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Os fundamentos constitucionais das diretivas antecipadas de vontade em matéria de cuidados de saúde e a dogmática jurídica para a validade e a eficácia das disposições
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As diretivas antecipadas permitem antecipar o exercício da autonomia pessoal, mediante projeção da vontade, relativa aos cuidados de saúde e fim de vida, para situações nas quais a pessoa não poderá exercê-la diretamente. A previsão desses instrumentos nos Estados democráticos e plurais é garantia dos direitos fundamentais à vida digna e à liberdade. Em uma leitura conjunta desses direitos, verifica-se que a vida que se protege é aquela que confere liberdade para o desenvolvimento da personalidade e o exercício da autonomia pessoal, sempre na promoção da dignidade, que encontra em cada ser humano a sua medida própria. A morte como um elemento da vida conduz a defesa de um direito a um fim de vida digno, como digna deve ser toda a existência da pessoa. As diretivas surgiram em decorrência de prolongamentos artificiais da vida, muitas vezes de forma irracional e degradante para a pessoa. A impossibilidade de comunicação e a inexistência de manifestação prévia acabam por impor a manutenção artificial da vida. Debates sobre eutanásia e suicídio assistido não tem vínculo direto com as diretivas antecipadas, embora também digam respeito a questões de fim de vida. As diretivas são um espaço para as determinações sobre cuidados de saúde dentro dos consensos éticos alcançados pelas sociedades nas quais forem aceitas. O objeto e conteúdo, pois, deverão estar de acordo com a legislação do local onde forem emitidas. A pesquisa investiga o caminho de criação e desenvolvimento desses instrumentos em vários países. Centra-se na Lei portuguesa nº 25/2012, que tem como objeto específico as diretivas antecipadas e, assim, é a mais detalhada. Analisa-se também sua utilização no Brasil, país no qual são disciplinadas apenas pelo Conselho Federal de Medicina. Como instrumento de promoção pessoal, que surge na esteira das alterações da relação médico/paciente e da teoria do consentimento informado, já inserida nos debates bioéticos, é necessário conferir a esses atos que já existem no mundo dos fatos o aval jurídico que lhes permita produzir os efeitos pretendidos. Essa tese dirige-se para o reconhecimento dos fundamentos constitucionais das diretivas e sua adaptação às categorias do direito.
Advance directives allow the previous exercise of person autonomy, through expression of a will, concerning health care and end of life, to situations in which the person cannot exercise it directly. The prevision of these instruments in a democratic and pluralistic state guarantees fundamental rights to liberty and a decent life. In a joint reading of these rights, it turns out that a life which is protected is one that gives freedom to the development of personality and the exercise of personal autonomy, always promoting the dignity that is found in each human being in its own measure. Death as an element of life leads to the defence of the right to a dignified death, as dignified as the person's whole existence should be. Directives arose as a result of the artificial prolongation of life, which is often irrational and degrading. The impossibility of communication and lack of prior approval end up imposing this artificial maintenance. Debates about euthanasia and assisted suicide have no direct link with advance directives, although they also concern end of life issues. These instruments are a space for stipulations on health care within the ethical consensus reached by the societies in which they are accepted. The subject and content of directives, therefore, must be in accordance with the law of the place where they are issued. This research investigates the path of creation and development of these instruments in several countries. It focuses on the Portuguese Law, No. 25/2012, which has the specific purpose of advance directives and thus is the most detailed. It also analyses its use in Brazil, a country where such acts are disciplined only by the Federal Council of Medicine. These instruments are a tool of personal promotion, coming in the wake of changes in the doctor/patient relationship and the theory of informed consent, as inserted in bioethical debates, it is necessary to give such directives, which already exist in the world of facts the legal backing that allows them to produce their intended effect. This thesis is directed to the recognition of the constitutional foundations of directives and their adaptation to the categories of law.
Advance directives allow the previous exercise of person autonomy, through expression of a will, concerning health care and end of life, to situations in which the person cannot exercise it directly. The prevision of these instruments in a democratic and pluralistic state guarantees fundamental rights to liberty and a decent life. In a joint reading of these rights, it turns out that a life which is protected is one that gives freedom to the development of personality and the exercise of personal autonomy, always promoting the dignity that is found in each human being in its own measure. Death as an element of life leads to the defence of the right to a dignified death, as dignified as the person's whole existence should be. Directives arose as a result of the artificial prolongation of life, which is often irrational and degrading. The impossibility of communication and lack of prior approval end up imposing this artificial maintenance. Debates about euthanasia and assisted suicide have no direct link with advance directives, although they also concern end of life issues. These instruments are a space for stipulations on health care within the ethical consensus reached by the societies in which they are accepted. The subject and content of directives, therefore, must be in accordance with the law of the place where they are issued. This research investigates the path of creation and development of these instruments in several countries. It focuses on the Portuguese Law, No. 25/2012, which has the specific purpose of advance directives and thus is the most detailed. It also analyses its use in Brazil, a country where such acts are disciplined only by the Federal Council of Medicine. These instruments are a tool of personal promotion, coming in the wake of changes in the doctor/patient relationship and the theory of informed consent, as inserted in bioethical debates, it is necessary to give such directives, which already exist in the world of facts the legal backing that allows them to produce their intended effect. This thesis is directed to the recognition of the constitutional foundations of directives and their adaptation to the categories of law.
Descrição
Tese de doutoramento, Direito (Ciências Jurídico-Políticas), Universidade de Lisboa, Faculdade de Direito, 2018
Palavras-chave
Teses de doutoramento - 2018