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Právna úprava asistovanej reprodukcie vo Švajčiarsku


 | 7.4.2011 | komentárov: 299

Švajčiarsko - európska krajina neobmedzených možností. Aj takto by sa dala označiť jedna z najvyspelejších krajín Európy, ktorá je charakteristická vysokou úrovňou poskytovania zdravotnej starostlivosti. Ak požiadavka mať vlastné dieťa prirodzeným spôsobom nie je splnená, až 27 centier v rámci 11 kantónov ponúka možnosť využiť metódy asistovanej reprodukcie. V tomto príspevku Vám ponúkame prehľad právnej úpravy asistovanej reprodukcie vo Švajčiarsku, ktorá v porovnaní s medicínskou praxou na Slovensku zahŕňa reštriktívnejšie pravidlá a princípy.

Obrazok Ústava: článok 119 (1)

Právny základ úpravy asistovanej reprodukcie nachádzame v Ústave ako prameni práva s najvyššou právnou silou a to konkrétne v článku 119. Tento článok zabezpečuje ochranu ľudskej bytosti proti zneužívaniu v oblasti asistovanej reprodukcie a genetického inžinierstva. Garantuje zachovávanie ľudskej dôstojnosti, osobnosti a rodiny. Ústava výslovne uvádza princípy, ktoré sa musia rešpektovať:


1. Akákoľvek forma klonovania a  zásah do genetickej informácie gamét a embryí je zakázaný.
2. Zákaz zlúčenia ľudských a zvieracích buniek.
3. Uchýliť sa k metódam asistovanej reprodukcie je možné len za predpokladu, že sterilita alebo nebezpečenstvo prenosu vážnej choroby sa nemôže odstrániť iným spôsobom. Metóda asistovanej reprodukcie sa nesmie využiť za účelom vytvorenia určitých vlastností u dieťaťa ani za účelom výskumu. Oplodniť ľudské vajíčko mimo ženského tela je povolené len za podmienok stanovených v zákone.
4. Darcovstvo embryí a akákoľvek  forma náhradného materstva je zakázaná.
5. Zákaz obchodovania s ľudským zárodkom.
6. Každá osoba má právo prístupu k údajom o predkoch.
7. Genetická informácia osoby môže byť analyzovaná, zaregistrovaná a oznámená iba so súhlasom tejto osoby a v medziach zákona.

Detailná ústavná úprava ponúka pevné základy v rámci tejto problematiky. Bližšie informácie o jednotlivých podmienkach a výkone upravuje Federálny zákon o medicínsky asistovanej reprodukcii, (2) ktorý nadobudol účinnosť 1. januára 2001 rovnako ako Nariadenie Federálnej rady, (3)ktoré sa zaoberá otázkami oprávnenia, kontroly a ochrany osobných údajov.



Federálny zákon o  asistovanej reprodukcii

Cieľom tohto zákona je stanoviť podmienky vykonávania asistovanej reprodukcie. V prvých ustanoveniach tohto zákona sa stretávame s definíciami pojmov, ktoré sú veľmi dôležité na interpretáciu samotného zákona.

Podľa nášho názoru je dôležité spomenúť a rozlišovať medzi týmito pojmami:

- Impregnované vajíčko: vajíčkom prenikne spermatozoid, ale ešte nedôjde k spojeniu jadier
- Embryo: plod po spojení jadier vajíčka a spematozoidu až do konca organogenézy

Asistovaná reprodukcia je vyhradená výlučne pre páry:
- ak je možné určiť príbuzenský vzťah (podľa švajčiarskeho Občianskeho zákonníka, u matky príbuzenstvo vyplýva z narodenia, u otca vzniká manželstvom, rozhodnutím súdu alebo uznaním)
- ak sú schopní, berúc do úvahy ich vek a osobnú situáciu, vychovávať svoje dieťa až do jeho dospelosti

Zákon ďalej výslovne uvádza, že jedine manželské páry môžu využiť darcovstvo spermií. Týmito vyjadreniami sa snaží zákonodarca zabezpečiť, aby sa dieťa narodilo do tradičnej rodiny s dvojakým príbuzenským vzťahom – materským a otcovským. Vylúčené sú teda homosexuálne páry a jednotlivci.
Ako definuje Ústava, tak rovnako aj zákon nám stanovuje, že využitie metód asistovanej reprodukcie je možné iba v prípade neplodnosti ak by iná liečba bola neúspešná, alebo v prípade nebezpečenstva prenosu závažných  nevyliečiteľných chorôb na potomkov, ak sa tie nedajú odvrátiť iným spôsobom.

Zákon výslovne zakazuje:

- Vykonávať praktiky, ktorými sa vplýva na pohlavie alebo iné vlastnosti dieťaťa
- Odber jednej alebo viacerých buniek z embrya in vitro a ich analýzu
- Používať gaméty alebo impregnované vajíčka osoby post mortem
- Darcovstvo vajíčok a embryí
- Náhradné materstvo

Je povinnosťou lekára informovať pár o príčinách neplodnosti, o samotnej metóde, ktorá sa bude aplikovať a jej výhody a riziká, o riziku viacnásobného tehotenstva, právnej úprave a finančných požiadavkách. Pred začatím samotnej liečby je páru ponechaná štvortýždňová  doba na rozmyslenie, počas ktorej im je ponúknutá možnosť konzultácie s inou osobou a psychológom.

Súhlas oboch partnerov je najesenciálnejšou požiadavkou. Musí byť písomný a vyžaduje sa pred začatím liečby a opakovane ak po troch cykloch liečby je metóda neúspešná. Súhlas obidvoch sa vyžaduje aj pred rozmrazením impregnovaných vajíčok. V prípade metódy, kedy môže dôjsť k viacnásobnému tehotenstvu musí pár akceptovať narodenie všetkých detí.

Zákon sa venuje aj otázke konzervovania. Gaméty môžu byť konzervované len na základe písomného súhlasu osoby na dobu najviac 5 rokov. Túto dobu je možné predĺžiť za účelom zabezpečenia si vlastných potomkov pred medicínskym zákrokom alebo výkonom určitej aktivity, ktorá môže zanechať  osobu neplodnou. V prípade odvolania súhlasu alebo uplynutím zákonnej doby konzervácie musia byť gaméty bezprostredne zničené. Obdobná úprava sa týka impregnovaných vajíčok, ktoré je možné konzervovať len so súhlasom páru a za účelom asistovanej reprodukcie. Rovnako je upravená doba 5tich rokov a bezprostredné zničenie po uplynutí tejto doby alebo po odvolaní súhlasu páru. Konzervácia embryí je striktne zakázaná (ide o jedno z najreštriktívnejších ustanovení v Európe). Embryo sa nesmie vyvíjať mimo tela matky po dobu dlhšiu ako je nevyhnutné pre úspešné uhniezdenie v maternici. Za limit na implantovanie embrya in vitro do maternice sa považuje 14. deň od oplodnenia (4) a počet vložených embryí nesmie byť vyšší ako 3.

Zákon upravuje podmienky asistovanej reprodukcie aj v prípade darcovstva spermií a výslovne uvádza:

- Spermie sa môžu použiť na účely asistovanej reprodukcie len so súhlasom darcu.
- Darcovstvo je bezplatné.
- Darca musí byť pred uskutočnením odberu informovaný o právnej úprave a o práve dieťaťa oboznámiť sa s informáciami o darcovstve zo spisu. (právo dieťaťa na informácie o predkoch vyplýva z Ústavy)
- Darca môže darovať spermie výlučne len v jednom  centre.
- V rámci jedného cyklu je zakázané použiť spermie z viacerých darcov.
- Spermie jedného darcu môžu byť využité na oplodnenie maximálne ôsmich detí.  
- Príbuzenský vzťah medzi darcom a párom sa vylučuje. Darca sa vyberá podľa krvnej skupiny a fyzickej podobnosti darcu na muža, z ktorého sa bude môcť odvodiť príbuzenský vzťah.
- Spermie sa konzervujú 80 rokov.

Dieťa narodené prostredníctvom darcu spermií nemôže poprieť príbuzenský vzťah s manželom svojej matky. Žaloba na určenie otcovstva voči darcovi je vylúčená. Údaje o darcovi v spise obsahujú:

- meno, priezvisko, rok narodenia, národnosť, profesiu, a vzdelanie
- dátum darovania spermie
- výsledky lekárskeho vyšetrenia
- informácie o fyzickom vzhľade  

Dieťa, dosiahnutím 18teho roku života môže obdržať údaje o identite darcu a jeho fyzickom zovňajšku. Darca musí byť o  takejto požiadavke vopred oboznámení. Dieťa obdrží údaje, ale darca môže odmietnuť stretnutie. Toto osobné právo darcu  musí dieťa  rešpektovať.

Otázky súvisiace s asistovanou reprodukciou sú obsiahnuté aj v iných zákonoch. Môžeme spomenúť napríklad Federálny zákon o výskume kmeňových buniek (5). Podľa ustanovení tohto zákona, ktorý nadobudol účinnosť 1. marca 2005, je striktne zakázané vytvoriť embryá s iným účelom ako pre oplodnenie. Nadpočetné embryá, ktoré vznikli in vitro no nemožno ich vložiť do tela matky, môžu byť za určitých okolností konzervované. Ide len o prípady kedy je konzervácia nevyhnutná pre vytvorenie kmeňových buniek a to najdlhšie do 7. dňa vývoja embrya. Podľa Federálneho zákona o transplantácii orgánov, tkanív a buniek, (6) umelá konzervácia nadpočetných embryí po siedmych dňoch vývoja za účelom odobratia tkanív a buniek na transplantáciu je zakázaná.

Momentálna situácia

Zákon o asistovanej reprodukcii a článok 119 Ústavy sú momentálne v štádiu modifikácie. Otázka sa týka hlavne povolenia predimplantačnej diagnostiky (le diagnostic préimplantatoire-DPI). Ide o medicínsky postup v oblasti oplodnenia in vitro s cieľom vyšetriť genotyp embryí pred ich samotným vložením do maternice. Hlavným cieľom diagnostiky je zabezpečiť, aby narodené dieťa netrpelo  genetickou chorobou, ktorej predispozícia bola potvrdená u rodičoch. Vo Švajčiarsku je DPI zakázaná (na rozdiel od Slovenska, kde sa bežne vykonáva) od účinnosti Zákona o asistovanej reprodukcii. Táto situácia sa pravdepodobne v najbližšej dobe zmení. Parlament poveril Federálnu radu aby vypracovala návrh zákonnej úpravy, ktorý povolí výkon DIP a stanoví striktné podmienky na jej realizáciu. Hlavným argumentom navrhovateľov novej zákonnej úpravy je zvýšiť šancu narodenia zdravého dieťaťa. Federálna rada si zachováva názor, že DPI môže byť vykonaná len pre páry, u ktorých sa prejavuje vysoké nebezpečenstvo prenosu vážnych genetických chorôb. Ďalej poznamenáva, že vykonanie DPI na základe iných ako medicínskych kritérií by malo byť zakázané. Úprava DPI vyvoláva nevyhnutnosť modifikácie článku 119 Ústavy a je teda za potreby vykonať ľudové hlasovanie. Švajčiarsky ľud by sa mal k tejto otázke vyjadriť v prvej polovici tohto roka. (7)

Záver

Ku koncu našej práce by sme si dovolili citovať profesora D. Sprumonta (8): „Ľudské dobrodružstvo sa začína počatím – prirodzeným aj umelým“ Je preto veľmi dôležité aby otázky týkajúce sa asistovanej reprodukcie boli detailne právne zakotvené, aby nedochádzalo k zneužívaniu ľudského života a ľudskej dôstojnosti.

Poznámky pod čiarou:

1. Pozri: RS 101 Constitution fédérale de la Confédération suisse, Art. 119 Procréation médicalement assistée et génie génétique dans le domaine humain
2. Pozri: RS 810.11 Loi fédérale du 18 décembre 1998 sur la procréation médicalement assistée (LPMA)
3. Pozri: RS 810.112.2 Ordonnance du 4 décembre 2000 sur la procréation médicalement assistée (OPMA)
4. Schorno D., Sprumont D.: Eros, Chronos et Thanatos: quelle place pour la norme? In: Le temp set le droit: recueil de travaux offerts à la journée de la société suisse des juriste, 2008, s. 286
5. RS 810.31 Loi Fédérale du 19 décembre 2003 relative à la recherche sur les cellules souches embryonnaire
6. RS 810.21 Loi fédérale du 8 octobre 2004 sur la transplantation d´organes, de tissus et de cellules
7. Pozri bližšie: http://www.bag.admin.ch – oficiálna stránka Federálneho úradu verejného zdravotníctva
8. Profesor v oblasti medicínskeho práva :Université de Fribourg a Unversité de Neuchâtel vo Švajčiarsku

AUTOR: Žofia Šuleková

Foto : nature.com


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