Latvia Association of Professional Health Care Chaplaincy
1. The legal regulations on end of life choices in Latvia
There are no specific regulations and laws regarding end of life choices in Latvia.
However a year ago Cabinet of Ministers in Latvia supported the “National Cancer Control program of Latvia 2009 – 2015” which stressed the importance of the quality of life of patients with cancer and paliative care as a specific part of that program.
There is not law that speaks or even mentions positively or negatively euthanasia or asisted suicide.
Criminal Law does not mention specifically any act that could be directly or indirectly asociated with euthanasia or asisted suicide. According to the Law any kind of such act is interpreted as a murder.
There is no legislation that mentions specifically DNR (do-not-resusitate) orders.
The Patients' Rights Law speaks about general patients' rights to information, physicians' duty to obtain informed consent from patienst or their proxy and patients' rights to agree or refuse treatment, partly or fully. Refusal should be signed by the patient or his/her proxy. Nevertheless the Law ir rather generaly written and it allows various interpretations including rather limited rights for patient's and his/her family' to take part and influence decisions regarding treatment.
Patients' rights to spiritual care are noted and acknowledged in the recently adopted Patients' Rights Law in a separate section.
Medical Treatment Law speaks about the physician's duties in Section 41 which reserves the final decision for the physician:
“A doctor shall obtain the consent of a patient for medical treatment, therefore the doctor has a duty to provide information to the patient in a comprehensible way regarding the diagnosis of the illness, the planned examination and medical treatment, as well as regarding other medical treatment methods and prognosis. The doctor has a duty to explain and inform the patient of the possible effects and complications of the disease. The doctor shall inform the patient of possible side-effects of the prescribed medical substances or medical treatment methods. The doctor may provide incomplete information to the patient regarding the diagnosis and prognosis of the disease if he or she considers that such information may cause deterioration of the state of health of the patient. (Medical Treatment Law of Latvia, Section 41).
2. The view of Latvian Churches on end of life choices?
The main religious organizations in Latvia share a negative attitude to the legalization of euthanasia and assisted suicide and actively take part in public debate about these questions. As the main Christian Churches (Evangelical Lutheran, Roman Catholic, Russian Orthodox, Baptist, United Methodist, Adventist, Pentacostal) enjoy authority in society's life, their voice is regarded as important and influential.
Although religious organizations have a common view on euthanasia and asisted suicide, t there could and should be more proactive work regarding patients' rights on information, treatment choices, withholding/withdrawing life sustaining treatment.
3. The main tensions in the chaplains’ general practice concerning quality of end of life?
A very urgent problem in patient care at the end of life is the total lack of a developed palliative care system in Latvia. Recent years which were marked by financial crises do not give much hope for better years in the near future. But needs are growing progressively. The good news is that chaplains have been accepted as full members of the multidisciplinary palliative care team. This could not be said about curative/active treatment teams.
In medical thinking dying and death still is considered as a fault and doctors feel strained in talking about poor prognosis and often choose not to tell the truth as if it could harm the patient or treatment plan. Palliative care is still considered only at the very end of life. Fear of death is very characteristic for our society.
The medical community is not so homogenous as religious organizations regarding euthanasia/assited suicide although the majority are strongly against it. There are views that asisted suicide should be legalized but not euthanasia. Medical people, especially paliative care professionals, advocate developing and strengthening the paliative care system as the basic platform for defending people who struggle with progressive diseases. Withdrawing intra-venous nutrition, hydratation, artificial ventilation or any other life sustaining treatment is informaly considered as passive euthanasia. Advocating patients' rights to take part in decision making on one hand and facing helplessness and a passive, dependant position of patients and families on the other hand make the chaplains' work often rather challenging.
Although new Regulations on allied healthcare professions called "supportive health care professions" were adopted a year ago and professional heathcare chaplains have been included in this list of professions which means theyare considered as a profession directly involved in health care and treatment, there is resistance to including chaplains in healthcare teams. It depends more on the chaplains' personal and professional skills than on legislation. This conclusion strongly correlates with constant lack of professional supervision and learning possibilities for professional chaplains.
28 February 2010