| Abstract: | Praėjus daugiau nei 15 metų po pirmojo įstatymo projekto pateikimo Seimui, buvo priimtas Pagalbinio apvaisinimo įstatymas. Tačiau, nepaisant įstatymo įsigaliojimo, stebint kaip iki tol, kiekvieną kartą bandant jį priimti, Seimas skildavo beveik tolygiai į priešingas stovyklas, t.y. pasisakantys už “konservatyvųjį” įstatymo projektą, kuris teikė pirmenybę embriono apsaugos klausimams ir “liberalųjį”, kuris siekė jog nevaisingumo problemų turintys pacientai gautų teisėtą lūkestį į veiksmingą ir saugią medicinos mokslo pažangą atitinkantį individualų gydymą, šiame darbe bandoma ieškoti priežasčių, lėmusių įstatymo nebūvimą per visus šiuos metus.
Taip pat, svarbu paminėti, jog Seimui buvo teikiamos skirtingos rekomendacijos, kurios įnešė dar daugiau sumaišties sprendžiant dėl tinkamiausio nevaisingumo gydymo būdo parinkimo. Todėl, šio darbo pagrindinis tikslas yra išanalizuoti ar teisiniu požiūriu priimtina embriono apsaugos pretekstu paneigti paciento teisę į medicinos mokslo įrodymais pagrįstą, efektyviausią, labiausiai paciento sveikatą tausojantį ir individualiu atveju tinkamiausią nevaisingumo gydymą.
Norint pasiekti užsibrėžtų tikslų, šiame darbe bus aptariamos paciento teisės gauti kokybiškas sveikatos priežiūros paslaugas. Taip pat, kas atsitinka, kai teisės aktais yra ribojama nevaisingumo problemų turinčių asmenų teisė nevaržomai pasirinkti tinkiamiausią ir jų individualius poreikius atitinkantį nevaisingumo gydymo būdą. Kaip matysime, neproporcingi draudimai skatina jog pacientai, norėdami užsitikrinti reprodukcines teises ir negalėdami jų realizuoti savo šalyje, renkasi reprodukcinį turizmą.
Analizuojama gydytojo pareiga užtikrinti tinkamiausią pagalbą ir kokie standartai jam yra taikomi.
Pati svarbiausia šio darbo dalis yra įrodymais pagrįstos medicinos principų taikymo dilema. Abiejuose Seimui teiktose gydytojų bendruomenės rekomendacijose yra remiamasi mokslo įrodymais pagrįsta medicina, tačiau jos taikymas yra skirtingai interpretuojamas. Todėl, siekiant suprasti kokiais principais reikia vadovautis, norint tikslingai naudotis šią metodologiją, atliktas praktinis jos pritaikymas. Buvo prieita prie išvados, jog netinkamas šių metodų taikymas gali klaidinti visuomenę, o dar svarbiau, įstatymų kūrėjus. Taigi, darbo hipotezė pasitvirtino, kad draudimas teikti individualiu atveju reikalingą medicinos mokslo įrodymais pagrįstą nevaisingumo gydymą prieštarauja paciento teisėms.
It took 15 years to pass the law in Lithuania of assisted reproduction to get passed since its initial presentation to the parliament. Nevertheless despite enforced law in place, observing its path towards approval parliament was always split in half with two opposing sides where one side was declaring a conservative approach which spoke out for embryo protection and liberal approach which pursued families with infertility problems to be able to get their lawful right to effective and safe medical solutions based on scientific progress and nurtured to individual needs. The task of this work is to find a reason which resulted in laws not being in place for the past period.
It is also very important to note that Parlament was provided with various recommendations that mislead in the process of confirming the most appropriate infertility treatment choice. Therefore, the main purpose of this work is to deliver an analysis whether it is lawful to decline the patience right to scientifically based, most effective and safe treatment based on the pretext of embryos protection beliefs.
The patient's right to quality health care regulation in the Republic of Lithuania have a sufficient legal basis to the Assisted Reproduction Law violate patients and infertile couples Constitutional right to high-quality, efficient medical science with proven methods based on fertility treatment. Information technology opportunities, legal and medical expertise availability due to the fact that today's patients and patient organizations have a growing influence in medical problems affecting legislation. In order to achieve this goal, this work will refer to patients right to get quality health care services as well as retro - actions of denial of freedom of choice to get services which would best serve the cause. The process will unveil that such prohibitions result in patients seeking help outside the country, in other words, reproductional tourism.
Assisted Reproduction Law does not prevent the use of modern technology. This is a complicated assisted reproduction procedures and greatly reduces their success. The law regulating infertility treatment is very important to take into account the experience of other countries in Europe and the case law. Patients in the European Union has the ability to move freely for therapeutic purposes, and the EU Member States belonging are free to adopt legislation regulating medicine. This means that different countries have different laws regulating infertility treatments, and patients are free to go abroad for treatment, even if their reproductive health care abroad in violation of their country's legislation. Also in this work particular attention is paid to the Maltese and Italian legal regulation of assisted reproduction law model. Lithuania offered so-called "conservative" Assisted Reproduction Law were drafted according to the model of the two countries.
This work will also approach the issue of doctors obligation to ensure the most suitable treatment and the standards applied. Doctor's legal responsibility to ensure the quality of services has increased, and its activities must conform to high medical standards. In selecting the individual patient's treatment, the doctor has to rely not only on good clinical practice, but also, and above all - the modern science of evidence based medicine and guidelines provided by the World Medical community. To the doctor and the patient choose the most appropriate treatment, they need autonomy. Doctor and patient autonomy principle may be restricted by law, so finding optimal solutions, productive dialogue between medical professionals and legislators is very important.
The most important part of this work is the dilemma of applying scientifically based medicinal principles. Infertility in the International Classification of Diseases recognized disease, and infertility solution to the problem must be subject to the same treatment and service delivery principles as any other disease. Both recommendations given to Parlament by the medical society are based on proven scientific facts although the interpretation of application varies. This is why it is very important that the multiplicity of opinions has to be proven on the basis of “Evidence based medicine”, meaning, use of medical information based on the best information in the medical literature. Also the information has to be critically analyzed by medical professionals and relevant to the condition being treated. Evidence based methodology helps to distinguishe between recognized scientific theories and what is called “Junk Science”. So, therefore in order to understand the principles to follow and to correctly adapt the methodology practical approach was taken.
Developed countries laws on assisted reproduction techniques should be developed and approved in accordance with the medical logic, be scientifically justified. These methods successfully applied around the world, scientifically approved and supervised by the international community of scientists. In conclusion, wrong application of methodology may mislead the public and more importantly lawmakers. Consequently confirming the hypothesis of this work, that prohibition of applying the individual approach to needed treatment based on scientifically proven solutions contradict to the rights of the patient to get the best possible treatment. |
