Res\u00fcsitasyon (CPR), ya\u015fam ile \u00f6l\u00fcm aras\u0131ndaki kritik e\u015fikte \u00f6zel bir \u00f6neme sahiptir. Ancak CPR\u2019\u0131n ba\u015far\u0131 \u015fans\u0131 d\u00fc\u015f\u00fck oldu\u011funda, ya\u015fam\u0131n\u0131n son evresinde bulunan hastalarla ilgilenen hekimler ve sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131, hem etik hem de hukuki a\u00e7\u0131dan karma\u015f\u0131k ikilemlerle kar\u015f\u0131la\u015fmaktad\u0131r. Bu kararlar, hekimlerin manevi ve etik y\u00fck\u00fcn\u00fc art\u0131r\u0131rken, hukuki sonu\u00e7lara ili\u015fkin kayg\u0131lar da karar verme s\u00fcrecini zorla\u015ft\u0131rmaktad\u0131r.<\/p>\n
\u201cDo Not Resuscitate\u201d (DNR) talimat\u0131, kalp veya solunum durdu\u011funda, \u00f6nceden verilmi\u015f t\u0131bbi talimat do\u011frultusunda CPR uygulanmamas\u0131n\u0131 ifade eder. Hasta haklar\u0131 \u00e7er\u00e7evesinde, ayd\u0131nlat\u0131lm\u0131\u015f onam olmaks\u0131z\u0131n yap\u0131lan t\u0131bbi m\u00fcdahaleler hukuka ayk\u0131r\u0131d\u0131r. Bu nedenle, hekimin hastan\u0131n tedaviyi reddetme iradesine sayg\u0131 g\u00f6stermesi gerekir. Ancak, DNR talimat\u0131n\u0131n hukuken ge\u00e7erlili\u011fi ve hekimin m\u00fcdahale y\u00fck\u00fcml\u00fcl\u00fc\u011f\u00fc konusundaki belirsizlikler tart\u0131\u015fma konusudur.<\/p>\n
T\u00fcrkiye\u2019de DNR talimatlar\u0131na dair \u00f6zel bir yasal d\u00fczenleme bulunmamaktad\u0131r. Bununla birlikte, hasta \u00f6zerkli\u011fi ve ya\u015fam hakk\u0131 kapsam\u0131nda hastan\u0131n tedaviyi reddetme hakk\u0131; Biyot\u0131p S\u00f6zle\u015fmesi, Hasta Haklar\u0131 Y\u00f6netmeli\u011fi ve T\u00fcrk Medeni Kanunu gibi d\u00fczenlemelerle g\u00fcvence alt\u0131na al\u0131nm\u0131\u015ft\u0131r. Ayr\u0131ca Anayasa\u2019da da bireyin sa\u011fl\u0131k ve v\u00fccut b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fcn korunmas\u0131 temel hak olarak yer almaktad\u0131r.<\/p>\n
Hekimler a\u00e7\u0131s\u0131ndan ise T\u0131bbi Deontoloji T\u00fcz\u00fc\u011f\u00fc, t\u0131bbi m\u00fcdahale yapma y\u00fck\u00fcml\u00fcl\u00fc\u011f\u00fcn\u00fc ve mesleki \u00f6zerkli\u011fi d\u00fczenler. Hekimin, tedavinin gereklili\u011fi ve yararl\u0131l\u0131\u011f\u0131na karar verme yetkisi vard\u0131r ancak bu karar hastan\u0131n r\u0131zas\u0131na ba\u011fl\u0131d\u0131r. Hastan\u0131n ge\u00e7erli bir DNR iradesi varsa, hekim buna sayg\u0131 g\u00f6stermek zorundad\u0131r.<\/p>\n
Beyhude m\u00fcdahale, klinik ama\u00e7lara ula\u015fmada etkisi olmayan tedavi olarak tan\u0131mlanabilir. Hekimlik Meslek Eti\u011fi Kurallar\u0131\u2019na g\u00f6re, hekim, hastas\u0131na yarar sa\u011flamayaca\u011f\u0131n\u0131 bildi\u011fi bir tedavi uygulayamaz (md. 30).Bu kurallar, hekimin mesleki \u00f6zerkli\u011fine dayanarak, t\u0131bbi m\u00fcdahalenin gereklili\u011fi ve yararl\u0131l\u0131\u011f\u0131na karar verme yetkisinin yaln\u0131zca hekime ait oldu\u011funu belirtmektedir. Ancak bu karar, hastan\u0131n r\u0131zas\u0131 ile s\u0131n\u0131rl\u0131d\u0131r. E\u011fer hastan\u0131n , canland\u0131rma yap\u0131lmamas\u0131 y\u00f6n\u00fcnde hukuken ge\u00e7erli bir irade beyan\u0131 varsa, hekim bu iradeye sayg\u0131 g\u00f6stermekle y\u00fck\u00fcml\u00fcd\u00fcr.<\/p>\n
Yarg\u0131tay kararlar\u0131 da hastan\u0131n sa\u011fl\u0131k ve beden b\u00fct\u00fcnl\u00fc\u011f\u00fcne ili\u015fkin karar verme yetkisinin hekime de\u011fil hastaya ait oldu\u011funu vurgulamaktad\u0131r. Bu nedenle, hastan\u0131n bilinci a\u00e7\u0131kken verdi\u011fi DNR talimat\u0131 ge\u00e7erli kabul edilmeli ve bilinci kapand\u0131\u011f\u0131nda bu m\u00fcdahaleden ka\u00e7\u0131n\u0131lmal\u0131d\u0131r.<\/p>\n
As\u0131l tart\u0131\u015fma, bilinci kapal\u0131 ve karar verme yetisi olmayan hastalarla ilgili durumlarda ne yap\u0131laca\u011f\u0131 noktas\u0131nda yo\u011funla\u015fmaktad\u0131r. Literat\u00fcrde, hastan\u0131n daha \u00f6nce tedaviyi reddetti\u011fi durumlarda, bilinci kapand\u0131ktan sonra da bu iradenin ge\u00e7erlili\u011fi korundu\u011fu y\u00f6n\u00fcnde genel bir g\u00f6r\u00fc\u015f birli\u011fi vard\u0131r fakat DNR talimatlar\u0131n\u0131n \u015fekli ve ba\u011flay\u0131c\u0131l\u0131\u011f\u0131 konusunda yasal bo\u015fluklar da bulunmaktad\u0131r. \u00d6rne\u011fin, DNR ifadesinin d\u00f6vme gibi kal\u0131c\u0131 y\u00f6ntemlerle bildirilmesi hukuken tart\u0131\u015fmal\u0131d\u0131r ve ge\u00e7erli kabul edilmemektedir.<\/p>\n
T\u0131bbi m\u00fcdahalenin zorunlulu\u011fu bulundu\u011funda, yaln\u0131zca hasta yak\u0131nlar\u0131n\u0131n talebi ile m\u00fcdahaleden ka\u00e7\u0131n\u0131lmas\u0131 hukuken m\u00fcmk\u00fcn de\u011fildir. Hekim, t\u0131bbi de\u011ferlendirmesi sonucunda res\u00fcsitasyonun gereksiz oldu\u011funa kanaat getirirse, hukuki sorumlulu\u011fu do\u011fmaz. Ancak gereklilik halinde ve hastan\u0131n ge\u00e7erli bir DNR talimat\u0131 yoksa, m\u00fcdahaleden ka\u00e7\u0131nmak hukuki sorumlulu\u011fa yol a\u00e7abilmektedir.<\/p>\n
CPR Uygulamamak Su\u00e7 mu? T\u00fcrkiye\u2019de DNR Talimat\u0131n\u0131n Hukuki Boyutlar\u0131 ve Riskleri<\/p>\n
Doktrinde, iradesini a\u00e7\u0131klayamayacak durumda olan bir hastaya kardiyopulmoner res\u00fcsitasyon (CPR) uygulanmamas\u0131n\u0131n ceza hukuku a\u00e7\u0131s\u0131ndan nas\u0131l de\u011ferlendirilece\u011fi tart\u0131\u015fmal\u0131 bir konudur. T\u00fcrk hukukunda \u00f6tanaziyi a\u00e7\u0131k\u00e7a yasaklayan bir kanun bulunmamakla birlikte, Hasta Haklar\u0131 Y\u00f6netmeli\u011fi’nin 13. maddesinde \u00f6tanazinin yasak oldu\u011fu ve hayat hakk\u0131n\u0131n devredilemeyece\u011fi h\u00fckme ba\u011flanm\u0131\u015ft\u0131r. Bu ba\u011flamda, bireyin ya\u015fam\u0131 \u00fczerindeki tasarruf hakk\u0131n\u0131 bir ba\u015fkas\u0131na devretmesi m\u00fcmk\u00fcn g\u00f6r\u00fclmemekte; ki\u015finin r\u0131zas\u0131na dayansa dahi, bir ba\u015fkas\u0131 taraf\u0131ndan ya\u015fam\u0131na son verilmesi kasten adam \u00f6ld\u00fcrme su\u00e7u kapsam\u0131nda de\u011ferlendirilmekte ve cezaland\u0131r\u0131lmaktad\u0131r.<\/p>\n
Bu nedenle, DNR talimat\u0131n\u0131 uygulayarak CPR yapmayan hekimin T\u00fcrkiye\u2019de konuya ili\u015fkin yasal d\u00fczenlemelerin eksikli\u011fi ve durumun pasif \u00f6tanazi olarak de\u011ferlendirilmesi halinde cezai sorumlulu\u011fu g\u00fcndeme gelebilir. \u00d6te yandan, hastan\u0131n tedaviyi reddetme hakk\u0131 mevcuttur ve bu hakk\u0131n kullan\u0131lmas\u0131 \u00f6tanazi olarak nitelendirilmemektedir. Dolay\u0131s\u0131yla, hastan\u0131n iradesine uygun olarak hekimin m\u00fcdahalede bulunmamas\u0131 ceza sorumlulu\u011fu do\u011furmamal\u0131d\u0131r.<\/p>\n
Pasif \u00f6tanazi, hekimin hastaya gerekli tedaviyi uygulamamas\u0131, yani tedavi s\u00fcrecine m\u00fcdahale etmeyerek \u00f6l\u00fcm\u00fcn h\u0131zland\u0131r\u0131lmas\u0131 anlam\u0131na gelir. Ancak DNR talebinde, pasif \u00f6tanaziden farkl\u0131 olarak ya\u015fam destek tedavisi uygulanmaya devam edilir; sadece hastan\u0131n kalp ve solunumu durdu\u011funda d\u0131\u015far\u0131dan m\u00fcdahale yap\u0131lmaz. Bu a\u00e7\u0131dan DNR, pasif \u00f6tanaziden ayr\u0131l\u0131r ve hastan\u0131n ya\u015fam hakk\u0131 ile \u00f6zerklik prensiplerine uygun bir uygulama olarak de\u011ferlendirilebilir.<\/p>\n
T\u00fcrk Hukukunda DNR Talimat\u0131 ve T\u0131bbi Yarars\u0131zl\u0131k: Hasta \u00d6zerkli\u011fi ve Hekimlerin Hukuki Sorumlulu\u011fu<\/p>\n
T\u00fcrk hukukunda, hekimin t\u0131bbi yarars\u0131zl\u0131k gerek\u00e7esiyle kardiyopulmoner res\u00fcsitasyon (CPR) uygulamamas\u0131na olanak tan\u0131yan net bir hukuki \u00e7er\u00e7evenin olu\u015fturulmas\u0131 gerekmektedir. Hekimlerin, DNR (Do Not Resuscitate) taleplerini hukuki bir teredd\u00fct ya\u015famadan yerine getirebilmeleri i\u00e7in mevcut yasal d\u00fczenlemelerde bu do\u011frultuda de\u011fi\u015fiklik yap\u0131lmas\u0131 zorunludur.<\/p>\n
Bu ba\u011flamda, t\u0131bbi yarars\u0131zl\u0131k kavram\u0131 hasta \u00f6zerkli\u011fi ve yararl\u0131l\u0131k ilkeleri dikkate al\u0131narak dar ve kesin s\u0131n\u0131rlarla yorumlanmal\u0131; m\u00fcmk\u00fcn olan her durumda hastan\u0131n veya yasal temsilcisinin a\u00e7\u0131k r\u0131zas\u0131 al\u0131nmal\u0131d\u0131r.<\/p>\n
Biyot\u0131p S\u00f6zle\u015fmesi\u2019nin 9. maddesinde d\u00fczenlenen \u201ct\u0131bbi talimatname\u201d uygulamas\u0131n\u0131n hayata ge\u00e7irilmesi, \u00f6zellikle ya\u015fam\u0131n son d\u00f6nemine ili\u015fkin hukuki ve etik sorunlar\u0131n \u00e7\u00f6z\u00fcm\u00fcne \u00f6nemli katk\u0131 sa\u011flayacakt\u0131r. Bu uygulaman\u0131n etkin ve hukuka uygun bi\u00e7imde y\u00fcr\u00fct\u00fclebilmesi i\u00e7in kapsam ve usule ili\u015fkin ayr\u0131nt\u0131lar\u0131n bir y\u00f6netmelikle belirlenmesi gerekmektedir.<\/p>\n
Ki\u015filerin ya\u015fam\u0131n sonuna dair tercihleri, Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 taraf\u0131ndan olu\u015fturulacak bir sistem arac\u0131l\u0131\u011f\u0131yla kaydedilmeli ve bu bilgilere gerekti\u011finde sa\u011fl\u0131k meslek mensuplar\u0131 taraf\u0131ndan h\u0131zl\u0131 ve g\u00fcvenli \u015fekilde eri\u015filebilmelidir. \u00d6zellikle kronik hastal\u0131\u011f\u0131 bulunan bireylerin, bilinci yerindeyken tedavi s\u00fcrecinden sorumlu hekimlerine tercihlerini bildirmesi ve bu tercihleri zaman i\u00e7inde de\u011fi\u015ftirebilme olana\u011f\u0131na sahip olmas\u0131, bireyin gelece\u011fini belirleme hakk\u0131 a\u00e7\u0131s\u0131ndan b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n
Hukukumuzda hastan\u0131n DNR talebinin ge\u00e7erlili\u011fi a\u00e7\u0131s\u0131ndan en temel \u00f6l\u00e7\u00fct \u201ca\u00e7\u0131k r\u0131za\u201dd\u0131r. Bu r\u0131za her zaman geri al\u0131nabilir olmal\u0131 ve hasta karar\u0131ndan d\u00f6nebilme hakk\u0131na sahip olmal\u0131d\u0131r. Hastan\u0131n a\u00e7\u0131k iradesinin belirlenmesinde en g\u00fcvenilir y\u00f6ntem, DNR talebinin yaz\u0131l\u0131 bir form arac\u0131l\u0131\u011f\u0131yla hasta taraf\u0131ndan imzalanmas\u0131 ve bu belgenin t\u0131bbi kay\u0131tlara i\u015flenmesidir.<\/p>\n
T\u0131bbi yarars\u0131zl\u0131k karar\u0131 do\u011frultusunda hastaya CPR uygulanmamas\u0131 i\u00e7in bu kavram\u0131n dar ve a\u00e7\u0131k s\u0131n\u0131rlarla tan\u0131mlanmas\u0131 zorunludur. \u00d6zellikle DNR talimat\u0131 ile pasif \u00f6tanazi aras\u0131ndaki fark\u0131n net bi\u00e7imde ortaya konmas\u0131 b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n
Sonu\u00e7 olarak, DNR talimat\u0131n\u0131n uygulanmas\u0131; hasta \u00f6zerkli\u011fini, onurlu ya\u015fam hakk\u0131n\u0131, v\u00fccut b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fc ve ya\u015fam kalitesini koruyan temel ilkelere uygundur. Hasta, t\u0131bbi m\u00fcdahalelere ili\u015fkin kararlar\u0131n\u0131 \u00f6zg\u00fcrce verebilmeli ve bu iradesine r\u0131za g\u00f6sterilmeli; hekim de bu karara sayg\u0131 duymal\u0131d\u0131r.<\/p>\n
Ece ERTU\u011e \u00d6ZKARA<\/p>\n
Avukat, Hem\u015fire<\/p>\n
KAYNAK\u00c7A<\/p>\n
American Heart Association Guidelines for Cardiopulmonary Resuscitation (AHA) (2014-2015)(Eri\u015fim Tarihi: 01.07.2015)<\/p>\n
\u0130l\u00e7in G\u00f6nen\u00e7, F. (2015). Hukuki ve etik a\u00e7\u0131dan res\u00fcsitasyon. SD Sa\u011fl\u0131k D\u00fc\u015f\u00fcncesi ve T\u0131p K\u00fclt\u00fcr\u00fc Dergisi, (Sonbahar), 72\u201375.<\/p>\n
Australian Resuscitation Council, New Zealand Resuscitation Council (2014). Standards for Resuscitation: Clinical Practice and Education (Eri\u015fim tarihi: 01.07.2015)<\/p>\n
Burns J. P., Edwards, J., Johnson,J., Cassem,N. H., Truog,R. D. (2003) \u201cDo-not-resuscitate order after 25 years\u201d, Crit Care Med. Vol. 31, No. 5, s.1543-1550. Do Not Attempt Resuscitation Orders (Eri\u015fim Tarihi:01.07.2015)<\/p>\n
\u00d6zko\u00e7ak, I., Utku, T., & \u00d6zcengiz, D. (2022, Haziran 1). Palyatif bak\u0131mda etik \u00e7al\u0131\u015ftay\u0131 raporu: Panel II \u2013 Ya\u015fam sonunda etik ikilemler ve palyatif bak\u0131mda bo\u015funa\/yarars\u0131z tedavi. Palyatif Bak\u0131m Derne\u011fi.<\/p>\n
Erkekol, F. \u00d6., Numano\u011flu, N., G\u00fcrkan \u00d6. \u00dc., Kaya A. (2002), \u201cYo\u011fun Bak\u0131m \u00dcnitelerine \u0130li\u015fkin Etik Konular \u201c, T\u00fcrk Toraks Dergisi, C.3, S.3, s.307-316. European Resuscitation Council (ERC) (Eri\u015fi Tarihi: 01.07.2015) http:\/\/ministryofethics.co.uk\/?p=11&q=1 (Eri\u015fim<\/p>\n
Tarihi: 01.07.2015)<\/p>\n
\u00c7avdar, P. (2024). T\u00fcrk ve Amerikan hukuklar\u0131nda canland\u0131rmama talimat\u0131n\u0131n (DNR) hukuki a\u00e7\u0131dan de\u011ferlendirilmesi. Y\u00fcksek\u00f6\u011fretim ve Bilim Hukuku Dergisi, 9(1), 197\u2013239.<\/p>\n
http:\/\/www.cprcertificationonlinehq.com\/ahacpr-guidelines-latest-jan-2014\/(Eri\u015fim Tarihi:01.07.2015)<\/p>\n
http:\/\/www.ilcor.org\/consensus-2010\/costr-2010- documents\/ (Eri\u015fim Tarihi: 01.07.2015)<\/p>\n
http:\/\/www.nzrc.org.nz\/assets\/Uploads\/Guidelines\/ Standards-for-Resuscitation-Clinical-Practice-and-Education.pdf (Eri\u015fim Tarihi: 01.07.2015)<\/p>\n
http:\/\/www.tkd.org.tr\/~\/media\/files\/tkd\/kilavuzlar\/aha-acc\/aha-2012-kilavuzu.pdf(Eri\u015fim Tarihi:01.07.2015)<\/p>\n
https:\/\/www.erc.edu\/doclibrary\/en\/(Eri\u015fim Tarihi: 01.07.2015)<\/p>\n
https:\/\/www.wsma.org\/POLST (Eri\u015fim Tarihi:01.07.2015)<\/p>\n
International Liaison Committee on Resuscitation (ILCOR) (Eri\u015fim Tarihi: 01.07.2015)<\/p>\n
Kardiyopulmoner Res\u00fcsitasyon ve Acil Kardiyovask\u00fcler Bak\u0131m \u0130\u00e7in 2010 AHA K\u0131lavuzu (Eri\u015fimTarihi: 01.07.2015)<\/p>\n
Motro, H. (1983), \u201cMedicolegal Aspects of Cardiopulmonary Resuscitation\u201d, Med Law 2, s.103-111.<\/p>\n
Hakeri, H. (2022). T\u0131p hukuku a\u00e7\u0131s\u0131ndan palyatif bak\u0131m. Dicle Adalet Dergisi, 6(1), 1\u201310.<\/p>\n
Sert, H., G\u00f6zdemir, M., I\u015f\u0131k, B. (2007), \u201cKardiyopulmoner Canland\u0131rma Yap\u0131lmamas\u0131 Etik mi?\u201d, Yeni T\u0131p Dergisi; 24, s. 85-89.<\/p>\n
Sorum, P. C. (1994), \u201cLimiting Cardiopulmonary Resuscitation\u201d, Alb. L. Rew. 614, s. 617-645.<\/p>\n
Washington State Medical Association. (2011) Physicians Orders for Life Sustaining Treatment (Eri\u015fim Tarihi: 01.07.2015)<\/p>\n
\u200bRes\u00fcsitasyon (CPR), ya\u015fam ile \u00f6l\u00fcm aras\u0131ndaki kritik e\u015fikte \u00f6zel bir \u00f6neme sahiptir. Ancak CPR\u2019\u0131n ba\u015far\u0131 \u015fans\u0131 d\u00fc\u015f\u00fck oldu\u011funda, ya\u015fam\u0131n\u0131n son evresinde bulunan hastalarla ilgilenen hekimler ve sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131, hem etik hem de hukuki a\u00e7\u0131dan karma\u015f\u0131k ikilemlerle kar\u015f\u0131la\u015fmaktad\u0131r. Bu kararlar, hekimlerin manevi ve etik y\u00fck\u00fcn\u00fc art\u0131r\u0131rken, hukuki sonu\u00e7lara ili\u015fkin kayg\u0131lar da karar verme s\u00fcrecini zorla\u015ft\u0131rmaktad\u0131r.<\/p>\n
\u201cDo Not Resuscitate\u201d (DNR) talimat\u0131, kalp veya solunum durdu\u011funda, \u00f6nceden verilmi\u015f t\u0131bbi talimat do\u011frultusunda CPR uygulanmamas\u0131n\u0131 ifade eder. Hasta haklar\u0131 \u00e7er\u00e7evesinde, ayd\u0131nlat\u0131lm\u0131\u015f onam olmaks\u0131z\u0131n yap\u0131lan t\u0131bbi m\u00fcdahaleler hukuka ayk\u0131r\u0131d\u0131r. Bu nedenle, hekimin hastan\u0131n tedaviyi reddetme iradesine sayg\u0131 g\u00f6stermesi gerekir. Ancak, DNR talimat\u0131n\u0131n hukuken ge\u00e7erlili\u011fi ve hekimin m\u00fcdahale y\u00fck\u00fcml\u00fcl\u00fc\u011f\u00fc konusundaki belirsizlikler tart\u0131\u015fma konusudur.<\/p>\n
T\u00fcrkiye\u2019de DNR talimatlar\u0131na dair \u00f6zel bir yasal d\u00fczenleme bulunmamaktad\u0131r. Bununla birlikte, hasta \u00f6zerkli\u011fi ve ya\u015fam hakk\u0131 kapsam\u0131nda hastan\u0131n tedaviyi reddetme hakk\u0131; Biyot\u0131p S\u00f6zle\u015fmesi, Hasta Haklar\u0131 Y\u00f6netmeli\u011fi ve T\u00fcrk Medeni Kanunu gibi d\u00fczenlemelerle g\u00fcvence alt\u0131na al\u0131nm\u0131\u015ft\u0131r. Ayr\u0131ca Anayasa\u2019da da bireyin sa\u011fl\u0131k ve v\u00fccut b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fcn korunmas\u0131 temel hak olarak yer almaktad\u0131r.<\/p>\n
Hekimler a\u00e7\u0131s\u0131ndan ise T\u0131bbi Deontoloji T\u00fcz\u00fc\u011f\u00fc, t\u0131bbi m\u00fcdahale yapma y\u00fck\u00fcml\u00fcl\u00fc\u011f\u00fcn\u00fc ve mesleki \u00f6zerkli\u011fi d\u00fczenler. Hekimin, tedavinin gereklili\u011fi ve yararl\u0131l\u0131\u011f\u0131na karar verme yetkisi vard\u0131r ancak bu karar hastan\u0131n r\u0131zas\u0131na ba\u011fl\u0131d\u0131r. Hastan\u0131n ge\u00e7erli bir DNR iradesi varsa, hekim buna sayg\u0131 g\u00f6stermek zorundad\u0131r.<\/p>\n
Beyhude m\u00fcdahale, klinik ama\u00e7lara ula\u015fmada etkisi olmayan tedavi olarak tan\u0131mlanabilir. Hekimlik Meslek Eti\u011fi Kurallar\u0131\u2019na g\u00f6re, hekim, hastas\u0131na yarar sa\u011flamayaca\u011f\u0131n\u0131 bildi\u011fi bir tedavi uygulayamaz (md. 30).Bu kurallar, hekimin mesleki \u00f6zerkli\u011fine dayanarak, t\u0131bbi m\u00fcdahalenin gereklili\u011fi ve yararl\u0131l\u0131\u011f\u0131na karar verme yetkisinin yaln\u0131zca hekime ait oldu\u011funu belirtmektedir. Ancak bu karar, hastan\u0131n r\u0131zas\u0131 ile s\u0131n\u0131rl\u0131d\u0131r. E\u011fer hastan\u0131n , canland\u0131rma yap\u0131lmamas\u0131 y\u00f6n\u00fcnde hukuken ge\u00e7erli bir irade beyan\u0131 varsa, hekim bu iradeye sayg\u0131 g\u00f6stermekle y\u00fck\u00fcml\u00fcd\u00fcr.<\/p>\n
Yarg\u0131tay kararlar\u0131 da hastan\u0131n sa\u011fl\u0131k ve beden b\u00fct\u00fcnl\u00fc\u011f\u00fcne ili\u015fkin karar verme yetkisinin hekime de\u011fil hastaya ait oldu\u011funu vurgulamaktad\u0131r. Bu nedenle, hastan\u0131n bilinci a\u00e7\u0131kken verdi\u011fi DNR talimat\u0131 ge\u00e7erli kabul edilmeli ve bilinci kapand\u0131\u011f\u0131nda bu m\u00fcdahaleden ka\u00e7\u0131n\u0131lmal\u0131d\u0131r.<\/p>\n
As\u0131l tart\u0131\u015fma, bilinci kapal\u0131 ve karar verme yetisi olmayan hastalarla ilgili durumlarda ne yap\u0131laca\u011f\u0131 noktas\u0131nda yo\u011funla\u015fmaktad\u0131r. Literat\u00fcrde, hastan\u0131n daha \u00f6nce tedaviyi reddetti\u011fi durumlarda, bilinci kapand\u0131ktan sonra da bu iradenin ge\u00e7erlili\u011fi korundu\u011fu y\u00f6n\u00fcnde genel bir g\u00f6r\u00fc\u015f birli\u011fi vard\u0131r fakat DNR talimatlar\u0131n\u0131n \u015fekli ve ba\u011flay\u0131c\u0131l\u0131\u011f\u0131 konusunda yasal bo\u015fluklar da bulunmaktad\u0131r. \u00d6rne\u011fin, DNR ifadesinin d\u00f6vme gibi kal\u0131c\u0131 y\u00f6ntemlerle bildirilmesi hukuken tart\u0131\u015fmal\u0131d\u0131r ve ge\u00e7erli kabul edilmemektedir.<\/p>\n
T\u0131bbi m\u00fcdahalenin zorunlulu\u011fu bulundu\u011funda, yaln\u0131zca hasta yak\u0131nlar\u0131n\u0131n talebi ile m\u00fcdahaleden ka\u00e7\u0131n\u0131lmas\u0131 hukuken m\u00fcmk\u00fcn de\u011fildir. Hekim, t\u0131bbi de\u011ferlendirmesi sonucunda res\u00fcsitasyonun gereksiz oldu\u011funa kanaat getirirse, hukuki sorumlulu\u011fu do\u011fmaz. Ancak gereklilik halinde ve hastan\u0131n ge\u00e7erli bir DNR talimat\u0131 yoksa, m\u00fcdahaleden ka\u00e7\u0131nmak hukuki sorumlulu\u011fa yol a\u00e7abilmektedir.<\/p>\n
CPR Uygulamamak Su\u00e7 mu? T\u00fcrkiye\u2019de DNR Talimat\u0131n\u0131n Hukuki Boyutlar\u0131 ve Riskleri<\/p>\n
Doktrinde, iradesini a\u00e7\u0131klayamayacak durumda olan bir hastaya kardiyopulmoner res\u00fcsitasyon (CPR) uygulanmamas\u0131n\u0131n ceza hukuku a\u00e7\u0131s\u0131ndan nas\u0131l de\u011ferlendirilece\u011fi tart\u0131\u015fmal\u0131 bir konudur. T\u00fcrk hukukunda \u00f6tanaziyi a\u00e7\u0131k\u00e7a yasaklayan bir kanun bulunmamakla birlikte, Hasta Haklar\u0131 Y\u00f6netmeli\u011fi’nin 13. maddesinde \u00f6tanazinin yasak oldu\u011fu ve hayat hakk\u0131n\u0131n devredilemeyece\u011fi h\u00fckme ba\u011flanm\u0131\u015ft\u0131r. Bu ba\u011flamda, bireyin ya\u015fam\u0131 \u00fczerindeki tasarruf hakk\u0131n\u0131 bir ba\u015fkas\u0131na devretmesi m\u00fcmk\u00fcn g\u00f6r\u00fclmemekte; ki\u015finin r\u0131zas\u0131na dayansa dahi, bir ba\u015fkas\u0131 taraf\u0131ndan ya\u015fam\u0131na son verilmesi kasten adam \u00f6ld\u00fcrme su\u00e7u kapsam\u0131nda de\u011ferlendirilmekte ve cezaland\u0131r\u0131lmaktad\u0131r.<\/p>\n
Bu nedenle, DNR talimat\u0131n\u0131 uygulayarak CPR yapmayan hekimin T\u00fcrkiye\u2019de konuya ili\u015fkin yasal d\u00fczenlemelerin eksikli\u011fi ve durumun pasif \u00f6tanazi olarak de\u011ferlendirilmesi halinde cezai sorumlulu\u011fu g\u00fcndeme gelebilir. \u00d6te yandan, hastan\u0131n tedaviyi reddetme hakk\u0131 mevcuttur ve bu hakk\u0131n kullan\u0131lmas\u0131 \u00f6tanazi olarak nitelendirilmemektedir. Dolay\u0131s\u0131yla, hastan\u0131n iradesine uygun olarak hekimin m\u00fcdahalede bulunmamas\u0131 ceza sorumlulu\u011fu do\u011furmamal\u0131d\u0131r.<\/p>\n
Pasif \u00f6tanazi, hekimin hastaya gerekli tedaviyi uygulamamas\u0131, yani tedavi s\u00fcrecine m\u00fcdahale etmeyerek \u00f6l\u00fcm\u00fcn h\u0131zland\u0131r\u0131lmas\u0131 anlam\u0131na gelir. Ancak DNR talebinde, pasif \u00f6tanaziden farkl\u0131 olarak ya\u015fam destek tedavisi uygulanmaya devam edilir; sadece hastan\u0131n kalp ve solunumu durdu\u011funda d\u0131\u015far\u0131dan m\u00fcdahale yap\u0131lmaz. Bu a\u00e7\u0131dan DNR, pasif \u00f6tanaziden ayr\u0131l\u0131r ve hastan\u0131n ya\u015fam hakk\u0131 ile \u00f6zerklik prensiplerine uygun bir uygulama olarak de\u011ferlendirilebilir.<\/p>\n
T\u00fcrk Hukukunda DNR Talimat\u0131 ve T\u0131bbi Yarars\u0131zl\u0131k: Hasta \u00d6zerkli\u011fi ve Hekimlerin Hukuki Sorumlulu\u011fu<\/p>\n
T\u00fcrk hukukunda, hekimin t\u0131bbi yarars\u0131zl\u0131k gerek\u00e7esiyle kardiyopulmoner res\u00fcsitasyon (CPR) uygulamamas\u0131na olanak tan\u0131yan net bir hukuki \u00e7er\u00e7evenin olu\u015fturulmas\u0131 gerekmektedir. Hekimlerin, DNR (Do Not Resuscitate) taleplerini hukuki bir teredd\u00fct ya\u015famadan yerine getirebilmeleri i\u00e7in mevcut yasal d\u00fczenlemelerde bu do\u011frultuda de\u011fi\u015fiklik yap\u0131lmas\u0131 zorunludur.<\/p>\n
Bu ba\u011flamda, t\u0131bbi yarars\u0131zl\u0131k kavram\u0131 hasta \u00f6zerkli\u011fi ve yararl\u0131l\u0131k ilkeleri dikkate al\u0131narak dar ve kesin s\u0131n\u0131rlarla yorumlanmal\u0131; m\u00fcmk\u00fcn olan her durumda hastan\u0131n veya yasal temsilcisinin a\u00e7\u0131k r\u0131zas\u0131 al\u0131nmal\u0131d\u0131r.<\/p>\n
Biyot\u0131p S\u00f6zle\u015fmesi\u2019nin 9. maddesinde d\u00fczenlenen \u201ct\u0131bbi talimatname\u201d uygulamas\u0131n\u0131n hayata ge\u00e7irilmesi, \u00f6zellikle ya\u015fam\u0131n son d\u00f6nemine ili\u015fkin hukuki ve etik sorunlar\u0131n \u00e7\u00f6z\u00fcm\u00fcne \u00f6nemli katk\u0131 sa\u011flayacakt\u0131r. Bu uygulaman\u0131n etkin ve hukuka uygun bi\u00e7imde y\u00fcr\u00fct\u00fclebilmesi i\u00e7in kapsam ve usule ili\u015fkin ayr\u0131nt\u0131lar\u0131n bir y\u00f6netmelikle belirlenmesi gerekmektedir.<\/p>\n
Ki\u015filerin ya\u015fam\u0131n sonuna dair tercihleri, Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 taraf\u0131ndan olu\u015fturulacak bir sistem arac\u0131l\u0131\u011f\u0131yla kaydedilmeli ve bu bilgilere gerekti\u011finde sa\u011fl\u0131k meslek mensuplar\u0131 taraf\u0131ndan h\u0131zl\u0131 ve g\u00fcvenli \u015fekilde eri\u015filebilmelidir. \u00d6zellikle kronik hastal\u0131\u011f\u0131 bulunan bireylerin, bilinci yerindeyken tedavi s\u00fcrecinden sorumlu hekimlerine tercihlerini bildirmesi ve bu tercihleri zaman i\u00e7inde de\u011fi\u015ftirebilme olana\u011f\u0131na sahip olmas\u0131, bireyin gelece\u011fini belirleme hakk\u0131 a\u00e7\u0131s\u0131ndan b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n
Hukukumuzda hastan\u0131n DNR talebinin ge\u00e7erlili\u011fi a\u00e7\u0131s\u0131ndan en temel \u00f6l\u00e7\u00fct \u201ca\u00e7\u0131k r\u0131za\u201dd\u0131r. Bu r\u0131za her zaman geri al\u0131nabilir olmal\u0131 ve hasta karar\u0131ndan d\u00f6nebilme hakk\u0131na sahip olmal\u0131d\u0131r. Hastan\u0131n a\u00e7\u0131k iradesinin belirlenmesinde en g\u00fcvenilir y\u00f6ntem, DNR talebinin yaz\u0131l\u0131 bir form arac\u0131l\u0131\u011f\u0131yla hasta taraf\u0131ndan imzalanmas\u0131 ve bu belgenin t\u0131bbi kay\u0131tlara i\u015flenmesidir.<\/p>\n
T\u0131bbi yarars\u0131zl\u0131k karar\u0131 do\u011frultusunda hastaya CPR uygulanmamas\u0131 i\u00e7in bu kavram\u0131n dar ve a\u00e7\u0131k s\u0131n\u0131rlarla tan\u0131mlanmas\u0131 zorunludur. \u00d6zellikle DNR talimat\u0131 ile pasif \u00f6tanazi aras\u0131ndaki fark\u0131n net bi\u00e7imde ortaya konmas\u0131 b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n
Sonu\u00e7 olarak, DNR talimat\u0131n\u0131n uygulanmas\u0131; hasta \u00f6zerkli\u011fini, onurlu ya\u015fam hakk\u0131n\u0131, v\u00fccut b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fc ve ya\u015fam kalitesini koruyan temel ilkelere uygundur. Hasta, t\u0131bbi m\u00fcdahalelere ili\u015fkin kararlar\u0131n\u0131 \u00f6zg\u00fcrce verebilmeli ve bu iradesine r\u0131za g\u00f6sterilmeli; hekim de bu karara sayg\u0131 duymal\u0131d\u0131r.<\/p>\n
Ece ERTU\u011e \u00d6ZKARA<\/p>\n
Avukat, Hem\u015fire<\/p>\n
KAYNAK\u00c7A<\/p>\n
American Heart Association Guidelines for Cardiopulmonary Resuscitation (AHA) (2014-2015)(Eri\u015fim Tarihi: 01.07.2015)<\/p>\n
\u0130l\u00e7in G\u00f6nen\u00e7, F. (2015). Hukuki ve etik a\u00e7\u0131dan res\u00fcsitasyon. SD Sa\u011fl\u0131k D\u00fc\u015f\u00fcncesi ve T\u0131p K\u00fclt\u00fcr\u00fc Dergisi, (Sonbahar), 72\u201375.<\/p>\n
Australian Resuscitation Council, New Zealand Resuscitation Council (2014). Standards for Resuscitation: Clinical Practice and Education (Eri\u015fim tarihi: 01.07.2015)<\/p>\n
Burns J. P., Edwards, J., Johnson,J., Cassem,N. H., Truog,R. D. (2003) \u201cDo-not-resuscitate order after 25 years\u201d, Crit Care Med. Vol. 31, No. 5, s.1543-1550. Do Not Attempt Resuscitation Orders (Eri\u015fim Tarihi:01.07.2015)<\/p>\n
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Erkekol, F. \u00d6., Numano\u011flu, N., G\u00fcrkan \u00d6. \u00dc., Kaya A. (2002), \u201cYo\u011fun Bak\u0131m \u00dcnitelerine \u0130li\u015fkin Etik Konular \u201c, T\u00fcrk Toraks Dergisi, C.3, S.3, s.307-316. European Resuscitation Council (ERC) (Eri\u015fi Tarihi: 01.07.2015) http:\/\/ministryofethics.co.uk\/?p=11&q=1 (Eri\u015fim<\/p>\n
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\u00c7avdar, P. (2024). T\u00fcrk ve Amerikan hukuklar\u0131nda canland\u0131rmama talimat\u0131n\u0131n (DNR) hukuki a\u00e7\u0131dan de\u011ferlendirilmesi. Y\u00fcksek\u00f6\u011fretim ve Bilim Hukuku Dergisi, 9(1), 197\u2013239.<\/p>\n
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http:\/\/www.nzrc.org.nz\/assets\/Uploads\/Guidelines\/ Standards-for-Resuscitation-Clinical-Practice-and-Education.pdf (Eri\u015fim Tarihi: 01.07.2015)<\/p>\n
http:\/\/www.tkd.org.tr\/~\/media\/files\/tkd\/kilavuzlar\/aha-acc\/aha-2012-kilavuzu.pdf(Eri\u015fim Tarihi:01.07.2015)<\/p>\n
https:\/\/www.erc.edu\/doclibrary\/en\/(Eri\u015fim Tarihi: 01.07.2015)<\/p>\n
https:\/\/www.wsma.org\/POLST (Eri\u015fim Tarihi:01.07.2015)<\/p>\n
International Liaison Committee on Resuscitation (ILCOR) (Eri\u015fim Tarihi: 01.07.2015)<\/p>\n
Kardiyopulmoner Res\u00fcsitasyon ve Acil Kardiyovask\u00fcler Bak\u0131m \u0130\u00e7in 2010 AHA K\u0131lavuzu (Eri\u015fimTarihi: 01.07.2015)<\/p>\n
Motro, H. (1983), \u201cMedicolegal Aspects of Cardiopulmonary Resuscitation\u201d, Med Law 2, s.103-111.<\/p>\n
Hakeri, H. (2022). T\u0131p hukuku a\u00e7\u0131s\u0131ndan palyatif bak\u0131m. Dicle Adalet Dergisi, 6(1), 1\u201310.<\/p>\n
Sert, H., G\u00f6zdemir, M., I\u015f\u0131k, B. (2007), \u201cKardiyopulmoner Canland\u0131rma Yap\u0131lmamas\u0131 Etik mi?\u201d, Yeni T\u0131p Dergisi; 24, s. 85-89.<\/p>\n
Sorum, P. C. (1994), \u201cLimiting Cardiopulmonary Resuscitation\u201d, Alb. L. Rew. 614, s. 617-645.<\/p>\n
Washington State Medical Association. (2011) Physicians Orders for Life Sustaining Treatment (Eri\u015fim Tarihi: 01.07.2015)\u00a0Hukuki Haber<\/p>\n
Haberin Al\u0131nt\u0131land\u0131\u011f\u0131 Kaynak: www.hukukihaber.net<\/p>","protected":false},"excerpt":{"rendered":"
Res\u00fcsitasyon (CPR), ya\u015fam ile \u00f6l\u00fcm aras\u0131ndaki kritik e\u015fikte \u00f6zel bir \u00f6neme sahiptir. Ancak CPR\u2019\u0131n ba\u015far\u0131 \u015fans\u0131 d\u00fc\u015f\u00fck oldu\u011funda, ya\u015fam\u0131n\u0131n son evresinde bulunan hastalarla ilgilenen hekimler ve sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131, hem etik hem de hukuki a\u00e7\u0131dan karma\u015f\u0131k ikilemlerle kar\u015f\u0131la\u015fmaktad\u0131r. Bu kararlar, hekimlerin manevi ve etik y\u00fck\u00fcn\u00fc art\u0131r\u0131rken, hukuki sonu\u00e7lara ili\u015fkin kayg\u0131lar da karar verme s\u00fcrecini zorla\u015ft\u0131rmaktad\u0131r. \u201cDo Not Resuscitate\u201d (DNR) talimat\u0131, kalp veya solunum durdu\u011funda, \u00f6nceden verilmi\u015f t\u0131bbi talimat do\u011frultusunda CPR uygulanmamas\u0131n\u0131 ifade eder. Hasta haklar\u0131 \u00e7er\u00e7evesinde, ayd\u0131nlat\u0131lm\u0131\u015f onam olmaks\u0131z\u0131n yap\u0131lan t\u0131bbi m\u00fcdahaleler hukuka ayk\u0131r\u0131d\u0131r. Bu nedenle, hekimin hastan\u0131n tedaviyi reddetme iradesine sayg\u0131 g\u00f6stermesi gerekir. Ancak, DNR talimat\u0131n\u0131n hukuken ge\u00e7erlili\u011fi ve hekimin m\u00fcdahale y\u00fck\u00fcml\u00fcl\u00fc\u011f\u00fc konusundaki belirsizlikler tart\u0131\u015fma konusudur. T\u00fcrkiye\u2019de DNR talimatlar\u0131na dair \u00f6zel bir yasal d\u00fczenleme bulunmamaktad\u0131r. Bununla birlikte, hasta \u00f6zerkli\u011fi ve ya\u015fam hakk\u0131 kapsam\u0131nda hastan\u0131n tedaviyi reddetme hakk\u0131; Biyot\u0131p S\u00f6zle\u015fmesi, Hasta Haklar\u0131 Y\u00f6netmeli\u011fi ve T\u00fcrk Medeni Kanunu gibi d\u00fczenlemelerle g\u00fcvence alt\u0131na al\u0131nm\u0131\u015ft\u0131r. Ayr\u0131ca Anayasa\u2019da da bireyin sa\u011fl\u0131k ve v\u00fccut b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fcn korunmas\u0131 temel hak olarak yer almaktad\u0131r. Hekimler a\u00e7\u0131s\u0131ndan ise T\u0131bbi Deontoloji T\u00fcz\u00fc\u011f\u00fc, t\u0131bbi m\u00fcdahale yapma y\u00fck\u00fcml\u00fcl\u00fc\u011f\u00fcn\u00fc ve mesleki \u00f6zerkli\u011fi d\u00fczenler. Hekimin, tedavinin gereklili\u011fi ve yararl\u0131l\u0131\u011f\u0131na karar verme yetkisi vard\u0131r ancak bu karar hastan\u0131n r\u0131zas\u0131na ba\u011fl\u0131d\u0131r. Hastan\u0131n ge\u00e7erli bir DNR iradesi varsa, hekim buna sayg\u0131 g\u00f6stermek zorundad\u0131r. Beyhude m\u00fcdahale, klinik ama\u00e7lara ula\u015fmada …<\/p>","protected":false},"author":3,"featured_media":0,"comment_status":"","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27],"tags":[],"class_list":["post-140564","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hukukihaber"],"acf":[],"yoast_head":"\n