Odmietnutie výkonu zdravotnej starostlivosti kvôli nadváhe | Medicínske právo
              

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Odmietnutie výkonu zdravotnej starostlivosti kvôli nadváhe


 | 29.10.2012 | komentárov: 361

„Povedala mi, že ma nemôže ošetriť, pretože vážim viac ako 200 libier. Nikdy som nepočula niečo také. Myslela som si, že doktori sú tu na to, aby vám pomohli.“ „V ten deň sa nestarala o moje zdravie. Myslím, že som pre ňu predstavovala iba príťaž, a možno príliš veľa práce...“

Obrazok Podľa nedávnych prieskumov trpí obezitou v súčasnosti viac ako tretina dospelých Američanov. Navyše, ako sa zdá, tento novodobý fenomén predstavuje popri vzniku srdcových chorôb, mŕtvice, cukrovky 2. typu či niektorých typov rakoviny aj nové zdravotné riziko, a to riziko odmietnutia lekárskeho ošetrenia.

V meste Shrewsbury (USA) lekárka Helen M. Carterová odmietla uzavrieť s pacientkou dohodu o poskytovaní zdravotnej starostlivosti iba na základe toho, že je obézna. Na  jar tohto roku sa totiž rozhodla zastaviť prijímanie obéznych pacientov, nakoľko jej ambulancia na to nie je technicky ani personálne vybavená a ošetrovanie takýchto pacientov pre ňu predstavuje riziko. V televíznom rozhovore svoje rozhodnutie zaviesť váhový limit zdôvodnila tromi po sebe idúcimi zraneniami, ktoré boli spôsobené pri snahe zabezpečiť starostlivosť pacientom ťažším ako 250 libier. Navyše, zdá sa, že Carterová tak urobila ako lekárka v úplnom súlade so svojimi právami.

Vytvorenie právneho vzťahu, ktorého predmetom je poskytovanie zdravotnej starostlivosti má v USA obdobne ako v Slovenskej republike zmluvnú povahu. Vzájomný vzťah medzi lekárom a pacientom vzniká na základe dohody o poskytovaní zdravotnej starostlivosti (ďalej len „dohoda“). Otázka zmluvnej slobody je však v USA koncipovaná omnoho voľnejšie.

V rámci slovenskej právnej úpravy, ustanovenie § 12 zákona č. 576/2004 Z. z. o zdravotnej starostlivosti  taxatívne, a teda úplne, vymenúva dôvody odmietnutia návrhu na uzatvorenie dohody zo strany poskytovateľa zdravotnej starostlivosti. Ide o situáciu, ak:

a) by uzatvorením takejto dohody prekročil svoje únosné pracovné zaťaženie,

b) osobný vzťah zdravotníckeho pracovníka k osobe, ktorej má zdravotnú starostlivosť poskytovať,    nezaručuje objektívne hodnotenie jej zdravotného stavu alebo

c) poskytovaniu zdravotnej starostlivosti bráni osobné presvedčenie zdravotníckeho pracovníka, ktorý má zdravotnú starostlivosť poskytovať,

pričom takýmto odmietnutím návrhu na uzatvorenie dohody nie je dotknuté právo osoby na poskytnutie neodkladnej starostlivosti.


Naproti tomu širšia zmluvná sloboda v USA zabezpečuje, že pacienti, ako aj lekári, si môžu absolútne slobodne zvoliť, s kým vstúpia do vzťahu poskytovania zdravotnej starostlivosti. Predpisom upravujúcim vzťahy v tejto oblasti je Etický kódex americkej medicínskej asociácie (AMA), podľa ktorého majú tak lekári, ako aj pacienti, právo ich vzájomný vzťah odmietnuť. Z ustanovení kódexu je dôležité najmä to, ktoré uvádza, že lekár môže odmietnuť výkon zdravotnej starostlivosti o pacienta, ktorého zdravotný stav nie je v súčasnej kompetencii lekára. Určitá ochrana sa pacientom zabezpečuje zakotvením všeobecného princípu nediskriminácie, a síce, že lekári nemôžu odmietnuť pacientov kvôli rase, farbe pleti, náboženstvu, národnostnému pôvodu, sexuálnej orientácii, pohlavnej identite, alebo na inom základe, ktorý by predstavoval nespravodlivú diskrimináciu.Carterová však svoj novozavedený triediaci proces prijímania pacientov nepovažuje za diskriminačný. Svoj krok obhajuje tým, že v okolí existujú aj iné, vhodnejšie zariadenia pre pacientov s nadváhou a zároveň dodáva: „Nie je to hmotnosť ako taká, je to choroba“.

Zaradila sa tak medzi viacerých lekárov považujúcich hmotnosť za dôvod odmietnutia niektorých pacientov. Minulý rok, podobne v snahe vyhnúť sa prijímaniu pacientov s nadváhou, pútalo pozornosť médií niekoľko gynekológov na Floride. "Ľudia si neuvedomujú, aké riziko na seba berieme tým, že sa staráme o týchto pacientov," uviedol Dr. Albert Triana. Vzniká tým väčšie riziko vzniku možných komplikácií, čím narastá aj riziko podania žaloby. U obéznych pacientok je počas chirurgického zákroku, ako aj v priebehu samotného tehotenstva, všetko zložitejšie.

Avšak, hoci majú lekári právo vybrať si, koho budú liečiť, otázne zostáva, či je takáto politika etická, a či ňou v konečnom dôsledku nemôže dôjsť k poškodeniu samotného pacienta. „Nie je vari psychickou a emocionálnou ujmou, pokiaľ Vás lekár, s ktorým sa pokúšate vytvoriť si dôverný, hlboko osobný vzťah, odmietne prezrieť, pretože Vaše telo nie je dosť štíhle? Čo ak to v pacientovi vyvolá rozpaky a poníženie, pre ktoré sa bude v budúcnosti vyhýbať vyhľadaniu lekárskej pomoci?“ pýta sa Jezebel Dodai Stewart.

Hoci lekárka odmietnutím pacientky neporušila zákonnú povinnosť (ako by tomu za rovnakých okolností bolo v našich podmienkach), posudzovať etiku takéhoto konania, je na mieste. Pred nami totiž vyvstáva otázka dvoch princípov: sloboda vo výbere pacienta a lekára na jednej strane a princíp nediskriminácie na strane druhej.

Akokoľvek, skutočne odmietnuť všetkých 35,7% klinicky obéznych Američanov, by bolo nateraz prinajmenšom nevhodné a ťažké.

Navyše, váha v súčasnosti nie je jediným faktorom ovplyvňujúcim lekárov pri výbere svojich pacientov. Vo februári tohto roku Wall Street Journal informoval o zvýšení počtu pediatrov, ktorí prestali prijímať pacientov, ktorých rodičia odmietli dať zaočkovať.

AUTOR: Jana Breburdová
FOTO: obesityinamerica.org

ZDROJE
http://www.businessinsider.com/woman-denied-medical-treatment-due-to-her-weight-2012-8
http://www.huffingtonpost.com/2012/08/27/ida-davidson-doctor-wont-treat-patient-weigh-200-pounds_n_1834714.html
http://www.wcvb.com/health/Doctor-refuses-to-treat-overweight-Shrewsbury-patient/-/9848730/16255838/-/item/0/-/12988lsz/-/index.html



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