Ethics, legislation and health-care organisation in Czech practice
Introduction
This domain tests Czech health law as applied to gynaecology and obstetrics: consent, confidentiality, abortion and sterilisation rules, assisted reproduction, documentation and the organisation of perinatal care.
Legal framework
- Act 372/2011 on health services: informed consent, the right to refuse treatment, the advance directive (dříve vyslovené přání), documentation and confidentiality. A competent adult may refuse even life-saving treatment.
- Act 373/2011 on specific health services: sterilisation (from 21 years, on written request, with counselling and a waiting period), assisted reproduction, sex reassignment and research.
- Abortion is governed by Act 66/1986: on request up to 12 weeks, up to 24 weeks for genetic indication, beyond that only to save the woman's life or for a lethal fetal anomaly. Minors require the involvement of a legal guardian and notification duties apply.
Consent and capacity
- Consent must be informed: diagnosis, proposed procedure, alternatives, material risks and consequences. Written consent is required for operations, sterilisation, abortion and research.
- Treatment without consent is permitted in an emergency when the patient cannot consent and delay would endanger life.
- Conscientious objection is recognised but must never deprive a patient of emergency care; the doctor must arrange referral.
Organisation of Czech perinatal care
- Perinatal centres are stratified by the level of neonatal intensive care; a fetus under 32 weeks or under 1500 g should be delivered where appropriate NICU care exists.
- Regionalisation, in-utero transport and perinatal mortality audit are expected knowledge.
- Maternal death is a notifiable event subject to national confidential enquiry.
Worked example
A 16-year-old requests termination at 9 weeks. In Czech practice she is capable of consenting to the procedure herself, but the law requires notification and involvement of her legal representative. The doctor confirms gestational age by ultrasound, excludes ectopic pregnancy, offers contraception advice and documents counselling about alternatives. Confidentiality towards the parents is limited by the statutory notification duty.
Traps
- Treating a patient's request as sufficient for sterilisation without the statutory age and waiting requirements.
- Discussing a diagnosis with relatives without consent.
- Overriding an advance directive because relatives disagree with it.
- Failing to document a patient's refusal of treatment.