Survey on chaplaincy and quality of end of life  

 

Survey on chaplaincy and quality of end of life 

Czech Republic

 

Pavel Pokorny
Commission for Spiritual Care in Health Service
of Ecumenical Council of Churches in the Czech Republic    

  1. What are the legal regulations on end of life choices in your country?

Up to now, there are no special legal regulations on this issue. Patients have the right to refuse treatment. Decisions on continuing or withdrawing treatment are made by the doctor in charge and the senior doctor (head of clinic or department). The doctor has to alleviate pain and suffering even if this increases the risk of death. There is no euthanasia or asisted suicide possible. A doctor does not even have to support a patient´s intention to die deliberately. All contested cases of patients´ deaths are treated according to the Criminal Code as killing.
Furthermore, the Czech Republic does not have any complex law on health care. Since the change in 1989, we have been looking for broader societal consensus.
On 26th February 2010, The Czech Medical Chamber issued a statement supporting decisions on non-continuing in futile treatment. This document speaks clearly about death, palliative care, and spiritual needs of patients. It seems to be a sign of change in language and thoughts about dying in our society.

  1. What is the view of your church (or the churches you represent) in your country on end of life choices?

The United Methodist Church in the Czech Republic.:  does not agree with euthanasia or assisted suicide; patients should have the right to stop futile treatment;
The Czechoslovak Hussite Church: based on the Decalogue, medical ethics, believed sense of suffering, and danger of misuse does not agree with euthanasia or assisted suicide;  
 The Silesian Evangelical Church of the Augsburg Confession: human life has to be respected and protected from conception to natural death;
     (Statements of other churches on this matter are not available at this moment.)
                                                         

  1. What are the main tensions in the chaplains’ general practice concerning quality of end of life? 

 For all parties involved in the process of dying, such as patients, their loved ones, and medical staff, death seems to be taboo. Communication about dying is disrupted, and they all are left feeling lonely. The opportunity to cooperate on crucial issues of completing life is missed.
Chaplains are usually not included in multidisciplinary medical team as respectful partners.

26th of February, 2010

 

 

Marie Opatrna, MD MA PhD
 Department of Oncology of the First faculty of Medicine and General Teaching Hospital, Prague

1. What are the legal regulations on end of life choices in your country?

Czech Legal System
In the Czech Republic there is not any law that would permit euthanasia or assisted suicide. There are no legal regulations on end of life choices; there is no such thing as a “living will” (advance directive, health care directive, etc.).

Czech Medical Associations
a) Czech Association of Anesthesiology, Resuscitation and Intensive Medicine
and Czech Association of Intensive Medicine
These two associations prepared in 2009 “Consensus opinion to provide palliative care for patients with irreversible organ disabilities”:
1. The Czech Republic legal system does not recognise the term “euthanasia”;
2. Terminology - definitions of palliative care, futile treatment, withholding and withdrawing treatment...  
3. Recommendation for clinical practice

b) Czech Association of Palliative Medicine, Czech Association for Clinical Pastoral Care and the hospice movement are also against euthanasia and assisted suicide.

Palliative and hospice care
a) In the Czech Republic there is one Complex Oncology Center – Designated Center of Integrated Oncology and Palliative Care.  The Center has been accredited by The European Society for Medical Oncology – ESMO since 2006. [Department of Oncology of the First Faculty of Medicine and General Teaching Hospital is a part of this Centre]

b) There are 13 hospices with about 350 beds in our country.

c) Although “the consumption of strong opioid analgesics is too low” [ Scholten W., Team Leader, Access to Controlled Medicines, WHO, Geneva; PragueOnco Journal, 2010.] , all teaching hospitals have centers for pain management. GPs and doctors in small hospitals are afraid of higher doses of opioids; this leads to the quality of pain management being reduced.

d) Palliative sedation is allowed. 

Debate on Euthanasia
There is no sociological research on views on euthanasia.The debate on euthanasia and assisted suicide is led mainly by politics and young people. Patients speak about euthanasia very rarely.

2. What is the view of your church (or the churches you represent) in your country on end of life choices?

The official view of churches and religious societies in the Czech Republic on euthanasia was published in December 2005 as “Statement of churches and religious organizations on the issue of euthanasia and accompanying the dying”.
This statement says that:
a) The question of euthanasia and accompanying the dying is becoming increasingly the subject of debate in society.
b) Life is understood as a gift from God, dying as a part of life. Comprehensive assistance for dying people is help to life). Churches and religious societies defend the right to die in dignity. Human dignity is embedded in faith in God and the divine act of creation.
c) Suffering (feelings of despair, helplessness and emptiness) is a difficult situation for dying people and also for those round about them; sympathy for suffering people. Disagreement with the effort to end sick people’s lives by lethal means.
d) Warning on dangers that would be associated with enacting euthanasia.
e) Requirement to provide integrated care for dying people and those who accompany them; for dignified dying is necessary to convey (for/to dying people) awareness that they are our fellowmen, they are not  left to themselves...
f) Proposal to pay more attention to the integral care of dying people in hospitals, and other settings.

Signed by:
Arcibiskup Jan Graubner, Česká biskupská konference; Archbishop Jan Graubner, president of the Czech Episcopal Conference
Pavel Černý, Ekumenická rada církví v ČR; Pavel Černý, president of the Ecumenical Council of Churches in the CR
Karol Sidon, vrchní pražský a zemský rabín; Karol Sidon, Chief Rabbi of Prague
Vladimír Sáňka, Ústředí muslimských obcí v ČR; Vladimir Sanka, headquarters of the Muslim community in the CR

The Statement (Prohlášení církví a náboženských společností v ČR k problematice eutanázie a doprovázení nemocných) is available in Czech language from
http://tisk.cirkev.cz/dokumenty/prohla-eni-cirkvi-a-nabo-enskych-spolecnosti-v-cr-k-problematice-eutanazie-a-doprovazeni-umirajicich.html

3. What are the main tensions in the chaplains´ general practice concerning quality of end of life?

Since Health Care Chaplaincy in the Czech Republic is not developed; it is difficult to determine what problems “chaplains” meet.
Chaplains have virtually no training in palliative care.

14th February 2009 I founded with doctors and theologians the Czech Associations for Clinical Pastoral Care to open up dialogue in our country and to help in our current unfavorable situation regarding healthcare chaplaincy.

 

                                                                        Marie Opatrna, M.D., MA, Ph.D.
                                                                        Department of Oncology of the First faculty of                                                                    Medicine and General Teaching Hospital
                                                                        Prague, Czech Republic
                                                                       
February 2010

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