Biomedical & Experimental Department, Faculty of Medicine, Tirana, Albania.
BMC Med Ethics. 2011 Jun 15;12:12. doi: 10.1186/1472-6939-12-12.
The Albanian medical system and Albanian health legislation have adopted a paternalistic position with regard to individual decision making. This reflects the practices of a not-so-remote past when state-run facilities and a totalitarian philosophy of medical care were politically imposed. Because of this history, advance directives concerning treatment refusal and do-not-resuscitate decisions are still extremely uncommon in Albania. Medical teams cannot abstain from intervening even when the patient explicitly and repeatedly solicits therapeutic abstinence. The Albanian law on health care has no provisions regarding limits or withdrawal of treatment. This restricts the individual's healthcare choices.
The question of 'medically futile' interventions and pointless life-prolonging treatment has been discussed by several authors. Dutch physicians call such interventions 'medisch zinloos' (senseless), and the Netherlands, as one of the first states to legislate on end-of-life situations, actually regulates such issues through appropriate laws. In contrast, leaving an 'advance directive' is not a viable option for Albanian ailing individuals of advanced age. Verbal requests are provided during periods of mental competence, but unfortunately such instructions are rarely taken seriously, and none of them has ever been upheld in a legal or other official forum.
End-of-life decisions, treatment refusal and do-not-resuscitate policies are hazardous options in Albania, from the legal point of view. Complying with them involves significant risk on the part of the physician. Culturally, the application of such instructions is influenced from a mixture of religious beliefs, death coping-behaviors and an immense confusion concerning the role of proxies as decision-makers. Nevertheless, Albanian tradition is familiar with the notion of 'amanet', a sort of living will that mainly deals the property and inheritance issues. Such living wills, verbally transmitted, may in certain cases include advance directives regarding end-of-life decisions of the patient including refusal or termination of futile medical treatments. Since these living wills are never formally and legally validated, their application is impossible and treatment refusal remains still non practicable. Tricks to avoid institutional treatment under desperate conditions are used, aiming to provide legal coverage for medical teams and relatives that in extreme situations comply with the advice of withholding senseless treatment.
阿尔巴尼亚的医疗体系和卫生立法对个人决策采取了家长式的立场。这反映了过去并不遥远的时代的做法，当时国家经营的设施和医疗保健的极权主义理念在政治上被强加。由于这段历史，拒绝治疗和不复苏的预先指示在阿尔巴尼亚仍然极其罕见。即使患者明确和反复要求停止治疗，医疗团队也不能不进行干预。阿尔巴尼亚的医疗保健法没有关于限制或停止治疗的规定。这限制了个人的医疗保健选择。
几位作者讨论了“医学上无效”的干预措施和无意义的延长生命的治疗问题。荷兰医生称这些干预措施为“medisch zinloos”（无意义的），荷兰作为最早立法解决临终情况的国家之一，实际上通过适当的法律来规范这些问题。相比之下，对于阿尔巴尼亚高龄患者来说，留下“预先指示”并不是一个可行的选择。在精神正常时期会提出口头请求，但不幸的是，这些指示很少被认真对待，而且在任何法律或其他官方场合都没有得到支持。
从法律角度来看，在阿尔巴尼亚，临终决策、拒绝治疗和不复苏政策是危险的选择。遵守这些政策会给医生带来重大风险。在文化上，这种指示的应用受到宗教信仰、应对死亡的行为以及对代理人作为决策者的角色的巨大困惑的混合影响。然而，阿尔巴尼亚传统熟悉“amanet”的概念，这是一种主要处理财产和遗产问题的生前遗嘱。这种生前遗嘱可以以口头形式传达，在某些情况下可能包括患者的临终决定的预先指示，包括拒绝或终止无效的医疗治疗。由于这些生前遗嘱从未正式合法验证，因此无法应用，拒绝治疗仍然不可行。在绝望的情况下，人们会使用一些技巧来避免机构治疗，目的是为医疗团队和亲属提供法律保护，在极端情况下，他们会遵守不进行无意义治疗的建议。
