For an in-depth analysis of IVF in Poland read “Poles apart” by Simon Brown @ ESHRE – European Society on Human Reproduction and Embryology (also attached) Monitoring freedom of research and cure in POLAND Table of content: A. Artificial reproduction technologies (ART) Bibliography B. Research with human embryonic stem cells (hESC) Bibliography C. End-of-life decisions Bibliography D. Abortion and contraception Bibliography E. Therapeutic uses of narcotic drugs Bibliography F. Pain treatments Bibliography G. General Bibliography A. Artificial reproduction technologies (ART) Currently the only rules regarding the ART in Poland are expressed in the position of the Polish Gynaecological Association which is not legally binding. Law of 1 July 2005 on the collection, preservation and transplantation of cells, tissues and organs [Ustawa z dnia 1 lipca 2005 r. o pobieraniu, przechowywaniu i przeszczepianiu komórek, tkanek i narządów] does NOT refer to the collection of embryonic stem cells and gonads, embryonic and foetal tissue, as well as blood (according to the articles 1.2.1 and 1.2.2). (Remark: according to some contacts with civil society, Polish Parliament is going to approve a law on fertility treatment which might lead to serious restrictions of IVF. Currently, due to governmental crisis, legislation seems to be postponed). Bibliography: • Infertility in Poland – present status, reasons and prognosis as a reflection of Central and Eastern Europe problems with reproduction, Sanocka D, Kurpisz M. Med Sci Monit. 2003 Mar;9(3):SR16-20. B. Research with human embryonic stem cells (hESC) Law of 1 July 2005 on the collection, preservation and transplantation of cells, tissues and organs [Ustawa z dnia 1 lipca 2005 r. o pobieraniu, przechowywaniu i przeszczepianiu komórek, tkanek i narządów] (Journal of Laws of 2005 n. 169 item 1411) does not refer to the collection of embryonic stem cells and gonads, embryonic and foetal tissue, as well as blood. Polish legal rules do not include separate regulations with respect to the human embryo and human embryo stem cells. There is also no legal definition for the embryonic stage of life. Regulations referring to legal protection and conduct rules in the pre-birth stage of human life are included in the Act of 7 January 1993 on Family Planning, Protection of Human Foetus and Admissible Conditions for an Abortion (Journal of Laws of 1993 n. 17 item 78) [unified text in Polish]. In accordance with the article 26 of the Act on the Medical Profession of 5 December 1996 (Journal of Laws of 1997 n. 28 item 152, unified text published in Journal of Laws of 2008 n. 136 item 857) [unified text in Polish], unborn children cannot participate in scientific experiments, which means indirectly that the participation of unborn children in therapeutic experiments is permissible, although there is no regulation on this issue. (Remark: according to UNESCO, Act n°17 of 7 January 1993 on family planning, protection of human foetus and admissible conditions for an abortion, art. 1, states that the right to life is accorded to every human being including at the prenatal stage. Furthermore, in accordance with the Medical Professions Act of 5 December 1996, unborn child cannot be part of a scientific experiment. According to UNESCO, article 21 of this law specifies that research on stem cells cannot either be qualified as therapeutic research as it has no direct benefit for the subject of the experiment. Hence, research on embryos is prohibited even if no specific legislation has been set in force on this issue. Quoting UNESCO Report of IBC on Human Cloning and International Governance “there is no definition on embryonic stages in the Polish legislation even if penalties are heavier when the foetus has became capable of living outside the pregnant mother’s body. Therefore any attempt to produce stem cells lines will be considered as an illegal abortion, as the embryo is destructed, which is liable to 3 years of prison�?). Poland has no legal regulations relating to the human cloning. In 1999, Poland signed the Additional Protocol to the Convention on Human Rights and Biomedicine on the prohibition of Cloning Human Beings of the Council of Europe. Nevertheless, the Code of Ethics for physicians forbids the participation of any physician in cloning proceedings (scientific or therapeutic) (Art. 39a) (text of the Code of Ethics in Polish). Bibliography: • Europe struggles with legalizing embryonic stem cell research, Allen Jr., John L.. National Catholic Reporter, 8/11/2006, Vol. 42 Issue 36, p3-3, 1/2p • Ethics and Patentability in Biotechnology, Rafał Witek, Science and Engineering Ethics (2005) 11, 105-111 C. End-of-life decisions C.1. Is a physician required to respect the patient’s refusal of life-sustaining treatment? There is no concept of “passive euthanasia” in the Polish legislation although in practice passive voluntary euthanasia is legal as a result of patient refusal to the further treatment. According to the article 32 point 1 of the Act on the Medical Profession of 5 December 1996 (Journal of Laws of 1997 n. 28 item 152, unified text published in Journal of Laws of 2008 n. 136 item 857) [unified text in Polish] a physician can only treat a patient who agreed to the treatment (with some exceptions). Consult also the Code of Ethics for physicians (text of the Code of Ethics in Polish) mainly articles 15 and 32. C.2. Is active euthanasia (taking positive steps to end life) lawful? According to the article 148 of penal code (homicide) and to the article 150 of penal code (homicide caused by compassion) are both crimes and everybody (not only a physician) is legally responsible for committing one of these crimes. Excerpts of the Polish Penal Code (source of the English version: NATLEX International Labour Organization): “Article 148. § 1. Whoever kills a human being shall be subject to the penalty of the deprivation of liberty for a minimum term of 8 years, the penalty of deprivation of liberty for 25 years or the penalty of deprivation of liberty for life . § 2. Whoever kills a human being: 1) with particular cruelty, 2) in connection with hostage taking, rape or robbery, 3) for motives deserving particular reprobation, 4) with the use of firearms or explosives shall be subject to the penalty of the deprivation of liberty for a minimum term of 12 years, the penalty of deprivation of liberty for 25 years or the penalty of deprivation of liberty for life . § 3. Whoever kills more than one person in one act or has earlier been validly and finally convicted for homicide shall be also subject to the penalty specified in § 2. § 4. Whoever kills a person due to the influence of an intense emotion justified by the circumstances shall be subject to the penalty of the deprivation of liberty for a term of between 1 and 10 years. Article 150. § 1. Whoever kills a human being on his demand and under the influence of compassion for him shall be subject to the penalty of the deprivation of liberty for a term of between 3 months and 5 years. § 2. In some extraordinary circumstances the court may apply an extraordinary mitigation of the penalty or even renounce its imposition�?. According to the article 31 of the Code of Ethics for physicians a physician can not perform euthanasia or help with a suicide (text of the Code of Ethics in Polish). C.3. Is physician-assisted suicide (patient ends own life with assistance of a physician) lawful? According to the article 151 of penal code any help in suicide is forbidden. Excerpts of the Polish Penal Code (source of the English version: NATLEX International Labour Organization): “Article 151. Whoever by persuasion or by rendering assistance induces a human being to make an attempt on his own life shall be subject to the penalty of the deprivation of liberty for a term of between 3 months and 5 years�?. According to the article 31 of the Code of Ethics for physicians a physician can not perform euthanasia or help with a suicide (text of the Code of Ethics in Polish). C.4. Are living will and/or advance directives enforceable? Currently there are no legal provisions on so called “life testaments” in Poland (no ban or consent). However, the problem was deeply considered by the Supreme Court in its resolution of 27 October 2005 (III CK 155/05, OSNIC 2006, n. 7-8, item. 137). In this resolution the Supreme Court accepted a possibility of so called “statements pro futuro”. Bibliography: • Euthanasia and law in Europe, Griffiths John, Oxford 2008 • Individualism, authoritarianism, and attitudes toward assisted death: cross-cultural, cross-regional, and experimental evidence, Kemmelmeier, Markus; Wieczorkowska, Grazyna; Erb, Hans-Peter; Burnstein, Eugene, Journal of applied social psychology, 32:1. pp.60-85. 2002 (1) (0807) D. Abortion and contraception D.1. Is it legal for a pregnant woman to terminate a pregnancy? The Act of 7 January 1993 on family planning, human embryo protection and conditions of permissibility of abortion [Ustawa z 7 stycznia 1993 o planowaniu rodziny, ochronie płodu ludzkiego i warunkach dopuszczalności przerywania ciąży] makes abortion illegal except for 3 situations (the article 4a): 1. When pregnancy is a threat either to mother’s life or mother’s health 2. When the foetus is seriously damaged 3. When there is a suspicion that the pregnancy is an effect of an illegal act. The Act penalizes the doctors, who perform abortion, not the women who have it. The possibility of abortion on social grounds was withdrawn by the Parliament elected in 1997 resulting from the decision of the Constitutional Tribunal (in Polish). The Constitutional Tribunal stated that abortion on social grounds is unconstitutional and justified its decision on the basis that Poland is a democratic state of law what for the members of CT implies the protection of life at its every stage. The Polish Constitution includes the provision of legal protection of life to every human being (art. 38) (source of the English version: Sejm website): “Article 38 – The Republic of Poland shall ensure the legal protection of the life of every human being�?. See also articles 152-154 of the Polish Penal Code (source of the English version: NATLEX International Labour Organization): “Article 152. § 1. Whoever, with consent of the woman, terminates her pregnancy in violation of the law shall be subject to the penalty of deprivation of liberty for up to 3 years. § 2. The same punishment shall be imposed on anyone, who renders assistance to a pregnant women in terminating her pregnancy in violation of the law or persuades her to do so. § 3. Whoever commits the act specified in § 1 or 2, after the foetus has became capable of living outside the pregnant woman’s body shall be subject to the penalty of the deprivation of liberty for a term of between 6 months and 8 years. Article 153. § 1. Whoever, through the use of force against a pregnant woman or by other means, without her consent, terminates the pregnancy or induces her by force, an illegal threat, or deceit to terminate the pregnancy shall be subject to the penalty of the deprivation of liberty for a term of between 6 months and 8 years. § 2. Whoever commits the act specified in § 1, after the foetus has become capable of living outside the pregnant woman’s body shall be subject to the penalty of the deprivation of liberty for a term of between 1 and 10 years. Article154. § 1. If the consequence of an act specified in Articles 152, §1 or 2 is the death of the pregnant woman, the perpetrator shall be subject to the penalty of the deprivation of liberty for a term of between 1 and 10 years. § 2. If the consequence of an act specified in Articles 152 § 3 or in Article 153 is the death of the pregnant woman, the perpetrator shall be subject to the penalty of the deprivation of liberty for a term of between 2 and 12 years�?. D.2. Is RU-486 (a drug used to induce pharmacological abortion) legally available to women? No. See the answer above (point D.1). D.3. Are contraceptives available over the counter? Contraceptives such as condoms are available over the counter without restrictions. Contraceptives such as pills are available in pharmacies with medical prescription. For specific products, please, consult the following database: database of pharmaceutical products in Poland (search for name, chemical name, producer etc. Source: Ministry of Health). D.4. Is the ‘morning-after pill’ (drug preventing implantation of an embryo in the uterus) legally available to women without prescription (over the counter)? In Poland the “morning-after” pill is legally available. The commonly used “morning-after” pill is called Escapelle (it replaced Postinor Duo). It is available with medical prescription and full price (no refund from the social/health security). Bibliography: • Contemporary women’s hell: Polish women’s stories, Nowicka, Wanda [Introduction], Reproductive health matters, 13:26. pp.160-162. 2005 (11) (6024) • Maternal Health Policies in Countries in Transition: Poland and Kyrgyzstan, 1990-2006, Wejnert, Barbara; Parrot, Andrea; Djumabaeva, Alma, Marriage & Family Review; 2008, Vol. 44 Issue 2/3, p279-300, 22p • Sources of Abortion Attitudes in Poland, Denmark, and the United States, Jelen, Ted G., Conference Papers – Southern Political Science Association, 2008 Annual Meeting, p1-17, 19p, 3 charts • Testing the Margin of Appreciation: Therapeutic Abortion, Reproductive ‘Rights’ and the Intriguing Case of Tysiąc v. Poland, Priaulx, Nicolette, European Journal of Health Law, Dec2008, Vol. 15 Issue 4, p361-379, 19p • Post-communism : women’s lives in transition, edited by Vesna Nikolić-Ristanović, Publication Basingstoke, Palgrave Macmillan, 2004 • Abortion and the law, Eser Albin, The Hague 2005 • Continuity and change in attitudes toward abortion: Poland and the United States, Jelen, Ted G., Wilco, Clyde, Politics and Gender; June 2005, Vol. 1 Issue 2, p297-317, 21p • Abortion and Contraception in Central and Eastern Europe, Stenvoll, Dag, Conference Papers — American Political Science Association; 2004 Annual Meeting, Chicago, IL, p1-12, 12p E. Therapeutic uses of narcotic drugs E.1. Is the therapeutic use of cannabis lawful? No. Cannabis is not a lawful medicine in Poland. Medicines based on Cannabis known in other countries, such as Marinol (USA, Canada) or Dronabinol (pure tetrahydrokannabinol) and Sativex (Canada, UK) are not registered in Poland. E.2. Is therapeutic use of heroin (legally distributed by doctors to heroin addicts) lawful? No. E.3. Are heroin-equivalents available? Yes. Opioids are used as a heroin-equivalent in Poland mainly in cancer pain treatment but also after surgeries. The use of opioid analgesics for long term management of chronic non-cancer pain is now an accepted, although still a controversial medical practice. Examples of opioids: • kodeina, • fentanyl, • meperydyna, • metadon, • morfina, • pentazocyna, • tramadol. The opioid analgesic commonly used in Poland for treatment of addicts is Metadon. Consult also the Law of 24 April 1997 on fighting against drug addiction (Ustawa z dnia 24 kwietnia 1997 r. o przeciwdziałaniu narkomanii, mainly articles 6 point 10 and 15 point 1 on “heroin-equivalent treatment”, text in Polish). Database of pharmaceutical products in Poland: search for name, chemical name, producer etc., source: Ministry of Health. Bibliography: • Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS, Addiction; Sep2008, Vol. 103 Issue 9, p1484-1492, 9p • The White Paper on Opioids and Pain: A Pan-European Challenge: The European White Paper on the Use of Opioids in Chronic Pain Management, Journal of Pain & Palliative Care Pharmacotherapy; 2006, Vol. 20 Issue 3, p79-87, 9p F. Pa
n treatments F.1. Are pain treatments available? (some country rankings could be available with indicators prepared by specialist organizations) In Poland standardised pain treatment has been introduced in accordance with WHO guidelines, usually referred to as the “analgesic ladder�?. The occasional failures of pain treatment are usually observed in cases of neuropathic pain. Legal acts related to the National Program Against Oncological Diseases of 2005 for years 2006-2015 which includes actions related to pain treatment (in Polish, source Ministry of Health). Law of 24 August 2004 on the health benefits financed from the public financial resources (Journal of Laws of 2004, n. 210, item 2135) [Ustawa z dnia 24 sierpnia 2004 r. o świadczeniach opieki zdrowotnej finansowanych ze środków publicznych] and in particular article 15 point 2.13a (palliative care): “Article 15 (unofficial translation), 2. Beneficiaries are entitled to the following health benefits financed from the public financial resources according to the rules stipulated in the Law (…); 13a) palliative care and hospice�?. Bibliography: • Assessment of quality of life, pain and effectiveness of treatment in palliative care patients, Mess E., Kempińska E., Leppert W., Krzyżanowski D. • Pain treatment as an issue in present-day oncology • Medical Academy of Lublin Website dedicated to pain and pain treatment [in Polish] • Perception of palliative care and euthanasia among recently graduated and experienced nurses, Tomasz Brzostek, Wim Dekkers, Zbigniew Zalewski, Anna Januszewska and Maciej Górkiewicz, Nursing Ethics; Nov2008, Vol. 15 Issue 6, p761-776, 16p, 8 charts (Mr Jarosław Gowin, deputy of Platforma Obywatelska, chair of the Panel on the Convention on Bioethics working in the Prime Minister’s Office, announced on 22nd November on the Polish radio (channel 3) that the Bill on Bioethics shall be presented in the Sejm in December 2008. The Panel on the Convention on Bioethics worked on a report on bioethics. Mr Gowin informed that the Bill on Bioethics shall be discussed with Prime Minister this year. It will make possible ratification of the Council of Europe Convention on Bioethics which was signed but not ratified by Poland. According to his words, for the time being, legislation in the field of bioethics is missing in Poland or, partially, not consisted with the Convention. For the time being no more information on the report or the bill is made public. For information on legal basis and composition of the Panel on the Convention on Bioethics read more). General bibliography: Books: • Internationale Perspektiven zu Status und Schutz des extrakorporalen Embryos : Rechtliche Regelungen und Stand der Debatte im Ausland = International perspectives on the status and protection of the extracorporeal embryo, Albin Eser; Hans-Georg Koch; Carola Seith (Hrsg.), Publication Baden-Baden, Nomos , 2007 • National regulations on ethics and research in Poland, Jacek A. Piątkiewicz; European Commission, Publication Luxembourg, EUR-OP , 2005 • Biojurisprudence, Tokarczyk Roman Andrzej, Lublin 2008 • Bioethics and health in international context, Royal Netherlands Academy of Arts and Sciences 2002 Articles: • Why eight EU Member States signed, but not yet ratified the Convention for Human Rights and Biomedicine, Goffin, T.Borry, P.Dierickx, K.Nys, Herman, Catholic University Leuven, Health policy. 86:2-3. pp.222-233. 2008 (05) (1995) • Ethical and social aspects of transplantation medicine in Poland and worldwide, Rowiński W., Published in Ann Transplant. 2006;11(3):31-7 • Genetic medicine: Polish deontological guidelines and the ethical practice of research studies with children, Niebrój LT. Published in Hum Reprod Genet Ethics. 2006;12(1):3-12. Review • Regulations of the ethical evaluation system of scientific and clinical research in connection with Poland joining the European Union, Raszeja S. Published in Arch Med Sadowej Kryminol. 2004 Apr-Sep;54(2-3):151-4. Polish