Cyfroteka.pl

klikaj i czytaj online

Cyfro
Czytomierz
00325 007880 15715101 na godz. na dobę w sumie
Medical law. Cases and commentaries - ebook/pdf
Medical law. Cases and commentaries - ebook/pdf
Autor: Liczba stron: 497
Wydawca: Wolters Kluwer Język publikacji: polski
ISBN: 978-83-264-4658-0 Data wydania:
Lektor:
Kategoria: ebooki >> prawo i podatki >> inne
Porównaj ceny (książka, ebook, audiobook).

The publication presents several dozen judgements of European and constitutional tribunals and of Polish as well as foreign courts which relate to the main issues of the debate conducted in Poland nowadays. They illustrate current development trends that occur in Polish and European medical law and also reveal the complexity and intricacy of medical issues. Separate statements enclosed to some judgements highlight the broad scope of problems arising in that field.

Glosses to each of the judgements and separate footnotes referring the reader to the literature provide a complete description of the subject matter. They also clarify the normative context of the cases reviewed. Moreover, all comments present problems from legal, ethical, political and even economic perspective. Both theoretical and practical aspects of issues concerning vindication of claims and the range of presentation of claims are highlighted in the book.

The Authors contributing to the publication are affiliated with the University of Warsaw. Their main research interests include medical law, civil law, constitutional law and European law.

The book is recommended for lawyers and physicians as well as all those interested in the field of bioethics and the issues of the health care.

Znajdź podobne książki Ostatnio czytane w tej kategorii

Darmowy fragment publikacji:

introduCtion I. The role of judicial decisions in development of medical law Medical.law.is.slowly.evolving.into.a classic.research.discipline,.also.lectured.on.at. third‑level.law.faculties..The.need.of.a modern.lawyer.to.complement.his/her.knowledge. within.this.area.has.increased.for.two.fundamental.reasons. First.of.all,.more.and.more.cases.arise.that.touch.upon.various.aspects.of.health.care. operation.and.provision.of.medical.services.connected.not.only,.as.it.used.to.be.formerly. the.case,.with.penal.or.civil.liability.of.a doctor,.but.also.concerning.the.most.complex. dilemmas,.legal.as.much.as.ethical,.such.as.assessment.of.the.legal.relevance.of.pro futuro declarations.(concerning.medical.proceedings.when.a patient.is.not.capable.of.expressing. consent),.determining.filiation.in.medically.assisted.procreation.treatment,.protection.of. personal.rights.of.transsexuals,.the.quality.of.life.of.a person.with.irremovable.genetic. defects,.criteria.for.ordering.services.when.it.is.impossible.to.satisfy.the.needs.of.all. awaiting.persons,.required.medical.intervention.standard,.considering.the.more.and. more.diversified.“offer”.from.modern.medicine.of.fundamentally.different.effectiveness. and,.last.but.not.least,.the.costs..These.are.only.a few.examples.of.problems,.far.from. exhausting.the.list,.which.until.recently,.as.it.seemed,.could.not.and.even.should.not. have.been.brought.to.court. Secondly,.the.process.of.specific.“juridisation”.of.medicine.has.commenced.and. is.related.to.fundamental.changes.in.the.sphere.of.legal.awareness.among.average. individuals,.whose.expectations.as.regards.exercising.their.right.to.health.protection. have.been.steadily.rising,.while.at.the.same.time,.the.distance.between.social.aspirations. and.possibilities.to.fulfil.them.has.increased,.which.results.in.tensions.and.further.legal. and.ethical.dilemmas. Given.the.circumstances,.judicial.decision‑making.has.begun.to.reflect.quite. accurately.discussions.on.the.borderline.of.modern.medicine.and.law..There.is.an.array. of.significant.reasons.for.which.an.analysis.of.medical.law.problems.from.the.angle.of. judicial.decisions.seems.fruitful.for.further.reflections.and.academic.research,.as.well.as. beneficial.from.the.perspective.of.practitioners’.needs.and.university.teaching..In.the. foreground,.there.is.the.nature.of.issues.to.be.resolved..The.statement.that.the.so‑called. “case.law”.plays.a far.more.important.role.in.medical.law.than.in.any.other.area.of.law.is. not.exaggerated,.for.here.the.research.perspective.is.far.more.strongly.influenced.by.issues. arising.against.the.background.of.particular.cases,.where.the.diversity.of.legal.assessments. Marek.Safjan 11 Introduction and.qualifications.depends.on.the.context,.certain.facts.of.the.case.and.circumstances..The. catalogue.of.“variables”,.which.must.be.considered.when.resolving.certain.problems,.is. quite.naturally.developed.at.a high.level.of.generality.through.normative.and.deontological. regulations,.and.already.the.confrontation.of.those.criteria.with.circumstances.of.a given. case.allows.one.to.find.a satisfactory.solution.or.answer..The.search.for.rightness.and. correctness.of.a certain.solution.more.often.requires.from.adjudicating.authorities.a higher. level.of.latitude,.creativity.and.particular.ease.in.decision‑making.(which.by.no.means. should.be.identified.with.arbitrariness).than.in.other.areas.of.law..The.methodology. of.resolving.legal.and.medical.disputes.is.based.not.only.on.the.subtlety.of.dogmatic. reasoning,.but.also.on.professional,.constant.confrontation.of.fundamental.assumptions. and.values.of.the.system.(very.often.of.hierarchically.highest.levels).with.individualised. circumstances.of.specific.cases..Thus,.presenting.the.methodology.against.the.background. of.the.“case.law”.seems.necessary.in.order.to.understand.interpretation.of.modern.medical. law..Deliberations.on,.e.g. autonomy.of.the.patient,.the.concept.of.“informed.consent”. and.the.scope.of.duty.to.inform,.would.be.up.in.the.air,.become.a pure,.empty.abstract. unless.they.were.confronted.with.the.circumstances.of.a specific.case..The.law,.as.per. our.continental.legal.tradition,.may.not.(and.should.not).be.excessively.casuistic.in.its. nature,.in.particular.as.regards.medical.law,.since.this.would.pose.too.considerable.a risk. of.issuing.unfair.decisions,.and.such.a risk,.in.consequence,.additionally.reinforces.the. need.to.exercise.necessary.judicial.discretion. Third.of.all,.medical.law,.more.often.than.other.fields,.involves.problems.which. the.law.maker.has.not.yet.responded.to,.has.not.yet.provided.adequate.solutions.to,. but.which,.in.practice,.require.adoption.of.a specific.stance.against.the.background.of. particular.cases..The.silence.of.the.law,.and.strictly.speaking.of.the.law.maker,.does.not. exempt.one.from.the.obligation.to.search.for.a correct.answer.with.respect.to.cases.that. arise.in.practice..The.law.detests.emptiness,.what.is.more,.it.may.not.admit.to.helplessness. and.avoid.decision‑making..It.is.in.such.cases.that.the.creative.role.of.courts.is.revealed,. which.“case.by.case”.identify.correct.decisions.and.search.for.answers,.which.with.time. become.established.norms..That.was.the.case.in.many.legal.systems.with.respect.to. problems.relating.to.medically.assisted.procreation,.where.at.the.first.stage,.the.rules. developed.by.judicial.decisions.were.established.to.eventually.take.the.form.of.normative. rules.introduced.to.relevant.codes..Such.a phenomenon.could.also.be.noticed.in.the.case. of.transsexualism,.which.issue.in.the.Polish.law.is.to.this.day.still.resolved.by.way.of. controversial.interpretation.of.provisions.of.the.Act.on.Registry.Office.Records..Similarly,. in.most.countries.assessment.and.classification.of.claims.as.the.so‑called.wrongful conception, wrongful life and.wrongful birth.are.based.on.judicial.decisions..In.most.of.legal.systems,. it.is.also.difficult.to.find.express.and.clear.legal.rules.referring.to.medical.proceedings. at.the.last.stage.of.life,.when.the.essence.of.such.is.a decision.on.discontinuance.or. continuance.of.therapy,.applying.extraordinary.measures.or.the.so‑called.persistent. therapy,.or.respecting.patient’s.wishes.expressed.in.advance.(in.the.so‑called.pro futuro. declarations)..Without.the.knowledge.of.judicial.decisions.in.these.fields.and.most.of.all. gradually.consolidating.interpretation.trends.in.judicial.practice,.probably.future.legal. solutions.could.not.be.brought.up.for.discussion. 12 Marek Safjan Judicial.decisions.in.medical.law.mean.a sequence.and.turning.points,.continuation. and.dramatic.turns.at.the.same.time..Naturally,.the.qualities.of.law.should.include. stability.and.predictability,.yet.as.it.can.be.seen.from.past.experiences,.radical.changes. in.assessment.and.classification.of.different.phenomena.were.often.triggered.under. the.influence.of.fundamental.and.significant.judicial.decisions..Such.phenomena. were.noticed.in.many.legal.systems,.for.instance.in.the.American.case.law.concerning. the.so‑called.cessation.of.therapy.in.persons.connected.for.many.years.to.apparatus. sustaining.blood.circulation.and.breathing.processes.(case.K. Quinlan.in.the.USA,.etc.),. resolutions.of.the.Federal.Constitutional.Court.of.Germany.or.the.Cour de Cassation.in. France.concerning.wrongful.life,.etc..In.medical.cases,.the.concepts.evolve.not.only. with.regard.to.phenomena.emerging.under.the.influence.of.modern.biotechnology. and.medicine,.but.also.surface.in.spheres.traditionally.pertaining.to.the.area.of.legal. reflections.and.analyses.and,.most.of.all,.civil.liability,.its.premises,.scope.and.rules..It.is. enough.to.take.a closer.look.at.the.evolution.that.has.taken.place.in.this.area.within.the. last.several.dozen.years.in.the.Polish.law.against.the.background.of.the.substantially.the. same.normative.solutions,.to.see.how.much.the.approach.expressed.in.judicial.decisions. has.changed.with.respect.to.main.categories.of.liability.such.as.fault.and.classification. of.cases.of.undue.diligence,.malpractice.and.a distinction.between.the.culpable.and. non‑culpable.error,.fault.of.an.institution.in.the.context.of.hospital.liability,.causation,. risk.in.vicarious.liability,.compensation.for.immaterial.harm,.concurrence.of.ex delicto. and.ex contractu.medical.liability,.etc. II. Assumptions of the study The.intention.of.the.authors.of.this.book.was.to.present.the.above‑discussed. tendencies.by.means.of.selected,.characteristic,.significant.and.sometimes.even.landmark. decisions.from.the.last.several.dozen.years. The.selected.judicial.decisions.are.not.exhaustive,.however,.an.effort.was.made. to.include.all.most.notable.settlements,.which.today.affect.the.accepted.manner.of. interpretation.and.the.approach.to.the.issues.of.medical.law..The.authors,.due.to.their. specialisation,.focus.on.judicial.decisions.in.civil.cases,.entering.the.area.of.the.penal.law. only.when.in.civil.judicial.decisions.no.relevant.provisions.were.found.that.would.be. good.examples.of.certain.basic.issues.emerging.in.medical.law.(e.g. problems.of.psychiatric. confidentiality,.Decision.of.the.Supreme.Court.of.20 April.2005,.I KZP.6/05;.scope.of.duty. to.provide.help,.Decision.of.the.Supreme.Court.of.14 June.1956,.IV.KO.17/55;.consent. against.the.background.of.subsidiary.function.of.the.penal.law,.Judgment.of.28 November. 2007,.V KK.81/07). Due.to.the.fundamental.meaning.of.constitutional.regulations.for.development.of. medical.law,.an.attempt.was.made.to.present.decisions.of.the.Polish.Constitutional.Tribunal. relating.to.this.subject.in.the.possibly.most.exhaustive.manner..Today,.such.decisions.are. a significant.point.of.reference.for.establishing.a proper.axiological.framework.when. settling.particular.problems,.especially.if.there.is.a need,.due.to.interpretative.difficulties,. 13 Introduction to.refer.to.such.principles.as.respect.for.the.dignity.of.each.person,.protection.of.life.and. bodily.integrity,.autonomy.and.privacy.of.an.individual. International.and.foreign.judicial.decisions.are.presented.only.in.an.illustrative. manner.for.the.study.is.not.of.comparative.nature.and.does.not.aim.at.comprehensive. presentation.of.tendencies.in.this.area.within.international.and.foreign.legal.systems..Such. a study.would.have.to.be.of.quite.a different.character.and.require.alternative.methodology. and.criteria.for.selecting.relevant.decisions..Thus,.the.authors.decided.to.choose.decisions,. which.are.of.special.importance.for.debates.taking.place.in.Poland.and.problems.that. emerge.today.against.the.background.of.the.Polish.practice.(e.g. case.of.Pretty before.the. ECHR.concerning.the.right.to.assisted.suicide.in.the.case.of.terminal.illness,.the.case.of. wrongful.life.in.German.and.French.judicature,.issues.of.transsexualism.in.European. judicature,.or.the.issue.of.forced.sterilisation.in.American.judicature,.all.of.which.have. been.brought.up.for.discussion.in.Poland). Decisions.and.commentaries.were.grouped.in.7 sections..Whereas.the.first.two. sections.include.constitutional.and.European.decisions.that.touch.upon.various.issues,. the.remaining.five.sections.concern.the.merits.and.are.related.to.particular.branches.of. medical.law..The.content.of.a conclusion.to.a particular.decision,.which.in.most.cases. is.consistent.with.the.conclusions.expressed.in.published.judicial.decisions,.was.the. criterion.for.the.classification.of.that.decision.to.a particular.section..Instances,.in.which. the.conclusion.is.of.”author’s”.nature.(that.is,.it.provides.separate.reasons.for.settlement. adopted.by.the.authors).were.expressly.stressed.in.the.text. The.authors’.commentaries.are.not.glosses.on.decisions.in.the.direct.meaning.of. the.term..Their.main.purpose.was.to.identify.the.most.important.problem.of.a given. resolution,.place.the.decision.in.the.context.of.previous.trends.in.judicial.decisions,.point. out.new.elements.and.arguments,.and.to.indicate.primary.moot.points..References.to. basic.literature.for.particular.sections.are.specified.in.the.introductory.parts.thereto.. Each.commentary.refers.also.to.the.most.significant.titles.in.literature.and.earlier.judicial. decisions,.which.are.relevant.to.issues.raised.in.specific.decisions. III. Tendencies and principles in modern medical law versus judicial decisions Judicial.decisions,.as.previously.mentioned,.reflect.well.the.evolutionary.process. which.has.been.taking.place.in.the.sphere.of.medical.law.for.several.dozen.years..It.is. worth.stressing.two.fundamental.stimuli.that.substantially.determine.the.directions.of. that.evolution..On.the.one.hand,.it.results.from.universal.recognition.of.the.principle. of.respect.for.the.dignity.of.each.person,.and.on.the.other.hand,.from.the.principle.of. autonomy.and.freedom.of.an.individual,.i.e. values.of.special.relevance.in.the.entire. array.of.cases.concerning.the.protection.of.life,.health,.bodily.integrity.and.privacy..Both. values.– dignity.and.autonomy.– are.interdependent:.there.is.no.protection.of.autonomy. and.freedom.without.prior.recognition.of.dignity.as.a fundamental.value.constituting. the.source.of.other.rights.and.freedoms,.but.the.dignity.will.also.be.violated.each.time. a person.is.fully.deprived.of.freedom.to.decide.about.himself/herself..Any.other.basic. 14 Marek Safjan normative.interpretations.and.principles.within.the.confines.of.medical.law.are.to.some. extent.derivatives.of.the.principle.of.dignity.and.autonomy,.and.this.concerns.matters. related,.among.others,.to.the.concept.of.informed.consent,.protection.of.confidentiality.and. privacy,.equal.access.to.benefits.from.public.funds,.medical.personnel’s.duty.to.inform,.etc. It.is.impossible.to.understand.modern.solutions.in.the.area.of.medical.law.without. referring.to.those.key.”initial”.values..The.development.of.the.concept.of.patient’s.autonomy. and.a fundamental.change.of.the.paradigm.in.the.patient.– doctor.relation.is.strongly. inspired.by.the.values.placed.at.higher.levels.of.the.legal.system,.which.is.the.reason. for.such.frequent.and.even.indispensable.references.to.constitutional.or.conventional. standards.in.modern,.both.medical.and.bioethical,.discussions..The.law,.also.judicial.law. in.this.area,.is.no.longer.a field.in.which.purely.dogmatic.analysis.could.lead.to.correct. conclusions.and.settlements. More.and.more.often,.serious.disputes.are.resolved.in.modern.medical.law.by. searching.for.a proper.point.of.balance.between.values.of.fundamental.meaning.which. are.in.conflict.in.given.circumstances..Thus,.a most.frequently.required.analysis.is.that. going.beyond.the.purely.formal,.juridical.scope.since.it.proves.necessary.to.determine. proper.relations.in.an.axiological.order..The.indispensability.of.such.an.approach.is.evident. not.only.against.the.background.of.judicial.decisions.relating.to.questions.which,.due. to.their.nature,.are.entangled.in.the.constitutional.or.conventional.context.(as.in.cases. decided.by.constitutional.and.international.courts),.but.also.in.the.light.of.very.specific. questions.about.the.character.of.prerequisites.and.the.scope.of.civil.liability.(e.g. in.the. case.of.claims.due.to.wrongful.life.or.wrongful.birth),.about.the.scope.of.duty.to.inform. in.the.case.of.bad.prognoses.(or.life.saving.intervention),.questions.about.the.limits.of. doctor’s.actions,.or.even.about.the.availability.of.certain.types.of.medical.services.and. the.criteria.for.fair.distribution.of.health.care.costs.in.the.society,.which.always.has. insufficient.resources.in.order.to.equally.satisfy.all.the.needs.and.expectations..The. conflict.of.values.and.principles.is.inherent.in.problems.considered.by.modern.courts.in. medical.cases,.and.each.judge,.to.a certain.extent,.plays.the.role.of.Dworkin’s.Hercules, searching.for.a possible “compromise”.by.applying.rational.and.balanced.arguments..The. presentation.of.many.judicial.decisions.in.this.book.is.a sort.of.“ad hoc.snapshot”.of.ideas. and.debates.in.the.current.phase,.which.in.many.respects.is.still.far.from.finding.clear. and.uncontroversial.answers. Apart.from.tendencies,.which.I believe.may.be.recognised.as.established.trends.in. judicial.decision‑making,.there.are.also.areas.of.considerable.uncertainty.and.heated. discussion..The.first.group.comprises.among.others.trends.in.judicial.decisions.that. clearly.express.the.idea.of.protection.of.the.patient’s.autonomy.in.medical.relations,. including.his/her.right.to.choose.between.alternative.therapies,.and.to.reject.(even. irrationally).the.appropriate.of.treatment,.as.well.as.the.right.to.obtain.full.information. about.one’s.condition.regardless.of.prognoses.and.expectations.of.successful.treatment.. The.value,.as.per.freedom.of.an.individual,.more.and.more.often.prevails.in.medical. context.over.other.traditional.interpretations,.based.for.instance.on.the.absolute.necessity.. Acknowledgement.of.the.fact.that.a person.in.matters.concerning.his/her.life.and.health.is. not.always.rational.and.may.not.be.guided.by.objectively.appropriate.choices,.moreover,. 15 Introduction he/she.may.even.make.decisions.which.are.clearly.against.his/her.interest,.seems.to.be. a truly.revolutionary.change.in.interpretation.of.medical.law..A number.of.decisions. following.this.approach.can.be.found.in.this.book,.e.g. Judgment.of.the.Supreme.Court. of.3 October.1962,.III CR 250/62,.concerning.contributory.negligence.of.the.injured, along. with.a commentary.in.Chapter IV. Established.tendencies.include.also.substantial.changes.in.the.sphere.of.civil.liability. for.damage,.which.are.expressed.among.others.by.continuously.extended.liability.of. medical.institutions.and.increasing.objectivisation.of.related.requirements..Today,. treatment.has.become.a complicated.process.involving.cooperation.at.multiple.levels,.based. on.complex.organisation.and.necessary,.broadly.understood.infrastructural.elements:.from. properly.qualified.staff.to.equipping.and.establishing.procedures..The.tendency.to.impose. more.stringent.liability.on.medical.institutions,.may.be,.in.a way,.deemed.a compensation. for.normative.changes.which.took.place.in.the.field.of.liability.of.public.authority.under. the.influence.of.new.constitutional.regulations..In.the.current.normative.situation,.the. State.Treasury.generally.does.not.bear.liability.for.damage.inflicted.in.relation.to.treatment. provided.by.public.health.care.institutions,.excluding.the.cases.where.such.damage. is.a result.of.unlawful.acts.of.public.authorities.(e.g. in.the.event.of.malfunctioning. of.relevant.organisational.structures.due.to.faulty.acts.of.public.authorities)..In.this. case,.an.appropriately.broad.concept.of.the.institutional.fault.referring.to.operations.of. certain.medical.institutions,.as.well.as.more.and.more.comprehensive.understanding.of. superiors‑subordinates.relations.with.respect.to.medical.services.performed.in.teams.(as. well.as.acts.classified.as.diagnosis.and.therapy).make.it.possible.to.look.for.grounds.for. liability.of.a medical.institution.in.Article 430.of.the.Civil.Code,.that.is.to.base.the.liability. on.the.principle.of.strict.liability. One.of.the.most.difficult.issues.being.a current.topic.for.discussion.in.the.field. of.liability.is.the.problem.of.the.required.medical.standard.in.times.of.more.and.more. variable.medical.offer,.both.with.regard.to.its.availability.and.accessibility,.and,.most.of. all,.with.reference.to.cost..Judicial.decisions.are.also.undergoing.a specific.evolution.in. this.respect.(which.is.well.illustrated.by.this.book),.expressed,.on.the.one.hand,.by.the. decision.of.the.Supreme.Court.issued.in.the.early.eighties.(Judgment.of.28 October.1983,. II.CR.358/83,.along.with.commentary.in.Chapter.IV).on.the.necessity.to.apply.the.highest. medical.standards,.and.on.the.other.hand,.by.the.decision.issued.ten.years.later.(Judgment. of.1 December.1998,.III.CKN.741/98,.along.with.a commentary.in.Chapter.IV),.where.the. court.presents.a more.moderate.approach,.excluding.the.possibility.of.ensuring.access.to. the.most.expensive.medical.technologies.to.every.person.and.the.need.to.account.for.an. actual.economic.situation.of.the.country.where.the.health.care.system.operates..However,. it.is.difficult.to.recognise.judicial.decisions.in.this.matter.as.established. Interesting.and.significant.changes.are.also.taking.place.with.respect.to.damage. compensation,.in.particular.immaterial.damage..This.tendency.is.related.to.the.increasing. role.of.patient’s.autonomy.and.higher.respect.for.his/her.rights.as.regards.privacy.and. right.to.avail.of.information..Decisions,.which,.regardless.of.the.appropriateness.and. rationality.of.doctor’s.actions,.acknowledge.the.violation.of.patient’s.autonomy,.with. respect.to.whom.the.duty.to.inform.has.been.breached.and.who.has.not.given.a proper. 16 Marek Safjan consent.to.medical.intervention,.may.be.deemed.characteristic.for.this.trend..In.such. circumstances,.compensation.for.immaterial.harm.and.infringement.of.the.patient’s. rights.has.become.a real.protection.measure.of.immaterial.interest,.the.extent.of.which.is. far.greater.than.it.used.to.be.over.ten.years.ago,.when.in.medical.context.compensation. was.exclusively.awarded.in.connection.with.the.violation.of.bodily.integrity,.bodily. injury.and.bodily.disorder.caused.by.medical.malpractice..This.tendency,.which.is.clearly. emerging.from.today’s.judicial.decisions,.is.affected.not.only.by.normative.changes,.but. also,.as.stressed.hereinabove,.by.a different.perspective.from.which.a patient–medical. personnel.relation.is.assessed.with.the.aim.of.effective.protection.of.immaterial.interests.. At.this.point.it.is.worth.mentioning.that.modern.jurisdiction.seems.to.acknowledge.the. necessity.of.a more.flexible.approach.to.the.issue.of.concurrence.of.ex delicto and ex contractu. liability.for.medical.damage.in.order.to.avoid.negative.consequences.of.the.– more.and. more.outdated.in.the.context.of.modern.private.law.– solution.in.our.system.associating. compensation.solely.with.the.grounds.for.liability.in.tort.(see judgment.of.the.Supreme. Court.of.17 December 2004,.II.CK.300/04,.along.with.a commentary.in.Chapter.IV). The.tendency,.which.is.more.and.more.noticeable.in.modern.legal.systems,.concerns. case.law.entering.the.areas.which.until.recently.have.not.been.considered.the.subject. of.juridical.analyses.and.court.decisions..This.phenomenon,.as.indicated.hereinabove,. referred.to.as.the.juridisation.of.medicine,.is.most.popular.in.the.Anglo‑Saxon.world,. especially.in.the.United.States..Particularly.characteristic.debates.in.this.respect.are.those. concerning.issues.related.to.terminal.care.for.incurably.ill.persons,.including.also.persons. in.a vegetative.condition,.whose.life.is.sustained.by.means.of.artificial.feeding.apparatus. or.blood.circulation.and.breathing.devices..Decisions.in.this.matter.have.become.the. subject.of.heated.legal.disputes,.in.the.course.of.which.threads.of.constitutional.nature. have.also.appeared. The.authors.decided.to.present.only.several.foreign.rulings.that.touch. upon.this.problem,.since.by.this.day.Polish.jurisdiction.has.not.included.any.decisions. issued.by.appropriate.court.instances.(these.are,.among.others,.the.case.of.Pretty.before. the.ECHR.with.a commentary.in.Chapter.II.and.American.decisions.in.the.case.Karen Quinlan.and.Harold Glucksberg,.with.a commentary.in.Chapter.VI)..In.the.context.of.these. circumstances,.fundamental.questions.for.modern.medical.law.seem.inescapable,.namely,. to.what.extent.the.law.should.(may?).enter.the.sphere.of.medical.decisions.and.assessments. and.“substitute”.doctors.themselves.in.making.complicated.ethical.and.medical.decisions?. For.instance,.is.it.justified.and.appropriate.for.the.law.to.make.an.attempt.to.establish.the. limits.of.doctor’s.obligations.in.terminal.cases,.specify.a set.of.measures.belonging.to.the. so‑called.extraordinary.and.persistent.therapy,.and.define.the.time.when.not.only.therapy. but.also.artificial.feeding.may.be.terminated?.Should.the.law.definitively.resolve.on.the. relevance.of.the.so‑called.pro futuro.declarations.(in.the.Anglo‑Saxon.terminology.referred. to.as.“living.will”)?.A wide‑ranging.public.discussion.about.the.aforementioned.issues.has. commenced.recently.in.Poland.and.one.may.believe.that.the.published.foreign.judicial. decisions.provide.an.adequate.illustration.of.the.problems..Different.arguments.weigh.in. favour.of.each.of.possible.approaches..On.the.one.hand,.certainty.and.detailed.nature.of. the.law.may.exclude.arbitrariness.of.courts.and.assessments.articulated.in.specific.cases. and.more.effectively.protect.of.rights.and.interests.of.such.persons..On.the.other.hand,. 17 Introduction excessively.casuistic.normative.regulations.may.lead.to.a dangerous.tendency.to.evaluate. human.life,.to.an.attempt.at.applying.objective.measures.and.criteria,.where.it.seems. especially.risky.considering.protection.of.dignity.of.each.individual..Undoubtedly,.we. reach.the.limits.of.legal.regulations.here.and.caution.should.be.exercised.not.to.overstep. those.bounds. The.criterion.of.quality.of.life.as.the.basis.for.ethical,.legal.and.medical.assessment. is.becoming.more.and.more.visible.in.the.disputes.within.the.area.of.modern.medicine. and.the.law. IV. Intentions and expectations One.may.hope.that.the.present.study,.which.is.the.first.publication.of.this.kind.that. falls.within.the.ambit.of.medical.law.in.Poland,.will.meet.the.expectations.of.both.lawyers. dealing.with.this.discipline.and.representatives.of.the.medical.profession..Each.discussion. on.the.topics.raised.in.this.book.must.account.for.the.existing.state.of.knowledge,.views. and.modern.tendencies,.and.the.judicial.decisions.are,.from.this.perspective,.a particularly. exhaustive.field.for.analyses..As.it.appears.from.this.study,.a number.of.questions,.very. often.of.fundamental.meaning,.still.remains.unanswered.and.encourages.discussion..The. discussion.in.Poland.is.currently.very.intense.and.the.belief.that.it.encounters.obstacles. related.to.the.difficulty.in.identifying.the.most.serious.problems.and.disputable.issues. seems.reasonable..One.of.the.most.significant.purposes.of.this.study.is.to.attempt.to.draw. up.a catalogue.of.such.fundamental.problems.arising.from.judicial.decisions. Chapter I ConstitutionAl stAndArds Bibliography:.J. Boć.(ed.),.Konstytucje Rzeczypospolitej oraz komentarz do Konstytucji RP z 1997 roku,.Wrocław.1998;.L. Bosek,.Bezprawie legislacyjne, Warszawa.2007;.L..Bosek,. Gwarancja godności ludzkiej w polskim prawie cywilnym,.Warszawa.2012;.L. Bosek,.Ochrona godności człowieka w prawie Unii Europejskiej a konstytucyjne granice przekazywania kompetencji państwa, Prz. Sejm. 2008,.No. 2,.pp. 61–92;.L..Bosek,.M..Wild,.Kontrola konstytucyjności prawa. Zagadnienia ustrojowe, procesowe i materialnoprawne,.Warszawa.2011;.K. Burger,.Das Verfassungsprinzip der Menschenwürde in Österreich, Frankfurt.am.Main–Berlin–Bern– Bruxelles–New.York–Oxford–Wien.2002;.K. Complak.(ed.), Godność człowieka jako kategoria prawa,.Wrocław.2001;.J. Duffar,.J. Robert,.Droits de l’homme et libertés fondamentales,.Paris. 1999;.E. J..Eberle,.Dignity and Liberty. Constitutional Visions in Germany and the United States,. Westport‑London.2002;.Ch..Enders,.Die Menschenwürde in der Verfassungsordnung: zur Dogmatik des Art. 1 GG, Tübingen.1997;.L. Garlicki.(ed.),.Konstytucja Rzeczpospolitej Polskiej. Komentarz, Warszawa.2003;.T. Geddert‑Steinacher,.Menchenwürde als Verfassungsbegriff. Aspekte der Rechtsprechung des Bundesverfassungsgerichts zu Art. 1 Abs. 1 Grundgesetz,.Berlin. 1990;.M. Królikowski,.M. Bajor‑Stachańczyk,.W. Odrowąż‑Sypniewski.(ed.),.Konstytucyjna formuła ochrony życia, Warszawa.2007;.T. Mazurczak.(ed.),.Zastosowanie biologii w medycynie a godność osoby ludzkiej. Aspekty etyczne i prawne. Materiały Konferencji poświęconej Konwencji o Ochronie Praw Człowieka i Godności Istoty Ludzkiej wobec Zastosowań Biologii i Medycyny Rady Europy, Warszawa.2006;.Ch..McCrudden,.Human Dignity and Judicial Interpretation of Human Rights,.The.European.Journal.of.International.Law.2008,.No. 4,.pp. 655–724,.http://ejil. oxfordjournals.org/cgi/content/full/19/4/655;.C. H..Nipperdey,.Grundrechte und Privatrecht, Bilefeld.1961;.E. Picker,.Godność człowieka a życie ludzkie,.Warszawa.2007;.D. Rousseau,.Les libertés individuelles et la dignité de la personne humaine,.Paris.1998;.F. Rymarz,.Zasada ochrony przyrodzonej i niezbywalnej godności człowieka w orzecznictwie Trybunału Konstytucyjnego,. PS 2003,.No. 6,.pp. 3–22;.M. Safjan,.Efekt horyzontalny praw podstawowych w prawie prywatnym: autonomia woli a zasada równego traktowania,.KPP 2009,.No. 2,.pp. 297–356;.M. Safjan,.Prawo i medycyna – ochrona praw jednostki a dylematy współczesnej medycyny,.Warszawa.1998;. P. Sarnecki.(ed.),.Prawo konstytucyjne RP, Warszawa.2008;.P. Tuleja,.Stosowanie konstytucji w świetle zasady jej nadrzędności (wybrane problemy), Kraków.2003;.P. Winczorek,.Komentarz do Konstytucji Rzeczypospolitej Polskiej z 2 kwietnia 1997 roku,.Warszawa.2008; K. Wojtyczek,. Granice ustawodawczej ingerencji w sferę praw człowieka w Konstytucji RP, Kraków.1999. 19 1. Right to conscientious objection  Leszek Bosek 1. right to ConsCientious objeCtion freedom of conscience – human dignity – medical ethics – horizontal effect of human rights and fundamental freedoms – abortion – unborn child – euthanasia ruling of the Constitutional tribunal of 15 january 1991, u 8/90 Conclusion1 “The freedom of conscience does not only mean the right to have a specific view or belief, but, first and foremost, to follow one’s own conscience and to be free from coercion to act against one’s conscience. This understanding of freedom of conscience is supported by the International Covenant on Civil and Political Rights adopted by the UN General Assembly on 16 December 1966 and ratified by Poland on 3 March 1977 (Dz. U. [Journal of Laws] No. 38, items 167 and 168)”. Facts of the case The.Human.Rights.Defender.moved.for.declaring.that.section 14.of.the.Regulation. of.the.Minister.of.Health.and.Social.Care.dated.30 April.1990.concerning.professional. qualifications.that.are.required.of.doctors.performing.abortions.and.the.manner.of.issuing. medical.reports.on.admissibility.of.performing.such.procedures.(Dz. U..[Journal of Laws]. No. 29,.item.178).contravenes.Article 2 sections 1.and.2.of.the.Act.dated.27 April.1956. on.Admissibility.of.Pregnancy.Termination.(Dz. U..[Journal of Laws],.No. 12,.item.61.as. amended.by.Dz. U..[Journal of Laws].of.1969,.No. 13,.item.95)..The.Human.Rights.Defender. explained.that.the.Regulation.exceeds.statutory.authorisation.for.it.allows.the.doctor.to. evade.the.duty.to.issue.appropriate.medical.reports. reasons for the ruling of the Constitutional tribunal Article 2.section 2.of.the.Act.of.27 April.1956.on.the.Conditions.of.Admissibility.of. Abortion.authorised.the.Minister.of.Health.and.Social.Care.to.determine.by.regulation. professional. qualifications. required. of. doctors. performing. pregnancy. termination. procedures.and.the.manner.of.issuing.medical.reports.on.the.admissibility.of.such. procedures..Section.14.of.the.Regulation.of.the.Minister.of.Health.and.Social.Care.of. 30 April.1990.concerns.neither.professional.qualifications.nor.the.manner.of.issuing. medical.reports..Consequently,.its.content.is.not.supported.by.statutory.delegation..The. Constitutional.Tribunal.in.its.decisions.on.many.occasions.pointed.out.the.necessity.for. keeping.legal.regulations.contained.in.lower‑ranking.acts.within.statutory.authorisation.. This.position.is.still.believed.to.be.right.and.applicable. The.presented.assumptions.do.not.allow,.however,.the.assertion.that.in.the.analysed. case.the.statutory.authorisation.has.been.exceeded..First.of.all,.it.has.to.be.made.clear.that.in. 1. Author’s.conclusion. Leszek.Bosek 21 Chapter I. Constitutional standards our.legal.system.there.is.no.provision.imposing.a duty.to.make.a report.on.the.admissibility. of.termination.of.pregnancy,.to.which.exceptions.could.be.provided.to.excuse.“evading”. such.duty..No.such.duty.is.imposed.particularly.by.the.Act.on.Admissibility.of.Pregnancy. Termination.[…]..The.duty.to.issue.a medical.report,.as.the.Human.Right.Defender. suggests,.does.not.follow.from.the.fact.that.the.Act.in.Article 2,.section 1.does.not.stipulate. the.possibility.that.a doctor.may.evade.preparation.of.the.report.on.the.admissibility. of.the.procedure..The.Act.specifies.the.conditions.of.admissibility.of.termination.of. pregnancy,.which.means.that.by.its.very.premises.it.concerns.situations.which.should. involve.extraordinary.legalisation.of.a conduct.that.is,.in.principle,.unlawful..Therefore,. penal.law.experts.and.commentators.treat.the.provisions.as.defining.a countertype,.that.is. a circumstance.excluding.the.unlawfulness.of.the.act..The.duty.to.follow.the.countertype. may.be.exceptional.and.usually.concerns.specific.services.who.act.to.restore.public.order. or.execute.the.authorities’.decision.[…]. The.law.as.it.applies.provides.for.provisions.allowing.a doctor.to.“evade”.issuing. a report.on.admissibility.of.pregnancy.termination.or.performing.the.procedure..The. right.of.a doctor.to.“evade”.should.be.derived.from.Article 82.section 1.of.the.Constitution. guaranteeing.freedom.of.conscience..The freedom of conscience does not only mean the right to have a specific view or belief, but, first and foremost, to follow one’s own conscience and to be free from coercion to act against one’s conscience. This understanding of freedom of conscience is supported by the International Covenant on Civil and Political Rights adopted by the UN General Assembly on 16 December 1966 and ratified by Poland on 3 March 1977 (Dz. U. [Journal of Laws] No. 38, item 167 and 168). Article 18.section 2.of.the.Covenant.reads:.“No.one.shall.be.subject.to.coercion. which.would.impair.his/her.freedom.to.have.or.to.adopt.a religion.or.belief.of.his/her. choice”..The.doctor’s.right.to.evade.issuing.the.report.on.admissibility.of.pregnancy. termination.or.performance.of.the.procedure.follows.directly.from.Principle.7.of.the. Ethical.and.deontological.principles of.a Polish.medical.doctor.reading.that:.“A doctor. shall.refuse.to.perform.such.acts.that.in.his/her.belief.and.according.to.his/her.conscience. may.be.harmful.or.unethical”..The.Ethical.and.deontological.principles,.by.virtue.of. Article 4,.section 1,.para. 2,.Article 41.and,.in.particular,.Article 63,.section 2.of.the.Act. of.17 May.1989.on.Medical.Chambers.(Dz. U..[Journal of Laws],.No. 30,.item.158),.have. been.incorporated.into.the.system.of.law,.thus.becoming.rules.of.conduct.binding.on. doctors..[…].In.light.of.the.foregoing,.section 14.of.the.said.Regulation.does.neither. introduce.a new.provision.into.the.current.system.of.law.nor.a provision.regulating. a matter.that.has.not.been.regulated.yet.or.regulating.the.same.matter.in.a different. manner..Therefore,.what.we.face.here.is.a clear.superfluum on.the.part.of.the.lawmaker,. which.while.being.a defect.in.the.legislative.technique,.cannot.be.judged.as.a violation. of.the.statutory.delegation..Not.regulating.anything,.section 14.cannot.contravene.the. delegation.constituting.an.authorisation.to.regulate.a segment.of.social.life..A repetition. of.a provision.of.a statutory.rank.in.a lower‑ranking.act.cannot.be.deemed.a development. of.a new.provision,.which.would.constitute.the.issue.of.exceeding.the.delegation.. Such.a repetition.may.be.treated.only.as.information.on.already.existing.provisions.. of.law.[…]. 22 1. Right to conscientious objection  Leszek Bosek Commentary 1..The.decision.concerns.several.issues,.however,.the.most.significant.is.the.legal. interpretation.of.the.so‑called.conscience.objection.clause..The.Constitutional.Tribunal. stated.that.the.conscience.objection.is.an.important.aspect.of.the.directly.applicable. fundamental.right.to.freedom.of.conscience.enshrined.in.the.Polish.Constitution.and.in. art..18.of.the.International.Covenant.on.Civil.and.Political.Rights..Although.the.decision. of.the.Tribunal.was.delivered.under.the.Constitution.of.1952.(“communist.constitution”),. the.decision.is.still.relevant.today,.under.the.Constitution.of.the.Republic.of.Poland.of. 1997..The.Constitution.of.1997.expressly.protects.the.freedom.of.conscience.to.a far.greater. extent.than.the.former.one.(Preamble,.Article.25.section.2,.Article.48.section.1,.Article.53. sections.1.and.3–7,.Article.85.section.3.and.Article.233.section.1). 2..The.decision.refers.to.global.standards.of.the.United.Nations..A General.Comment. No..22.on.Article 18.of.the.the.International.Covenant.on.Civil.and.Political.Rights.provides,. inter alia,.the.following.interpretation.of.that.provision:.“The.Covenant.does.not.explicitly. refer.to.a right.to.conscientious.objection,.but.the.Committee.believes.that.such.a right.can. be.derived.from.article.18,.inasmuch.as.the.obligation.to.use.lethal.force.may.seriously. conflict.with.the.freedom.of.conscience.and.the.right.to.manifest.one’s.religion.or.belief.[…]”.. This.position.is.enforced.by.the.United.Nations.Human.Rights.Committee.(UNHRC)..On. 3 November.2006.in.the.cases.of.Yeo-Bum Yoon v. Republic of Korea.and.Myung-Jin Choi v. Republic of Korea.the.UNHRC.held.that.conviction.and.sentence.of.two.Jehovah’s.Witnesses.for.refusal. of.military.service.amounts.to.a restriction.on.their.ability.to.manifest.their.religion.or.belief.. The.UNHRC.went.on.to.conclude.that.the.interference.with.the.applicants’.rights.guaranteed. by.Article.18.was.not.necessary.and.that.there.had.been.a violation.of.that.provision.2 3..The.decision.of.the.Constitutional.Tribunal.conforms.to.the.Convention.for. the.Protection.of.Human.Rights.and.Fundamental.Freedoms.from.1950,.which.also. enshrines.an.individual.right.to.conscience.objection.as.an.aspect.of.the.right.to.freedom.of. conscience.(art..9.of.the.Convention)..On.7.July.2011.the.Grand.Chamber.of.the.European. Court.of.Human.Rights.held.in.the.case.Bayatyan v. Armenia that.art..9.of.the.Convention. is.directly.applicable.at.least.in.cases,.where.there.is.no.doubt.that.there.is.“a serious.and. insurmountable.conflict.between.the.obligation.to.serve”.and.“a person’s.conscience.or. his.deeply.and.genuinely.held.religious.or.other.beliefs.of.sufficient.cogency,.seriousness,. cohesion.and.importance”..The.Court.found.that.even.article.4.§.3.(b).of.the.Convention. expressly.leaving.the.choice.of.recognising.conscientious.objectors.in.military.context.to. each.Contracting.Party,.cannot.wave.the.guaranty.of.art..9.of.the.Convention.3.The.Court. stressed.that.the.member.States.of.the.Council.of.Europe.must.reconcile.the.possible. conflict.between.individual.conscience.and.legal.obligations..“Accordingly,.a State.which. has.not.done.so.enjoys.only.a limited.margin.of.appreciation.and.must.advance.convincing. and.compelling.reasons.to.justify.any.interference..In.particular,.it.must.demonstrate.that. the.interference.corresponds.to.a ‘pressing.social.need’”.4 2. Communications.Nos..1321/2004.and 1322/2004,.U.N..Doc..CCPR/C/88/D/1321‑1322/2004,.23.January.2007. Judgment.of.the.Grand.Chamber.of.the.ECHR,.7th.July.2011,.Bayatyan v. Armenia,.appl..no..23459/03,.para..109. 3. 4. Judgment. of. the. Grand. Chamber. of. the. ECHR,. 7th. July. 2011,. Bayatyan v. Armenia,. appl..no.. 23459/03,. para. 100,.123. 23 Chapter I. Constitutional standards 4..The.conscience.clause.is.regulated.by.Article 39.MDDPA..Pursuant.to.the.provision,. the.doctor.may.refrain.from.providing.a medical.service.against.his.or.her.conscience. subject.to.Article 30.of.the.Act,5.provided.that.the.doctor.indicates.possible.ways.of.receiving. such.service.from.another.doctor.or.in.another.health.care.facility.and.provide.grounds. for.and.take.down.this.fact.in.medical.records..A doctor.who.performs.the.profession. under.an.employment.contract.or.when.on.service,.shall.moreover.provide.a prior.written. notification.to.his.or.her.superior..The.provision.applies.if.under.contractual.or.statutory. duties.a doctor.is.obliged.to.perform.a specific.service.with.respect.to.a specific.patient.. The.non‑contractual.source.of.the.duty.may.be,.for.instance,.the.patient’s.right.“to.receive. immediate.health.care.services.by.reason.of.a threat.to.life.or.health”.(Article 7.section 1. of.the.Act.on.Patients’.Rights.and.the.Patient’s.Ombudsman,.which.does.not.clarify.the. claims.of.the.addressee).or.Article 30.MDDPA.which.is.directly.referred.to.by.Article 39. MDDPA. 5..The.provision.resolves.the.conflict.of.the.patient’s.interest.in.receiving.a health. care.service.(positive.conduct).and.the.doctor’s.interest.in.refraining.from.some.acts,.which. regardless.of.the.patient.he.or.she.deems.inacceptable.(negative.freedom)..The.assumed. solution.is.criticised.for.lack.of.precision.and.disproportionate.restriction.of.professional. and.personal.freedom.of.a doctor.(especially.in.part.establishing.the.obligation.to.“indicate. possible.ways.of.obtaining.such.service.from.another.doctor”.which.presupposes.that. a doctor.shall.have.the.positive.knowledge.about.axiological.preferences.of.other.doctors;. the.Act.does.not.specify.the.manner.of.obtaining.such.knowledge.6 6..A.more.precise.regulation.is.stipulated.in.the.Act.of.5 July.1996.on.Nurse.and. Midwife.Professions..Article 23.of.the.Act.reads.that.a nurse.and.midwife.may.refrain, upon. prior.written.notification.of.the.superior,.from.performing.a health.care.service.against. his.or.her.conscience,.subject.to.Article19.(a nurse,.midwife.shall.provide.aid.in.each.case. of.a threat.of.losing.life.or.suffering.a severe.detriment.to.health.in.accordance.with.their. professional.qualifications). 7..Other.medical.legislation.does.not.include.provisions.implementing.the.freedom. of.conscience.guarantees.indicated.by.the.Constitutional.Tribunal..This.may.give.rise. to.a question.whether,.in.the.face.of.the.lawmaker’s.idleness,.vertical.or.horizontal. effectiveness.of.the.guarantees.in.medical.relations.is.permissible..The.Constitutional. Tribunal.provides.an.affirmative.answer.to.the.question.mentioning.a superfluum on.the. part.of.the.lawmaker.in.the.analysed.regulation..A similar.view.was.provided.by.the. Hungarian.Constitutional.Tribunal.which.concluded.that.the.lack.of.conscience.clause. with.respect.to.doctors.in.statutory.provisions.did.not.mean.that.a legislation.omission. occurred, for.a doctor.may.always.invoke.the.directly.effective.constitutional.guarantee. and.effectively.evade.the.duty.to.participate.in.a pregnancy.termination.procedure. (judgment.of.the.Hungarian CT.of.17 December.1991,.ref..54/19917). 5. Article.30.reads.that.a.doctor.shall.provide.medical.aid.in.each.case,.where.the.culpable.delay.in.the. provision.thereof.could.result.in.loss.of.life,.severe.bodily.injury.or.health.disorder.and.in.other.urgent.cases. 6. See,.for.instance,.R..Kubiak,.Prawo medyczne, Łódź.2010,.p. 225. 7. Hungarian Report and General Report,.[in:].Constitutional Jurisprudence in the Area of Freedom of Religion and Belifes. 11th Conference of the European Constitutional Courts,.Warsaw.2000..See.also.G..Kiss,.Die Wirkung der Grundrechte 24 1. Right to conscientious objection  Leszek Bosek 8..The.Constitution.of.1997.classifies.the.freedom.of.conscience.as.a personal.right. under.special.protection.and.excludes.the.restriction.of.the.protection.thereof.also.in.times. of.martial.law.and.states.of.emergency.(Article 233.section 1)..Therefore,.the.commentators. of.the.Constitution.are.induced.to.claim.that.the.human.dignity,.which.is.a source.of. personal.rights.and.freedoms,.stays.in.close.relation.to.the.freedom.of.conscience.8.As. opposed.to.dignity,.the.freedom.of.conscience.is.not,.however,.under.absolute.protection. to.the.extent.to.which.it.is.interpersonal..Article 85.section 3.of.the.Constitution.is.an. indication.of.possible.restrictions.of.the.freedom.of.conscience.allowed.under.the.statute.. Pursuant.thereto,.even.the.duty.to.defend.the.Republic.of.Poland.does.not.justify.the. restriction.of.freedom.of.conscience. 9..A.similar.significance.of.the.freedom.of.conscience.is.ascribed.by.the.Council.of. Europe.in.the.Resolution.of.the.Parliamentary.Assembly.of.7 October.2010,.No. 1763.(2010). on.the.right.to.conscientious.objection.in.lawful.medical.care..Paragraph.1.of.the.Resolution. reads.that.no.person,.hospital.or.institution.(legal.person).shall.be.coerced,.held.liable. or.discriminated.against.in.any.manner.because.of.a refusal.to.perform,.accommodate,. assist.or.submit.to.an.abortion,.the.performance.of.a human.miscarriage.or.euthanasia. or.any.act.which.could.cause.the.death.of.a human.foetus.or.embryo,.for.any.reason. (http://assembly.coe.int/Mainf.asp?link=/Documents/AdoptedText/ta10/ERES1763.htm). 10..The.Council.of.Europe.took.a stance.in.quite.a complex.and.embroiled.in. disagreements.issue.of.the.conscience.clause.with.respect.to.legal.persons.and.institutions.. On.the.one.hand,.the.opinion.that.legal.persons.are.not.entitled.to.a personal.right,. i.e. conscience,.seems.reasonable..Conscience.may.not.be.fully.compared.with,.for. instance,.such.other.personal.rights.as.good.name.or.reputation.attributed.to.legal.persons. (see Article 43 CC)..On.the.other.hand,.the.opinion.that.axiological.valuations.are.of. absolutely.no.meaning.to.legal.persons.is.not.convincing..Some.organisational.entities. for.their.legal.nature,.e.g. religious.associations,.or.for.the.purpose.of.the.establishment. or.core.objects.of.operations,.e.g. running.a hospice,.school.or.hospital,.may.be.based.on. certain.significant.choices.of.ethical.nature.of.their.members.or.founders..The.Polish. Constitutional.Tribunal.has.recognised.(act.call.W 11/91).that.the.provisions.regarding. the.protection.of.rights.and.freedoms.of.citizens.pertain.not.only.to.natural.persons.but. also.to.legal.persons.that.combine.their.actions..The.Tribunal.has.referred.to.the.example. of.co‑operatives,.companies.and.associations.(thus.legal.persons.of.corporate.type).as.well. as.churches.and.religious.organisations.if.they.operate.as.institutions.associating.citizens. and.implementing.their.rights.and.freedoms.(to.celebrate.religious.cult,.upbringing. in ungarischen Arbietsrecht: Versuche zur Widerherstellung eines umgestürzten Gleichgewichts [in:].Festschrift für Rolf Birk zum siebzigsten Geburtstag,.H..Konzen,.S..Krebber,.Th..Raab,.B. Veit,.B..Waas.(eds.),.Tübingen.2008,.p. 364 8. B.. Lewaszkiewicz‑Petrykowska,. General Report,. [in:]. Constitutional jurisprudence in the area of freedom of religion and beliefs, 11th Conference of the European Constitutional Courts,.Warszawa.2000,.p..20;.M..Safjan,.Wolność religijna w konstytucjach państw europejskich,.[in:].Materiały III Międzynarodowej Konferencji na temat “Religia i wolność religijna w Unii Europejskiej”, Warszawa, 2–4 września 2002,.J..Krukowski,.O..Theisen.(ed.),.Lublin.2003,.p..73;.M. Granat,. Granice wolności religijnej w społeczeństwie pluralistycznym,.[in:].Materiały III Międzynarodowej Konferencji na temat “Religia i wolność religijna w Unii Europejskiej”, Warszawa, 2–4 września 2002,.J..Krukowski,.O..Theisen.(ed.),.Lublin.2003,.p..176.. Similar.view:.P..Sarnecki,.Komentarz do art. 53 [in:].Konstytucja Rzeczypospolitej Polskiej,.L..Garlicki.(ed.),.Warszawa. 2003,.p. 3. 25 Chapter I. Constitutional standards and.charity).9.Would.forcing.such.persons.to.act.against.their.identity.and.in.a manner. discrediting.the.sense.of.their.establishment.be.necessary.or.sensu stricto proportionate?. At.this.point,.there.is.no.need.to.determine.whether.the.protection.would.be.required. under.the.effective.per analogiam.guarantee.of.the.freedom.of.conscience.or.directly. effective.general.freedom.of.association.or.business.activity.or.whether.it.would.be.not. justified..A pragmatic.resolution.for.the.purpose.of.medical.law.is.proposed.by.Article 18b. of.the.Act.on.Health.Care.Facilities,.pursuant.to.which.a health.care.facility.may.make. the.information.about.the.scope.or.type.of.provided.health.care.services.public,.as.well.as. by.corresponding.Article 12.of.the.Act.on.Patients’.Rights.and.the.Patients’.Ombudsman,. pursuant.to.which.the.patient.has.a right.to.information.about.the scope and type.of.health. care.services.provided.by.an.entity.rendering.health.care.services,.including.preventive. schemes.financed.from.public.funds.implemented.by.such.entity..These.provisions.do. not.indicate.that.the.Polish.legal.system.provides.for.an.absolute.duty.to.render.all.health. care.services.by.every.health.care.facility. Additional information sources OTK.1991,.No. 1,.item.8. http://www.trybunal.gov.pl/OTK/doc/doc.htm some references to the judgment in literature W..Johann,.B..Lewaszkiewicz‑Petrykowska,.Constitutional Jurisprudence in the Area of Freeom of Religion and Beliefs – the Status of the Individual. General Report.[in:].Constitutional Jurisprudence in the Area of Freedom of Religion and Belifes. 11th Conference of the European Constitutional Courts,.Warsaw.2000,.p..52. E..Zielińska.(ed.), Ustawa o zawodach lekarza i lekarza dentysty. Komentarz,.Warszawa.2008,. p. 558. recommended literature A..Bagińska,.Obowiązek udzielenia pomocy lekarskiej oraz prawnie dopuszczalne możliwości od jego odstąpienia.[in:].J..Haberko.(ed.),.Lege artis. Problemy prawa medycznego,.Poznań. 2008,.p. 27.et.seq. Constitutional Jurisprudence in the Area of Freedom of Religion and Belifes. 11th Conference of the European Constitutional Courts,.Warsaw.2000. D..Friedmann,.D..Barak‑Erez.(eds.),.Human Rights in Private Law,.Oxford–Portland,. Oregon.2001. Fundamental Rights and Private Law in the European Union,.vol. I.and.II,.G..Brüggemeier,. A. Colombi.Ciacchi,.G..Comandé.(eds.),.Cambridge.2010. 9. W..Johann,.B..Lewaszkiewicz‑Petrykowska,.Constitutional Jurisprudence in the Area of Freeom of Religion and Beliefs – the Status of the Individual. General Report.[in:].Constitutional Jurisprudence in the Area of Freedom of Religion and Belifes. 11th Conference of the European Constitutional Courts, Warsaw.2000,.p..49. 26 1. Right to conscientious objection  Leszek Bosek M.. Granat,. Granice wolności religijnej w społeczeństwie pluralistycznym,. [in:]. Materiały III Międzynarodowej Konferencji na temat religia i wolność religijna w Unii Europejskiej, Warszawa, 2–4 września 2002,.J..Krukowski,.O..Theisen.(ed.),.Lublin.2003,.p..176. J..Haberko,.Sumienie medycyny i litera prawa w obronie życia i zdrowia ludzkiego.[in:].J..Haberko. (ed.),.Lege artis. Problemy prawa medycznego,.Poznań.2008,.p. 27.et.seq. W..Janyga,.Przestępstwo obrazy uczuć religijnych w polskim prawie karnym w świetle współczesnego pojmowania wolności sumienia i wyznania,.Warszawa.2010. Z..Kędzia,.Horyzontalne działanie praw obywatelskich,.[in:] Państwo – Prawo – Obywatel. Zbiór studiów ku czci prof. A. Łopatki,.J..Łętowski,.W..Sokolewicz.(eds.),.Warszawa.1989,.pp. 519–525. L..Kubicki,.Sumienie lekarza jako kategoria prawna,.PiM 1999,.No. 4,.pp. 3–15. B..Lewaszkiewicz‑Petrykowska,.General Report,.[in:].Constitutional jurisprudence in the area of freedom of religion and beliefs, 11th Conference of the European Constitutional Courts,. Warszawa.2000.. M..Piechowiak,.Pojęcie praw człowieka.[in:] Podstawowe prawa jednostki i ich sądowa ochrona,. L..Wiśniewski.(ed.),.Warszawa.1997,.p. 29.et.seq. M..Safjan,.Efekt horyzontalny praw podstawowych w prawie prywatnym: autonomia woli a zasada równego traktowania,.KPP 2009,.No. 2,.pp. 297–356. M..Safjan,.Refleksje wokół konstytucyjnych uwarunkowań rozwoju ochrony dóbr osobistych,. KPP 2002,.No. 1,.pp. 224.et.seq. M.. Safjan,. Wolność religijna w konstytucjach państw europejskich,. [in:]. Materiały III Międzynarodowej Konferencji na temat religia i wolność religijna w Unii Europejskiej, Warszawa, 2–4 września 2002,.J..Krukowski,.O..Theisen.(ed.),.Lublin.2003.. J..Sinclair.[in:] Boberg’s Law of Persons and The Family,.B..v. Heerden,.A..Cockrell,.R..Keightley. (eds.),.Cape.Town–Johannesburg.1999,.p. 11.et.seq. K..Szczucki,.Klauzula sumienia – uwagi de lege lata i de lege ferenda,.Studia.Iuridica.2009,. K..Wojtyczek,.Horyzontalny wymiar praw człowieka zagwarantowanych w Konstytucji,.KPP 1999,. vol. LX,.pp. 167–175. No. 2,.pp. 226.et.seq. E..Zielińska,.Klauzula sumienia,.PiM 2003,.No. 13,.p. 22.et.seq. A. Zieliński,.Ochrona praw podmiotowych.[in:] System Prawa Prywatnego, vol. II, Prawo cywilne – cześć ogólna,.Z..Radwański.(ed.),.Warszawa.2002,.p. 656.et.seq. A..Zoll,.Prawo lekarza do odmowy udzielenia świadczeń zdrowotnych i jego granice,.PiM 2003,. No. 13,.p. 18.et.seq. M..Żelichowski,.Klauzula sumienia – aspekt prawny,.Medycyna.Praktyczna.– Ginekologia. i Położnictwo.2005,.No. 6,.p. 74.et.seq. Chapter I. Constitutional standards 2. MediCAl ethiCs Code of Medical ethics – rules of reference – protection of human life – supervision over due performance of the medical profession – self‑governments in professions of public trust – abortion – nasciturus – conceived child – human foetus – conflict of duties – corporate autonomy decision of the Constitutional tribunal10 of 7 october 1992, u 1/92 Conclusion “The subject of assessment by the Constitutional Tribunal shall not be an ethical norm itself but only a legal norm, which is clarified by the ethical norm”. Facts of the case The.Human.Rights.Defender.by.the.application.of.7 January.1992.moved.for.deciding. inter.alia.whether.Article 37.of.the.Code.of.Medical.Ethics,.as.a regulation.– in.the.opinion. of.the.HRD.– issued.by.a state.administrative.body,.is.compliant.with.the.Constitution. and.the.Act.of.24 April.1956.on.Admissibility.of.Pregnancy.Termination..In.the.opinion. of.the.HRD,.the.Code.of.Medical.Ethics.limits.circumstances.in.which.termination.of. pregnancy.is.admissible.since.it.vests.an.extensive.right.in.a doctor.to.be.guided.by.his. or.her.conscience,.thus.diverging.from.previously.applicable.provisions.of.the.law. reasons for the ruling of the Constitutional tribunal “[…].Norms.specified.in.the.Code.of.Medical.Ethics.which.were.questioned.by. the.Human.Rights.Defender.in.the.application.are.of.deontological.nature.and.do.not. pertain.to.the.norms.of.state.administration..Establishment of deontological norms does not fall within the competence of state authorities. Thus, the state is not authorised to order the establishment of such norms from anyone, not even from self‑government of the medical profession. The state may only order development of legal norms. Deontological norms themselves are not of legal nature..They.belong.to.a collection. of.ethical.norms.which.is.independent.of.the.law..Authorisation.included.in.the.Act. on.Medical.Chambers.which.allows.the.convention.of.doctors.to.adopt.deontological. norms.is.only.a statutory.approval.of.the.commonly.recognized.right.of.the.medical. corporation.(and.also.of.other.professional.corporations).to.specify.the.deontological.rules. in.compliance.with.the.system.of.values.recognized.by.such.bodies..The.authorisation. is.not,.however,.a statutory.delegation.of.right.understood.as.assignment.to.the.medical. self‑government.functions.falling.within.the.competence.of.the.state.administration..No. state.administrative.body.has.ever.been.or.may.be.authorised.to.specify.deontological. norms.with.respect.to.doctors. 10. Full.panel. 28 Leszek Bosek
Pobierz darmowy fragment (pdf)

Gdzie kupić całą publikację:

Medical law. Cases and commentaries
Autor:

Opinie na temat publikacji:


Inne popularne pozycje z tej kategorii:


Czytaj również:


Prowadzisz stronę lub blog? Wstaw link do fragmentu tej książki i współpracuj z Cyfroteką: