Previously expressed wishes or about human freedom and dignity

Summary

In current medical practice a patient is viewed as a competent person able to participate on the health care decision-making and determine his or her own future. This idea is based on the respect for autonomy, which stems from the belief in human dignity. Today, the right to self-determination is being considered also in relation to patients who are not able to express their wishes for example due to the permanent vegetative state. Advance directives, which, to some degree, can help patients with decision-making, have been used in USA since 1969. The documents have developed from general, vague proclamations to very detailed instructions addressed to health care professionals and the relatives of the patient. Advance directives have been introduced in several European countries, and the recommendation to take into consideration the patient’s previously expressed wishes is implemented in the Convention on Human Rights and Biomedicine. Previously expressed wishes (advance directives) are mentioned in the new law on providing healthcare services that has been prepared by the Czech Ministry of Health. If the law is approved the Czech patients will be able to express their wishes about future health care. For the advance directives to work though, it is important that there be a sound balance between the patient’s wishes and the conscience of the doctor.

Key words:
dignity, freedom, human rights, conscience, previously expressed wishes