Perinatal palliative care in Poland: current legal status, organization, standards and guidelines
Abstract
The term “perinatal hospice” as a form of targeted care for pregnant women and their families in cases of diagnosed lethal fetal anomalies first appeared in the medical literature in 1997. The terminology regarding care for families expecting the birth of a sick child has evolved, ultimately adopting the currently used term perinatal palliative care. In Poland, the first model of perinatal palliative care, which included perinatal diagnostics and hospice care, was developed and implemented in 1999. In this article, the current legal status, standards, guidelines, and organization of perinatal palliative care in Poland in the first half of 2024 and present issues and needs for changes related to implementing this care have been presented.
Keywords: perinatal hospicelethal fetal anomaliesperinatal palliative carelegal regulationsstandards and guidelines
References
- Sieroszewski P, Haus O, Zimmer M, et al. Recommendations for prenatal diagnostics of the Polish Society of Gynaecologists and Obstetricians and the Polish Society of Human Genetics. Ginekol Pol. 2022; 93(5): 427–437.
- Perinatal hospice – the Polish model. https://hospicjum.waw.pl/ (27.06.2024).
- Hospice for unborn children. Information Bulletin of the Warsaw Children's Hospice No. 1 (59) March 2012. perinatalne.pl (27.06.2024).
- Rutkowska M, Szczepaniak S, Maciejewski TM, et al. 25 years of work: The Interdisciplinary Team for Fetal Malformation at the Institute of Mother and Child in Warsaw — from counselling to clinical ethics. Dev Period Med. 2019; 23(4): 246–252.
- Constitution of the Republic of Poland, Minister of April 2, 1997. sejm.gov.pl (28.06.2024).
- Act on Patient Rights and the Patient Rights Ombudsman, Journal of Laws 2008, No. 52, item 417, as amended.
- Act on Healthcare, Journal of Laws 2011, No. 112, item 654, as amended.
- Act of November 4, 2016 on Support for Pregnant Women and Families: For Life. sip.lex.pl (28.06.2024).
- Act of January 7, 1993 on Family Planning, Protection of Human Fetus, and Conditions for Permissibility of Termination of Pregnanc. isap.sejm.gov.pl (28.06.2024).
- Regulation of the Minister of Health (MZ) dated January 31, 2017. Journal of Laws 2017, item 236. https://isap.sejm.gov.pl/isap.nsf/download.xsp/WDU20170000236/O/D20170236.pdf (28.06.2024).
- Regulation of the Minister of Health (MZ) regulation has since undergone further amendments in 2018. Journal of Laws 2018, item 1185. https://dziennikustaw.gov.pl/D2018000118501.pdf (28.06.2024).
- Regulation of the Minister of Health (MZ) in 2020 (Journal of Laws 2020, item 457). https://dziennikustaw.gov.pl/D2020000045701.pdf (28.06.2024).
- Announcement of the Minister of Health of December 17, 2021 on the publication of the consolidated text of the regulation of the Minister of Health on guaranteed benefits in the field of palliative and hospice care. Journal of Laws 2022, item 262. isap.sejm.gov.pl (28.06.2024).
- Standards of procedures and medical procedures for pediatric home palliative care in children's hospices. Standards of perinatal palliative care. Collective work, ed. Dangel T. Warsaw Children's Hospice, 2019. hospicjum.waw.pl (28.06.2024).
- Rutkowska M. Newborn at the limit of viability. Part 2: Recommendations regarding treatment of mother and newborn at the limit of viability considering ethical aspects. Med Wieku Rozwoj. 2011; 15(3): 356–368.
- Rutkowska M. Recommendations for managing the mother and newborn at the limit of viability, considering ethical aspects. Pediatr Dypl. 2012; 16(3): 71–79.
- Rutkowska M, Szczepaniak S, Walas W. Ethical guidelines for neonatal care, including palliative care. In: Standards of medical care for newborns in Poland. Recommendations of the Polish Neonatology Society. Media-Press, Warsaw 2015: 14–29.
- Rutkowska M, Szczepaniak S, Walas W. Guidelines for making decisions about initiating palliative care in neonatology. In: Standards of medical care for newborns in Poland. Recommendations of the Polish Neonatology Society, 5th edition. PTN and Media-Press, Warsaw 2023: 26–52.
- Standards for procedures in medical therapies used at the end of life. Position of the Team appointed by the Patient Rights Ombudsman to develop the above standards. Patient Rights Ombudsman. Warsaw, 2021. gov.pl (28.06.2024).
- Regulation of the Minister of Health in 2024 (Journal of Laws 2024, item 767). https://isap.sejm.gov.pl/isap.nsf/download.xsp/WDU20240000767/O/D20240767.pdf (28.06.2024).
- Supreme Audit Office, Providing palliative and hospice care. Information on control results, Warszawa 2019. https://www.nik.gov.pl/plik/id,21371,vp,24011.pdf (10.11.2024).
- Jarzębińska A. Perinatalna opieka paliatywna w Polsce. Charakterystyka ilościowa wybranych aspektów. ZNKUL. 2022; 65(2): 29–41.
- Tataj-Puzyna U, Szlendak B, Kaptacz I, et al. Accessibility and challenges of perinatal palliative care in Poland. Palliat Med Pract. 2023; 17(2): 111–120.
- egulation No. 74/2018/DSOZ of the President of the National Health Fund dated July 31, 2018, on defining the conditions for concluding and implementing contracts for palliative and hospice care. nfz.gov.pl (27.06.2024).
- Regulation No. 196/2021/DSOZ of the President of the National Health Fund dated December 10, 2021, on defining the conditions for concluding and implementing contracts for palliative and hospice care. baw.nfz.gov.pl (28.06.2024).
- Regulation No.54/2024/DSOZ of the President of the National Health Fund dated May 29, 2024. https://baw.nfz.gov.pl/NFZ/document/43256/Zarzadzenie-54_2024_DSOZ (28.06.2024).
- Borski M. Perinatal palliative care in Poland – an introduction. Ann Administr Law. 2022; 22(4): 33–48.
- Sobolewska E, Harasim-Piszczatowska E, Kułak-Bejda A, et al. Perinatal hospice — is there a need for such units to function in the opinion of Polish society? Med Paliat. 2021; 13(3): 145–152.
- Oelmeier K, Schmitz R, Möllers M, et al. Satisfaction with and feasibility of prenatal counseling via telemedicine: a prospective cohort study. Telemed J E Health. 2022; 28(8): 1193–1198.
- Oelmeier K, Schmitz R, Möllers M, et al. Creating a telemedicine network of specialists in maternal-fetal medicine: a prospective cohort study. Telemed J E Health. 2023; 29(11): 1723–1729.
- Pachocki J. Kaźmierczyk P, Osuch A. et al. Podstawowe zasady udzielania świadczeń telemedycznych. Poradnik Telemedycznej Grupy Roboczej. http://telemedycyna-poradnik.pl/api/file/events/rtgr/poradnik_dla_lekarzy-1.pdf (28.06.2024).
