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Poskytovanie zdravotnej starostlivosti v rovine medicínskej etiky. I. časť


 | 17.4.2016 | komentárov: 284

Cieľom predkladaného článku je objasnenie problematiky medicínskej etiky a jej významu v procese poskytovania zdravotnej starostlivosti. Autori sa bližšie venujú analýze otázok právnej povahy Etického kódexu zdravotníckeho pracovníka, vynútiteľnosti dodržiavania jeho ustanovení a podávajú stručný výklad k najdôležitejších častiam Etického kódexu.

Obrazok

Stručný úvod k pojmu medicínska etika

 

Pacient je v dnešnej technicky pokrokovo vyvinutej medicíne často vnímaný zo strany zdravotníckeho pracovníka cez optiku diagnostických prístrojov len ako objekt zdravotnej starostlivosti. V mnohých prípadoch sa aj napriek poskytnutej účinnej liečbe zabúda na celkový rozmer a hĺbku ľudskej existencie pacienta, ktorému sa zdravotná starostlivosť poskytuje. A práve tu nachádza svoje opodstatnenie medicínska etika.

Pojem medicínska (lekárska) etika [1] označuje vedeckú disciplínu, ktorá sa zaoberá jednak etickými hodnotami, mravnými normami a ich realizáciou v konkrétnej lekárskej praxi, a súčasne mravnými požiadavkami, ktoré určujú správanie a vzťahy, ktoré sú charakteristické pre osoby vykonávajúce povolanie lekára. [2] Z hľadiska správneho používania pojmov treba od pojmu medicínska etika odlišovať pojem zdravotnícka etika, resp. etika v zdravotníctve (angl. „healthcare ethics“), ktorý je svojím obsahom širší a zahŕňa v sebe okrem etických problémov lekárov aj ostatné zdravotnícke profesie. Máme na mysli predovšetkým etiku zdravotných sestier a ošetrovateliek, stavovskú etiku lekárnikov, ale napr. aj etiku duchovných pôsobiacich v zdravotníckych zariadeniach (pastorálna etika). Navyše, zdravotnícka etika tematizuje aj „bolestivé“ oblasti, ktoré sú integrálnou súčasťou rozhodovacích procesov v rámci poskytovania zdravotnej starostlivosti, ako sú napr. etické aspekty financovania zdravotníctva a pod. [3]

V nadväznosti na analýzu problematiky medicínskej etiky je nevyhnutné poukázať na štyri princípy, ktoré tvoria jej základné piliere: [4] 

  • Princíp autonómie (voluntas aegroti suprema lex) Pacient má právo byť poučený o účele, následkoch a rizikách poskytnutia alebo odmietnutia zdravotnej starostlivosti a mnohých ďalších aspektoch súvisiacich s odporúčaným zdravotným výkonom a na ich základe má právo slobodne sa rozhodnúť, či na poskytnutie zdravotnej starostlivosti udelí súhlas.
  • Princíp prospešnosti (salus aegroti suprema lex) Podstatou tohto princípu je požiadavka, aby prvoradým záujmom lekára pri výkone jeho povolania bolo dobro pacienta, ochrana života a zdravia pacienta, a to bez ohľadu na osobný zisk alebo záujmy tretích osôb.
  • Princíp „predovšetkým neškodiť“ (primum non nocere) V súlade s týmto princípom je lekár povinný pri poskytovaní zdravotnej starostlivosti obmedziť a predchádzať možným rizikám, a súčasne musí zvažovať škodlivé následky, ktoré by mohlo vyvolať jeho konanie vo vzťahu k pacientovi. 
  • Princíp spravodlivosti (iustitia) Posledný spomedzi princípov medicínskej etiky vyjadruje požiadavku na rovnosť a spravodlivosť pri prerozdeľovaní nedostatkových zdravotníckych materiálov a pomôcok, prípadne pri rozhodovaní o tom, komu bude nedostatková zdravotná starostlivosť poskytnutá.

 

Normy medicínskej etiky v podmienkach právneho poriadku SR


S rozvojom medicínskej etiky, ktorej vzostup nastal predovšetkým v období po druhej svetovej vojne, sa začali v demokratických spoločnostiach postupne objavovať aj jednotlivé kodifikácie etických kódexov lekárov a iných zdravotníckych pracovníkov. V podmienkach právneho poriadku Slovenskej republiky boli snahy o kodifikáciu etických noriem zdravotníckych pracovníkov zakončené prijatím Etického kódexu zdravotníckeho pracovníka (ďalej len „Etický kódex“). Znenie Etického kódexu bolo inkorporované priamo do textu zákona č. 578/2004 Z. z. o poskytovateľoch zdravotnej starostlivosti, zdravotníckych pracovníkoch, stavovských organizáciách v zdravotníctve a o zmene a doplnení niektorých zákonov v z. n. p. (ďalej len „zákon o poskytovateľoch zdravotnej starostlivosti“) a v súčasnosti tvorí prílohu č. 4 cit. zákona.[5]

Etický kódex je základný predpis medicínskej etiky, ktorý je záväzný pre všetkých zdravotníckych pracovníkov vykonávajúcich zdravotnícke povolanie v procese poskytovania zdravotnej starostlivosti (lekár, zubný lekár, farmaceut, sestra, pôrodná asistentka, fyzioterapeut a pod.. [6]

 

Etická alebo právna povaha (záväznosť) noriem Etického kódexu

 

Jednou z prvých otázok, ktoré sa vynárajú pri podrobnejšej analýze právnej povahy ustanovení Etického kódexu je jeho záväznosť z hľadiska etickej alebo právnej normy. Zákon o poskytovateľoch zdravotnej starostlivosti odkazuje na Etický kódex hneď na niekoľkých miestach. V prvom rade treba venovať pozornosť ust.§ 52 ods. 2 písm. a) zákona o poskytovateľoch zdravotnej starostlivosti, podľa ktorého je člen komory (každý zdravotnícky pracovník zapísaný do zoznamu členov príslušnej komory alebo čestný člen príslušnej komory) [7] povinný vykonávať svoje zdravotnícke povolanie odborne, v súlade so všeobecne záväznými právnymi predpismi a s Etickým kódexom, ktorý je uvedený v prílohe č. 4 tohto zákona. Uvedená povinnosť sa navyše prostredníctvom ust. § 80 ods. 1 písm. e) cit. zákona rozširuje na všetkých zdravotníckych pracovníkov. [8] Výkladom citovaných ustanovení zákona o poskytovateľoch zdravotnej starostlivosti dospejeme k záveru, že aplikácia ustanovení Etického kódexu je zákonnou povinnosťou každého zdravotníckeho pracovníka, ktorú je pri výkone svojho povolania povinný rešpektovať.

Zákon o poskytovaní zdravotnej starostlivosti odkazuje na Etický kódex aj vo svojej štvrtej časti upravujúcej disciplinárne opatrenia a disciplinárne konanie. Konkrétne v ust. § 65 ods. 1 okrem iného definuje porušenie povinnosti vykonávať zdravotnícke povolanie v súlade s Etickým kódexom ako disciplinárne previnenie, ktoré je sankcionovateľné v rámci disciplinárnych opatrení podľa ust. § 65 ods. 2 písm. b) zákona o poskytovateľoch zdravotnej starostlivosti. Otázkou teda ostáva, či je vôbec možné považovať normy Etického kódexu za „čisto“ etické normy, keďže dôvodom ich záväznosti je právna (zákonná) norma. V odpovedi na nastolenú otázku sa pri súčasnom zohľadnení vyššie uvádzaných skutočností stotožňujeme s názorovým prúdom [9], podľa ktorého súčasná legislatívna úprava obsiahnutá v zákone o poskytovateľoch zdravotnej starostlivosti „stiera“ rozdiel medzi etickými a právnymi normami v oblasti zdravotnej starostlivosti. Argumentačne je tento právny záver možné „podoprieť“ viacerými tvrdeniami.

V prvom rade treba vyzdvihnúť fakt, že Etický kódex zdravotníckeho pracovníka nie je len „obyčajným“ stavovským predpisom príslušných zdravotníckych komôr, ale ako súčasť všeobecne záväzného právneho predpisu je inkorporovaný (včlenený) do právneho poriadku Slovenskej republiky. Ďalším dôležitým aspektom je už spomínané „uzákonenie“ postupu zdravotníckeho pracovníka pri výkone zdravotníckeho povolania v súlade s Etickým kódexom, no a v neposlednom rade možnosť sankcionovať porušenia tejto povinnosti v rámci disciplinárnej zodpovednosti zdravotníckeho pracovníka.

 


 

Literatúra a poznámky

1. Pojem medicínska etika a lekárska etika sú v kontexte tohto článku používané ako synonymá.

2. Pozri VLČEK, R. – HRUBEŠOVÁ, Z.: Zdravotnícke právo. Bratislava: Ing. Miroslav Mračko – EPOS, 2007. s. 69 – 71.

3. BARANCOVÁ, H. a kol.: Medicínske právo. 1. vydanie, Bratislava: VEDA, vydavateľstvo SAV, 2008. s. 216.

4. Porovnaj napr. VLČEK, R. – HRUBEŠOVÁ, Z.: Zdravotnícke právo. Bratislava: Ing. Miroslav Mračko – EPOS, 2007. s.71 a BARANCOVÁ, H. a kol.: Medicínske právo. 1. Vydanie. Bratislava: VEDA, vydavateľstvo SAV, 2008. s. 216-217.

5. Stav platný k 5.4.2013.

6. Výpočet zdravotníckych pracovníkov je obsiahnutý v ustanovení § 27 zákona o poskytovateľoch zdravotnej starostlivosti

7. Výpočet komôr zdravotníckych pracovníkov, ich postavenie, úlohy, členstvo v nich a ďalšie podrobnosti o činnosti týchto komôr upravuje zákon o poskytovateľoch zdravotnej starostlivosti v piatej časti pod názvom Komory.

8. Rozšírenie povinnosti vykonávať zdravotnícke povolanie v súlade s Etickým kódexom na všetkých zdravotníckych pracovníkov v súlade s § 80 citovaného zákona nachádza svoje opodstatnenie v nadväznosti na skutočnosť, že členstvo zdravotníckych pracovníkov v príslušných komorách podľa súčasného znenia zákona o zdravotnej starostlivosti (stav platný k 5.4.2013) je dobrovoľné.

9. Pozri napr. BARANCOVÁ, H. a kol.: Medicínske právo. 1. vydanie. Bratislava: VEDA, vydavateľstvo SAV, 2008. s. 223.

10. DRGONEC, J.: Základné práva a slobody podľa Ústavy Slovenskej republiky. 2.zväzok. Bratislava: MANZ, 1999 s. 212.

11. MOJZEŠOVÁ, M.: Etika optimálnej komunikácie lekár – pacient/klient. In: Human Rights Forum 2012, Zborník príspevkov z vedeckej konferencie. Bratislava 2012, s. 155 – 160.

12. Ustanovenie § 80 ods. 2 zákona č. 578/2004 Z.z. o poskytovateľoch zdravotnej starostlivosti, zdravotníckych pracovníkoch, stavovských organizáciách v zdravotníctve a o zmene a doplnení niektorých zákonov

13. Pozri ustanovenie § 80 ods. 4, 5 zákona o poskytovateľoch zdravotnej starostlivosti

14. ŠOLTÉS, L. a kol.: Vybrané kapitoly z medicínskej etiky. Bratislava: Univerzita Komenského, 2001.

15. BARANCOVÁ, H. a kol.: Medicínske právo. 1. vydanie, Bratislava: Veda, vydavateľstvo SAV, 2008. s. 233.

16. zákon o poskytovateľoch zdravotnej starostlivosti v ustanovení § 52 ods. 2 písm. a) v súlade s ustanovením § 80 ods.1 písm. e) predmetného zákona ukladá každému zdravotníckemu pracovníkovi zákonnú povinnosť vykonávať svoje zdravotnícke povolanie v súlade s Etickým kódexom.

17. Ustanovenie § 60 ods. 2 písm. f) zákona o poskytovateľoch zdravotnej starostlivosti

18. Pozri ustanovenie § 66 ods. 1 zákona o poskytovateľoch zdravotnej starostlivosti.

 


 

zdroj: KUBALA, J., VOLČKO, V.: Poskytovanie zdravotnej starostlivosti v rovine medicínskej etiky. In Právo a manažment v zdravotníctve,  číslo 4/2013,roč. IV, ISSN 1338-2071.

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