Rozhovor s hosťom mesiaca máj 2012: JUDr. Petr Šustek, PhD. | Medicínske právo
              

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Rozhovor s hosťom mesiaca máj 2012: JUDr. Petr Šustek, PhD.


 | 14.5.2012 | komentárov: 312

Prinášame rozhovor s hosťom mesiaca máj JUDr. Petrom Šustekom, PhD., advokátom, ktorý sa dlhoročne venuje medicínskemu právu, bioetickým otázkam, vzdelávaniu lekárov a v náväznosti nato aj zdravotníckej legislatíve. V rozhovore priblíži témy, ktorým sa mieni venovať ako hosť tohto mesiaca, a totiž problematike objektívnej zodpovednosti v zdravotníctve a sekundárnych obetí v práve.

Obrazok MEDIUS: Dobrý deň. Máte právnické vzdelanie, prečo ste sa rozhodli zamerať na medicínske právo?

Již jako student jsem se věnoval medicínským a bioetickým otázkám a společně s kolegou Ondřejem Dostálem jsme založili Asociaci pro medicínské právo a bioetiku. Proto bylo asi přirozené, že jsem po studiích v této oblasti setrval.

MEDIUS: Čomu sa aktuálne venujete?

Zejména nové české zdravotnické legislativě a odpovědnostním otázkám. Působím na Právnické fakultě Univerzity Karlovy v Praze jakožto koordinátor Centra zdravotnického práva a zároveň odborný asistent na Katedře občanského práva. V této souvislosti nemohu nezmínit, že součástí právního řádu ČR se stal nový občanský zákoník, který má nabýt účinnosti k 1. 1. 2014, a bude jistě zajímavé zmínit mimo jiné to, že mezi kontrakty zařadil též smlouvu o péči o zdraví. Zdravotnické právo přednáším jak na půdě Právnické fakulty, tak na 3. lékařské fakultě UK v Praze, 2. lékařské fakultě UK v Praze a na Právnické fakultě Univerzity Palackého v Olomouci. Mimo výše uvedené se věnuji také soukromé advokátní praxi.

MEDIUS: Z Vašej skúsenosti pri vyučovaní lekárov, čo si myslíte, v ktorej oblasti ich právnych znalostí sú najväčšie nedostatky?

Vnitřně cítím, že největším problémem je podřazení prakticky nastalých situací pod právní řešení. Jinak řečeno, ne vždy si dokáží lékaři reálně představit, jakou právní konsekvenci mají jednotlivé kroky, které činí, a to i když jsou na to upozorňováni.

MEDIUS: Myslíte si, že vzdelávanie lekárov reálne prispieva k predchádzaniu porušovaniu práv pacientov?

Ano a ne. Je velký rozdíl mezi jednotlivými zdravotnickými pracovníky. U části z nich dochází k chápání práv pacientů jako nárůstu zbytečné administrativy, u druhých ke zvýšení standardu poskytovaných zdravotních služeb. Proto stále vidím světlo na konci tunelu:)

MEDIUS: Akú tému ste si vybrali ako hosť mesiaca? Z akého dôvodu?

Vybral jsem si dvě témata – Objektivní odpovědnost ve zdravotnictví a otázka sekundárních obětí v právu. Vybraná témata jsou dle mého názoru z hlediska aktuální rozhodovací činnosti soudů neustálená a  není jim věnován náležitý prostor v odborné literatuře.

Objektivní odpovědnost ve smyslu § 421a občanského zákoníku se stala zajímavým tématem zejména s ohledem na aktuální rozhodnutí Nejvyššího soudu v ČR. Jedná se např. o rozhodnutí sp. zn. 25 Cdo 2046/2007 ze dne 29. 7. 2009, kdy žalobce byl na svém zdraví poškozen pořezáním v dutině břišní při laparoskopické operaci jícnu troakarem. Vyvolávajícím činitelem poškození zdraví žalobce byly shledány vlastnosti přístroje, kterými jsou jeho konstrukce a ostrost. Podle NS ČR příčina vzniku škody na zdraví žalobce spočívá tedy v povaze tohoto přístroje, který při použití ke svému účelu je způsobilý vyvolat určitý škodný následek a v daném případě jej také způsobil. Okolnost, jež poranění způsobila a jež má původ v povaze přístroje užitého při lékařském zákroku, spočívá tedy v jeho charakteristických vlastnostech. Z hlediska § 421a obč. zák. dle soudu pak není významné, zda přístroj při jeho užití selhal či zda byl zcela funkční a nůž se automaticky neskryl z důvodu anatomických poměrů pacienta či jeho dispozice.

S ohledem na uvedené je třeba se např. v souvislosti s laparoskopickými zákroky zamýšlet nad tím, zda je zdravotní služby takového charakteru vůbec možné poskytovat, aniž bychom nenaváděli lékaře k tzv. defenzivní medicíně.

V této souvislosti odkazuji také na velmi zajímavý článek Jana Petrova uveřejněný na blogu Jiné právo: http://jinepravo.blogspot.com/2011/10/kladivo-na-zdravotnictvi-421a-obc-zak_10.html

K otázce sekundárních obětí se vyjadřuji podrobněji v odpovědích na další otázky.

MEDIUS: Otázka druhotných obetí v práve je témou, právnickou literatúrou pomerne málo reflektovanou resp. týkajúcou sa predovšetkým trestného práva. Môžete priblížiť o čo ide ?

Vztah mezi manžely, partnery, vztah mezi dítětem a rodičem či mezi sourozenci je již z povahy věci jedním z nejužších a nejintenzivnějším mezilidských vztahů. Tyto vztahy jsou charakteristické úzkým sepětím více fyzických osob. Právě s ohledem na ono sepětí lze konstatovat, že je-li do práv některé z těchto fyzických osob zasaženo, nelze jako „zasaženou“ posuzovat pouze fyzickou osobu, proti níž zásah směřuje, nýbrž i tu, která je s ním ve výše uvedeném smyslu spjata. K zásahům majícím tzv. sekundární oběti dochází lidskou činností. Typickou oblastí lidské činnosti, ve které je postižení sekundárních obětí obzvláště zřejmé, je oblast poskytování zdravotní péče.

Důsledkem zásahu do tělesné integrity fyzické osoby může být poškození zdraví či dokonce smrt lidské bytosti. Je-li příčinou takového následku jednání, které je v rozporu s právními normami, tedy které je protiprávní, ocitáme se mimo jiné v oblasti občanskoprávní odpovědnosti. V této souvislosti lze uvažovat jak o odpovědnosti za škodu, tak o odpovědnosti za zásah do práv na ochranu osobnosti fyzické osoby.

Poškození zdraví či smrt fyzické osoby však představuje bezpochyby i zásah do vztahů kvalifikovaných výše, tedy do soukromého a rodinného života dalších osob. V důsledku protiprávního jednání je tak (negativně) narušen život několika lidí, kromě primárního cíle zásahu i tzv. sekundární oběti , které v důsledku neoprávněného zásahu utrpí na svých právech jistou újmu.

MEDIUS: Od čoho závisí úspešné uplatnenie nárokov tzv. sekundárnych obetí? Zohľadňujú vôbec súdy tento typ zodpovednosti popri zodpovednosti primárnej?

Náhrada nemajetkové újmy způsobená usmrcení osoby blízké je zakotvena v § 444 odst. 3 občanského zákoníku, kde je stanovena i výše jednorázového odškodnění za usmrcení (zpravidla 240 tis. Kč,-), přičemž judikatura dovodila v případě nedostačující kompenzace možnost domáhat se i náhrady nemajetkové újmy v penězích dle ustanovení o ochraně osobnosti dle § 11 an. občanského zákoníku (nález Ústavního soudu sp. zn. Pl. ÚS 16/04 ze dne 4. 5. 2005).

Nabízí se otázka, zda vůbec a jaké nároky plynou osobám vztahově s poškozenou fyzickou osobou spjatým, pokud nebude přímo usmrcen, ale bude poškozeno jeho zdraví. Mnohdy vážná poškození zdraví jsou společností vnímána citlivěji než samotné usmrcení. V 444 odst. 3 občanského zákoníku odpověď na takto položenou otázku není a stejně tak ani soudní praxe se doposud nevyjádřila, zda i poškozením zdraví může být zasaženo do soukromého a rodinného života dalších osob.

Nedořešená se jeví i otázka psychické újmy osoby blízké pacientovi, která v důsledku úmrtí pacienta utrpí intenzivní šok či dokonce např. posttraumatickou stresovou poruchu, tedy škodu na zdraví. Dle stále aktuálního názoru soudů nelze u sekundární oběti dohledat příčinnou souvislost mezi protiprávním jednáním a škodou na jejím zdraví (rozhodnutí býv. Nejvyššího soudu ČSR, publikovaným pod č. 7 ve Sbírce soudních rozhodnutí a stanovisek, roč. 1979 či 25 Cdo 1455/2003). Otázkou však je, zda toto posouzení není příliš přísné, neboť bez protiprávního jednání by následek v podobě kvalifikované psychické újmy nenastal.
Odborná veřejnost nastolenému tématu nevěnuje dostatečnou pozornost. Fenomén sekundárních obětí nebyl doposud náležitě řešen v odborné literatuře, což pouze potvrzuje potřebu se mu důsledně věnovat.

Ďakujem za rozhovor a teším sa na príspevky.

Spracovala: Zuzana Zoláková


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