of membership or other penalty for anything that, in good faith and without
negligence, was done or refused to be done by the person and which may under this Act lawfully be done or refused to be done.
(3) A request by a patient for assistance under this Act, or giving of such assistance in good faith by a medical practitioner in compliance with this
Act, shall not constitute neglect for any purpose of law or alone constitute or indicate a disability for the purposes of an application under section 8 of the Adult Guardianship Act.
(4) A health care provider is not under any duty, whether by contract, statute or other legal
requirement, to participate in the provision to a patient of assistance under this
Act, and if a health care provider is unable or unwilling to carry out a direction of a medical practitioner for the purpose of the medical practitioner assisting a patient under this Act and the patient transfers his or her care to another health care
provider, the former health care provider shall, on request, transfer a copy of the patient's relevant medical records to the new health care
provider.
21. Regulations
The Administrator may make regulations, not inconsistent with this Act, prescribing all
matters:
(a) required or permitted by this Act to be prescribed; or
(b) necessary or convenient to be prescribed for carrying out or giving effect to this Act.
SCHEDULE
Section 7
REQUEST FOR ASSISTANCE TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER
I,________________________have been advised by my
medical_________________________practitioner that I am suffering from__________________an illness which will ultimately result in my death and this has been confirmed by a second medical
practitioner.
I have been fully informed of the nature of my illness and its likely course and the medical
treatment, including palliative care, counselling and psychiatric support and extraordinary measures that may keep me
alive, that is available to me and I am satisfied that there is no medical treatment reasonably available that is acceptable to me in my
circumstances.
I request my medical practitioner to assist me to terminate my life in a humane and dignified
manner.
I understand that I have the right to rescind this request at any time.
Signed:
Dated:
DECLARATION OF WITNESSES
I declare that:
(a) the person signing this request is personally known to me;
(b) he/she is a patient under my care;
(c) he /she signed the request in my presence and in the presence of the second witness to this
request;
(d) I am satisfied that he/she is of sound mind and that his/her decision to end
his/her life has been made freely, voluntarily and after due
consideration.
Signed: Patient's Medical Practicioner
I declare that:
(a) the person signing this request is known to me;
(b) I have discussed his/her case with him/her and his/her medical
practitioner;
(c) he/she signed the request in my presence and in the presence of his/her medical
practitioner;
(d) I am satisfied that he/she is of sound mind and that his/her decision to end
his/her life has been made freely, voluntarily and after due
consideration;
(e) I am satisfied that the conditions of section 7 of the Act have been or will be complied
with.
Signed: Second Medical Practitioner
[Where under section 7(4) an interpreter is required to be present]
DECLARATION OF INTERPRETER
I declare that:
(a) the person signing this request or on whose behalf it is signed is known to me;
(b) I am an interpreter qualified to interpret in the first language of the patient as required by section 7(4);
(c) I have interpreted for the patient in connection with the completion and signing of this
certificate;
(d) in my opinion, the patient understands the meaning and nature of this
certificate.
Signed: Qualified Interpreter.
ANEXO V
LEY DEL ESTADO DE OREGON SOBRE UNA MUERTE DIGNA
THE OREGON DEATH WITH DIGNITY ACT (1994)
(ORS 127.800-897. Implemented: 27 October l997)
SECTION I
GENERAL PROVISIONS
1.01 Definitions. The following words and phrases, whenever used in this Act, shall have the following meanings:
(1) "Adult" means an individual who is 18 years of age or older.
(2) "Attending physician" means the physician who has primary responsibility for the care of the patient and treatment of the patient's disease.
(3) "Consulting physician" means the physician who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient's disease.
(4) "Counseling" means a consultation between a state licensed psychiatrist or psychologist and a patient for the purpose of determining whether the patient is suffering from a psychiatric or psychological disorder, or depression causing impaired judgment.
(5) "Health care provider" means a person licensed, certified, or otherwise authorized or permitted by the law of this State to administer health care in the ordinary course of business or practice of a profession, and includes a health care facility.
(6) "Incapable" means that in the opinion of a court or in the opinion of the patient's attending physician or consulting physician, a patient lacks the ability to make and communicate health care decisions to health care providers, including communication through persons familiar with the patient's manner of communicating if those persons are available. Capable means not incapable.
(7) "Informed decision" means a decision by a qualified patient, to request and obtain a prescription to end his or her life in a humane and dignified manner, that is based on an appreciation of the relevant facts and after being fully informed by the attending physician of:
(a) his or her medical diagnosis;
(b) his or her prognosis:
(c) the potential risks associated with taking the medication to be prescribed;
(d) the probable result of taking the medication to be prescribed;
(e) the feasible alternatives, including, but not limited to, comfort care, hospice care and pain control.
(8) "Medically confirmed" means the medical opinion of the attending physician has been confirmed by a consulting physician who has examined the patient and the patient's relevant medical records.
(9) "Patient" means a person who is under the care of a physician.
(10) "Physician" means a doctor of medicine or osteopathy licensed to practice medicine by the Board of Medical Examiners for the State of Oregon.
(11) "Qualified patient" means a capable adult who is a resident of Oregon and has satisfied the requirements of this Act in order to obtain a prescription for medication to end his or her life in a humane and dignified manner.
(12) "Terminal disease" means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six (6)
months.
SECTION 2
WRITTEN REQUEST FOR MEDICATION TO END ONE'S LIFE IN A HUMANE AND DIGNIFIED MANNER
2.01 Who may initiate a written request for medication
An adult who is capable, is a resident of Oregon, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication for the purpose of ending his or her life in a humane and dignified manner in accordance
with this Act.
2.02 Form of the written request
(1) A valid request for medication under this Act shall be in substantially the form described in Section 6 of this Act, signed and dated by the patient and witnessed by at least two individuals who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is capable, acting voluntarily, and is not being coerced to sign the request.
(2) One of the witnesses shall be a person who is not:
(a) A relative of the patient by blood, marriage or adoption;
(b) A person who at the time the request is signed would be entitled to any portion of the estate of the qualified patient upon death under any will or by operation of law; or
(c) An owner, operator or employee of a health care facility where the qualified patient is receiving medical treatment or is a resident.
(3) The patient's attending physician at the time the request is signed shall not be a witness.
(4) If the patient is a patient in a long term care facility at the time the written request is made, one of the witnesses shall be an individual designated by the facility and having the qualifications specified by the Department of Hu man Resources by rule.
SECTION 3
SAFEGUARDS
3.01 Attending physician responsibilities
The attending physician shall:
(1) Make the initial determination of whether a patient has a terminal disease, is capable, and has made the request voluntarily;
(2) Inform the patient of;
(a) his or her medical diagnosis;
(b) his or her prognosis;
(c) the potential risks associated with taking the medication to be prescribed;
(d) the probable result of taking the medication to be prescribed;
(e) the feasible alternatives, including, but not limited to, comfort care, hospice care and pain control.
(3) Refer the patient to a consulting physician for medical confirmation of the diagnosis, and for determination that the patient is capable and acting voluntarily;
(4) Refer the patient for counseling if appropriate pursuant to Section 3.03;
(5) Request that the patient notify next of kin;
(6) Inform the patient that he or she has an opportunity to rescind the request at any time and in any manner, and offer the patient an opportunity to rescind at the end of the 15 day waiting period pursuant to Section 3.06;
(7) Verify, immediately prior to writing the prescription for medication under this Act, that the patient is making an informed decision;
(8) Fulfill the medical record documentation requirements of Section 3.09;
(9) Ensure that all appropriate steps are carried out in accordance with this Act prior to writing a prescription for medication to enable a qualified patient to end his or her life in a humane and dignified
manner.
3.02 Consulting Physician Confirmation
Before a patient is qualified under this Act, a consulting physician shall examine the patient and his or her relevant medical records and confirm, in writing, the attending physician's diagnosis that the patient is suffering from a ter minal disease, and verify that the patient is capable, is acting voluntarily and has made an informed
decision.
3.03 Counseling Referral
If in the opinion of the attending physician or the consulting physician a patient may be suffering from a psychiatric or psychological disorder, or depression causing impaired judgment, either physician shall refer the patient for counseling. No medication to end a patient's life in a humane and dignified manner shall be prescribed until the person performing the counseling determines that the person is not suffering from a psychiatric or psychological disorder, or depression causing impaired
judgment.
3.04 Informed decision
No person shall receive a prescription for medication to end his or her life in a humane and dignified manner unless he or she has made an informed decision as defined in Section 1.01(7). Immediately prior to writing a prescription for medication under this Act, the attending physician shall verify that the patient is making an informed
decision.
3.05 Family notification
The attending physician shall ask the patient to notify next of kin of his or her request for medication pursuant to this Act. A patient who declines or is unable to notify next of kin shall not have his or her request denied for that
reason.
3.06 Written and oral requests
In order to receive a prescription for medication to end his or her life in a humane and dignified manner, a qualified patient shall have made an oral request and a written request, and reiterate the oral request to his or her attending physician no less than fifteen (15) days after making the initial oral request. At the time the qualified patient makes his or her second oral request, the attending physician shall offer the patient an opportunity to rescind the
request.
3.07 Right to rescind request
A patient may rescind his or her request at any time and in any manner without regard to his or her mental state. No prescription for medication under this Act may be written without the attending physician offering the qualified patient an opportunity to rescind the
request.
3.08 Waiting periods
No less than fifteen (15) days shall elapse between the patient's initial and oral request and the writing of a prescription under this Act. No less than 48 hours shall elapse between the patient's written request and the writing of a prescription under this Act.
3.09 Medical record documentation requirements
The following shall be documented or filed in the patient's medical record:
(1) All oral requests by a patient for medication to end his or her life in a humane and dignified manner;
(2) All written requests by a patient for medication to end his or her life in a humane and dignified manner;
(3) The attending physician's diagnosis and prognosis, determination that the patient is capable, acting voluntarily and has made an informed decision.
(4) The consulting physician's diagnosis and prognosis, and verification that the patient is capable, acting voluntarily and has made an informed decision;
(5) A report of the outcome and determinations made during counseling, of performed;
(6) The attending physician's offer to the patient to rescind his or her request at the time of the patient's second oral request pursuant to Section 3.06; and
(7) A note by the attending physician indicating that all requirements under this Act have been met and indicating the steps taken to carry out the request, including a notation of the medication prescribed.
3.10 Residency requirements
Only requests made by Oregon residents, under this Act, shall be granted.
3.11 Reporting requirements
(1) The Health Division shall annually review a sample of records maintained pursuant to this Act.
(2) The Health Division shall make rules to facilitate the collection of information regarding compliance with this Act. The information collected shall not be a public record and may not be made available for inspection by the public.
(3) The Health Division shall generate and make available to the public an annual statistical report of information collected under Section 3.11(2) of this Act.
3.12 Effect on construction of wills, contracts and statutes
(1) No provision in a contract, will or other agreement, whether written or oral, to the extent the provision would affect whether a person may make or rescind a request for medication to end his or her life in a humane and dignified manner, shall be valid.
(2) No obligation owing under any currently existing contract shall be conditioned or affected by the making or rescinding of a request, by a person, for medication to end his or her life in a humane and dignified manner.
3.13 Insurance or annuity policies
The sale, procurement, or issuance of any life, health, or accident insurance or annuity policy or the rate charged for any policy shall not be conditioned upon or affected by the making or rescinding of a request, by a person, for medication to end his or her life in a humane and dignified manner. Neither shall a qualified patient's act of ingesting medication to end his or her life in a humane and dignified manner have an effect upon a life, health, or accident insurance or annuity
policy.
3.14 Construction of act
Nothing in this Act shall be construed to authorize a physician or any other person to end a patient's life by lethal injection, mercy killing or active euthanasia. Actions taken in accordance with this Act shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the
law.
SECTION 4
IMMUNITIES AND LIABILITIES
4.01 Immunities
Except as provided in Section 4.02:
(1) No person shall be subject to civil or criminal liability or professional disciplinary action for participating in good faith compliance with this Act. This includes being present when a qualified patient takes the prescribed medica tion to end his or her life in a humane and dignified manner.
(2) No professional organization or association, or health care provider, may subject a person to censure, discipline, suspension, loss of license, loss of privileges, loss of membership or other penalty for participating or refusing to participate in good faith compliance with this Act.
(3) No request by a patient for or provision by an attending physician of medication in good faith compliance with the provisions of this Act shall constitute neglect for any purpose of law or provide the sole basis for the appointment of a guardian or conservator.
(4) No health care provider shall be under any duty, whether by contract, by statute or by any other legal requirement to participate in the provision to a qualified patient of medication to end his or her life in a humane and dignified manner. If a health care provider is unable or unwilling to carry out a patient's health care provider shall transfer, upon request, a copy of the patient's relevant medical records to the new health care
provider.
4.02 Liabilities
1. A person who without authorization of the patient willfully alters or forges a request for medication or conceals or destroys a rescission of that request with the intent or effect of causing the patient's death shall be guilty of a Class A felony.
2. A person who coerces or exerts undue influence on a patient to request medication for the purpose of ending the patient's life, or to destroy a rescission of such a request, shall be guilty of a Class A felony.
3. Nothing in this Act limits further liability for civil damages resulting from other negligent conduct or intentional misconduct by any persons.
4. The penalties in this Act do not preclude criminal penalties applicable under other law for conduct which is inconsistent with the provisions of this Act.
SECTION 5
SEVERABILITY
5.01 Severability
Any section of this Act being held invalid as to any person or circumstance shall not affect the application of any other section of this Act which can be given full effect without the invalid section or
application.
SECTION 6
FORM OF THE REQUEST
6.01 Form of the request
A request for a medication as authorized by this Act shall be in substantially the following form:
REQUEST FOR MEDICATION TO END MY LIFE IN A HUMANE AND
DIGNIFIED MANNER
I, _______________________, am an adult of sound mind.
I am suffering from ___________________________, which by my attending physician has determined is a terminal disease and which has been medically formed by a consulting physician.
I have been fully informed of my diagnosis, prognosis, the nature of medication to be prescribed and potential associated risks, the expected result, and the feasible alternatives, including comfort care, hospice care and pain control.
I request that my attending physician prescribe medication that will end my life in a humane and dignified manner.
INITIAL ONE:
____ I have informed my family of my decision and taken their opinionsp into consideration.
____ I have decided not to inform my family of my decision.
____ I have no family to inform of my decision.
I understand that I have the right to rescind this request at any time.
I understand the full import of this request and I expect to die when I take the medication to be prescribed.
I make this request voluntarily and without reservation, and I accept full moral responsibility for my actions.
Signed: _____________________________
Dated: ______________________________
DECLARATION OF WITNESSES
We declare that the person signing this request:
(a) Is personally known to us or has provided proof of identity;
(b) Signed this request in our presence;
(c) Appears to be of sound mind and not under duress, fraud or undue influence;
(d) Is not a patient for whom either of us is attending physician.
________________________________________________Witness 1/
Date
________________________________________________ Witness 2/
Date
Note: One witness shall not be a relative (by blood, marriage or adoption) of the person signing this request, shall not be entitled to any portion of the person's estate upon death and shall not own, operate or be employed at a health care facility where the person is a patient or resident. If the patient is an inpatient at a health care facility, one of the witnesses shall be an individual designated by the
facility.
ORS 127.800-897 implemented as from 27 October 1997.
El
Senado belga respalda la eutanasia
Debate también otro
proyecto de ley sobre cuidados paliativos
La
Comisiones de Justicia y Asuntos Sociales del Senado belga han aprobado
las condiciones en que la eutanasia será legal, que precisará una
demanda voluntaria, expresa y reiterada, y las certificación por
dos facultativos del sufrimiento físico o psíquico insoportable. Las
opiniones médicas deberán ser ratificadas por un médico especialista
(según la patología que presente el paciente), que no tendrá
vínculos con el primer facultativo ni con el demandante de la
eutanasia. El
texto presenta ambigüedades y es inaceptable para la profesión médica
según la oposición, por lo que el Senado pretende equilibrarlo con la
futura aprobación de un proyecto de ley sobre los cuidados paliativos.
Copyright © 2000
ACTUALIDAD DEL DERECHO SANITARIO. Reservados todos los derechos.
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