Após regulamentação, cresce 690% o número de testamentos vitais lavrados no Brasil

12/08/2015Fonte: Colégio Notarial do Brasil - Seção São Paulo

Documento relata cuidados, tratamentos e procedimentos aos quais um paciente em estado terminal quer ser submetido

 A cada ano que passa, aumenta o número de pessoas que se preocupam em indicar seus desejos, caso fiquem impossibilitadas de manifestar suas vontades. Segundo levantamento do Colégio Notarial do Brasil – Seção São Paulo, em 2014, 548 brasileiros recorreram ao testamento vital, número 16% maior do que o registrado no período anterior. O documento que é lavrado por um tabelião de notas, permite ao paciente, antecipadamente, expressar sua vontade quanto às diretrizes de um tratamento médico futuro, caso fique impossibilitado de manifestar sua vontade em virtude de acidente ou doença grave.

Por meio desse documento é possível determinar, por exemplo, que a pessoa não deseja submeter-se a tratamento para prolongamento da vida de modo artificial.  De acordo com a Resolução 1995/2012 do Conselho Federal de Medicina (CFM), os médicos deverão levar em consideração a vontade do paciente incapacitado de comunicar-se caso tenha deixado previamente expressos os seus desejos sobre os cuidados e tratamentos que quer ou não receber, respeitando-se as disposições do Código de Ética Médica.

A resolução do CFM ajudou a impulsionar e disseminar a lavratura de testamentos vitais em todo o país. Um ano antes da regulamentação, por exemplo, os cartórios de notas brasileiros haviam lavrado apenas 69 documentos. Passados dois anos, a lavratura do documento cresceu 690%, fechando 2014 com 548. Destaque para São Paulo, Mato Grosso e Rio Grande do Sul, os estados que mais realizaram esse tipo de documento. Somente em 2014, as entidades federativas documentaram respectivamente, 377, 86 e 53 testamentos vitais.

“Qualquer pessoa plenamente capaz pode fazer seu testamento vital perante um tabelião de notas. Basta apresentar seus documentos pessoais e declarar que tipo de cláusulas deseja incluir. A escritura será apresentada posteriormente aos médicos pelos familiares ou por quem o declarante indicar caso futuramente ele seja acometido por uma doença grave ou fique impossibilitado de manifestar sua vontade em decorrência de algum acidente”, detalha o presidente do Colégio Notarial do Brasil, Carlos Fernando Brasil Chaves.

O preço desse documento é R$ 326,27 em São Paulo e pode variar de estado para estado.

Diretivas Antecipadas de Vontade

No testamento vital não se pode prever a eutanásia - procedimento proibido no Brasil e que ocorre quando o médico induz a morte do paciente. Na verdade, o testamento vital não se trata verdadeiramente de um testamento, mas de uma escritura pública declaratória que produzirá efeitos enquanto o testador ainda estiver vivo, com a finalidade de garantir a dignidade do tratamento do paciente.

“A legislação brasileira não permite a eutanásia, mas é possível determinar a qual tipo de tratamento a pessoa quer ser submetida. Além disso, no documento, a pessoa pode designar um ou mais representantes, que tomem decisões sobre tratamentos em nome dela quando já não estiver mais consciente”, explica Carlos Fernando Brasil Chaves, presidente da seção São Paulo do CNB.

10 motivos para fazer testamento vital (ou DAV):

Dignidade

A Declaração Antecipada de Vontade (DAV) permite que o paciente escolha previamente a que tipo de tratamento médico deseja ou não ser submetido, preservando o direito à vida e morte dignas.

Tranquilidade

A DAV não antecipa a morte do paciente (eutanásia), apenas garante que ela ocorra de modo natural ou permite o seu retardamento, conforme a vontade do paciente.

Respeito

A DAV feita por escritura pública gera tranquilidade ao paciente de que a sua vontade será respeitada quando ele não puder mais se manifestar.

Paz

A DAV proporciona maior conforto e menos sofrimento para a família do paciente no momento de dor.

Segurança

A escritura pública oferece maior segurança para o médico cumprir integralmente os desejos do paciente, resguardando-o contra eventuais pressões de seus familiares.

Autonomia

A DAV pode ser feita por qualquer pessoa, a qualquer tempo, desde que ela esteja lúcida e consiga expressar a sua vontade quanto ao destino de seu próprio corpo.

Lealdade

Pela DAV é possível nomear um procurador para ficar responsável por apresentar aos médicos e à família do paciente, os desejos e escolhas antecipadamente feitas por ele.

Revogabilidade

A DAV pode ser alterada ou revogada a qualquer tempo, desde que o paciente esteja lúcido.

Perpetuidade

A DAV fica eternamente arquivada em cartório, possibilitando a obtenção de segunda via (certidão) do ato a qualquer tempo.

Liberdade

É livre a escolha do tabelião de notas qualquer que seja o domicílio da parte.

 

Acordão - Autorização Judicial para interrupção de gestação de gêmeos siameses portadores de gemelaridade imperfeita

OITAVA CÂMARA CRIMINAL
HABEAS CORPUS Nº 0023285-95.2015.8.19.0000
IMPETRANTE: DRª L M
PACIENTE 1: J
PACIENTE 2: L
AUT. COATORA: MM JUÍZA DA 4ª VARA CRIMINAL DA COMARCA DA CAPITAL
RELATOR: DES. CLAUDIO TAVARES DE OLIVEIRA JUNIOR

HABEAS CORPUS. GEMELARIDADE IMPERFEITA, ALTAMENTE RARA E GRAVE. IMPETRANTE QUE SE INSURGE CONTRA A SENTENÇA NA QUAL A MM JUÍZA JULGOU EXTINTO, SEM RESOLUÇÃO DE MÉRITO, O PROCESSO EM QUE SE PRETENDIA A OBTENÇÃO DE ALVARÁ JUDICIAL, COM O FIM DE AUTORIZAR A INTERRUPÇÃO DE GRAVIDEZ. ORDEM CONCEDIDA.

leia na íntegra o acórdão

Genetic Testing On Embryos Faces Ballot Box Test

 By Marc-André Miserez

 The question of whether Switzerland should allow the testing of embryos conceived in vitro (IVF) for genetic defects and serious illnesses will be put to a nationwide vote on June 14.

But the result of the ballot – a constitutional amendment – is set to be challenged to a second vote at a later stage. A group led by members of a small centrist party pledged to collect signatures to bring down a law already prepared by parliament to implement the constitutional reform.

A practice which is already common in several neighbouring countries, pre-implantation genetic diagnosis (PGD) is the genetic analysis of embryos conceived in vitro before they are implanted into the mother’s uterus.

Article 119 of the Swiss constitution already covers medically assisted reproduction and genetic engineering but makes no mention of PGD. Nor is it mentioned in the proposed amendment of that article on which the Swiss will vote in June.

The proposed amendment may be a minor modification to the text, but it could have major consequences.

Currently the constitution allows for the creation in vitro of only the number of embryos “that can be immediately implanted”, which in practice is three. If the amendment is passed, it will be possible to create as many “as necessary for medically assisted reproduction”, which could be up to 12 embryos.

 

Extended scope

 

However, following extensive debate on the issue, the parliament has already effectively extended the scope of the law as it would be applied should the amendment pass the ballot box test.

Aside from the creation of 12 embryos per treatment cycle, the law would authorise testing the embryos for incurable diseases and genetic anomalies such as Down syndrome.

It would also, with a view to the risks associated with multiple births, allow the freezing of embryos so that just one could be implanted at a time and the others saved for future attempts.

The parliament declined however, to authorise the creation of embryos to harvest stem cells for the sole purpose of providing medical treatment to a sibling.

While the law could seem restrictive compared to those of other western countries, it remains too liberal in the eyes of many Swiss.

The small centrist Protestant Party – its grassroots traditionally being members of the Protestant and Evangelical Free churches - has already announced its intention to attack the law via referendum, and to force a second vote.

The party can realistically count on support from all corners, with responses to such emotive issues usually driven by personal convictions rather than political alliances.

 

Baby selection

 

Marco Romano, a parliamentarian for the centre Christian Democrats, says allowing PGD could open the door to any manner of as yet undiscovered technological procedures being carried out on human embryos.

Romano, who was “tentatively in favour” of PGD early in the debate, says his position is “absolutely not dictated by religion”, but he changed his mind after having visited a reproductive medicine clinic in Lugano.

“There I saw the film I did not want to see,” he says.

“I spoke at length with a professor and I had the impression that the specialists want to use anything that technology makes possible, to the point of playing with life, reducing it to a point that is almost banal,” Romano adds.

“In the United States, 10% of testing is used to determine the sex of the child. In Switzerland, the parliamentary debate very clearly showed the willingness of some people to go even further. In accepting PGD, we open a door and we don’t know exactly where it will take us.”

But Romano is in favour of allowing prenatal diagnostic testing on foetuses in the uterus, which is allowed in Switzerland and can lead some parents to a decision to abort the pregnancy, possible up to 12 weeks.

“Sometimes it is necessary. But with PGD we are going a step further. It becomes a selection, the tendency to want a made-to-measure baby. For me, it’s the moment to say stop. I don’t want to allow the possibility of greater selection,” he says.

 

Creating certainty

 

Supporters of PGD argue that allowing the procedure will add a layer of certainty for would-be parents.

“We have to clearly communicate what this will allow for couples, instead of starting to enter into all the fantasies about medically assisted reproduction,” says Liliane Maury Pasquier, senator for the leftwing Social Democrats.

A trained midwife and member of the commission that examined the parliamentary project, Maury Pasquier says the “obstacle course” that couples navigate before turning to in vitro fertilisation – often years of unsuccessful attempts to conceive, the shock of being diagnosed as infertile and/or with a serious transmissible disease - is “painful and humanly difficult”.

“When a couple starts in vitro fertilisation, there is already quite a history that has preceded it,” she says.

“And finally, they find themselves with an embryo that is ready to be implanted and if PGD is not done [many couples will have this procedure in neighbouring countries, ndlr], we have the beginnings of a pregnancy, in which a woman has placed all her hopes … or not at all, because she is scared of what a PGD could have revealed. And so it adds even more weeks of uncertainty.”

Maury Pasquier argues allowing PGD will provide mothers and the potential children with “more security” and help to “avoid adding suffering to suffering”.

 

Technology and personal choice

 

Romano does not deny that Switzerland – like all the older countries – needs more children. However he argues that a baby is “a gift, surely the most beautiful that we can receive, but it is not a right.

“We cannot legislate it. But today, we have a tendency to see rights for everyone. And when I see what happens in other countries and the possibilities that technology offers, it scares me.”

Maury Pasquier argues that the choice of whether to bring a child into the world, or to have a handicapped child, must remain “eminently personal”.

“At the moment of prenatal diagnostic testing (on a foetus), we leave the choice up to the parents. So we should also leave it to them at the moment of a PGD,” she says.

“If we’re talking about human dignity, a 12-week-old foetus has potentially more than a five-day-old embryo,” Maury Pasquier adds.

 

Translated from French by Sophie Douez, swissinfo.ch

 

Disabled divided

 

Arguably those for whom the issue of preimplantation genetic diagnosis (PGD) is most relevant, the various Swiss associations for the disabled are divided on the issue.

Those who support allowing the procedure include the umbrella organisation Integration Handicap which applauds a reform that “gives couples who carry serious hereditary diseases the possibility to not pass the disease on to their children”, says the organisation’s equality manager Caroline Hess Klein.

In opposition, a coalition of 17 organisations is calling for a No vote on June 14. Secretary of the Agile group, Magali Corpataux says authorising PGD will mean parents run the risk “of reproaching themselves for having the choice and not making the choice that is considered right”.

However both groups oppose the law already voted by parliament which they argue goes too far. “There is a fear that, through this, it will be society that decides which life is worth living or not,” says Hess Klein.

Gillick Competence

Gillick competence is a term originating in England and is used in medical law to decide whether a child (16 years or younger) is able to consent to his or her own medical treatment, without the need for parental permission or knowledge.

The standard is based on a decision of the House of Lords in the case Gillick v West Norfolk and Wisbech Area Health Authority[1985] (1985) 3 All ER 402 (HL). The case is binding in England and Wales, and has been approved in Australia, Canada and New Zealand. Similar provision is made in Scotland by The Age of Legal Capacity (Scotland) Act 1991. In Northern Ireland, although separate legislation applies, the then Department of Health and Social Services Northern Ireland stated that there was no reason to suppose that the House of Lords' decision would not be followed by the Northern Ireland Courts. (Wikipedia)

*****

Gillick (A.P.) (Respondent)
v.
West Norfolk and Wisbech Area Health Authority and the
Department of Health and Social Security (Appellants)
(England)
JUDGMENT
Die Jovis 17° Octobris 1985

The main question in this appeal is whether a doctor can

lawfully prescribe contraception for a girl under 16 years of age,
without the consent of her parents. The second appellant, the
Department of Health and Social Security ("the D.H.S.S.")
maintains that a doctor can do so. The respondent, Mrs. Gillick,
maintains that he cannot. The first appellant, West Norfolk and
Wisbech Area Health Authority, was not represented when the
appeal reached this House, but in the Court of Appeal they were
represented by the same counsel as the D.H.S.S.

Full text of decision