Request from a family member for the Patient to be treated with CDS

Request from a family member for the Patient to be treated with CDS


D. _______________________________________________________________, of legal age, with identification number ______________________________________________ as a FAMILY MEMBER of ______________________________________ with identification no. ___________________________________ its representation and in defense of its legitimate interest, in full possession of the intellectual and volitional capacities, freely and voluntarily, duly informed, requests that the treatment with CHLORINE DIOXIDE be applied to _________________________________________________________ according to the standardized protocols and advice of the expert D . ___________________________________________________.                                             

This request is protected by the obligation to "behave fraternally with one another", article 1 of the Universal Declaration of Human Rights of December 10, 1948, and by the duty of public and private institutions and the medical profession;

.- To safeguard the right to life and physical and moral integrity of the person contained in the Universal Declaration of Human Rights of December 10, 1948, Convention for the Protection of Human Rights and Fundamental Freedoms Rome of November 4 1950 , International Covenant on Civil and Political Rights of December 16, 1966.

.- of the right of self-determination of the patient of the Declaration of Lisbon of the AMM on the Rights of the Patient of 1981.

.- of the duty of recognition of the professional autonomy and clinical independence of physicians, in accordance with the Declaration of the AMM on the Independence and Professional Freedom of the Physician of 1986, Declaration of Madrid of the AMM on the Autonomy and Professional Self-regulation of 1987, WMA Seoul Declaration on Professional Autonomy and Clinical Independence 2008, WMA Madrid Declaration on Professional Regulation 2009.

.- respect for the human being in scientific research, the 1947 Nuremberg Code of Medical Ethics, the 1949 International Code of Medical Deontology, the 1997 Oviedo Convention, the 1964 Helsinki Declaration, the 1978 Belmont Report, the guidelines CIOMS 2002 International Ethics for Biomedical Research in Humans, 2005 UNESCO Universal Declaration on Biomedical and Human Rights.

SODIUM CHLORITE, was declared  Orphan drug for the treatment of amyotrophic lateral sclerosis by the European Commission, in accordance with the COMMISSION IMPLEMENTING DECISION of 19.6.2013.

            For these reasons, the assistance Center and its doctors are required to apply the treatment with CHLORINE DIOXIDE in compliance with the;

            .- art 37 of the Declaration of Helsinki adopted by the 18th World Medical Assembly, 1964:

«When proven interventions do not exist in patient care or other known interventions have proven ineffective, the doctor, after seeking expert advice, with the informed consent of the patient or an authorized legal representative, can afford to use unproven interventions, if, in his opinion, this gives some hope of saving his life, restore health or alleviate suffering »

.-  art 36 of the International Code of Medical Deontology «1. The doctor has the duty to try to cure or improve the patient, whenever possible. When it is no longer so, the obligation to apply the appropriate measures to achieve their well-being remains, even when this may lead to a shortening of life. 2. The doctor must not undertake or continue diagnostic or therapeutic actions harmful to the patient, without hope of benefits, useless or obstinate. You should withdraw, adjust, or not initiate treatment when the limited prognosis so advises. The diagnostic tests and the therapeutic and support measures must be adapted to the clinical situation of the patient. It must avoid futility, both quantitative and qualitative. 3. The doctor, after adequate information to the patient, must take into account his willingness to reject any procedure, even treatments aimed at prolonging life. 4.When the patient's condition does not allow him to make decisions, the doctor must take into consideration, in order of preference, the indications previously made by the patient, the previous instructions and the opinion of the patient in the voice of their representatives. It is the duty of the doctor to collaborate with the people who have the mission of guaranteeing compliance with the patient's wishes.

.- art 59 of the International Code of Medical Deontology "Research with human beings should be carried out when scientific advance is not possible by alternative means of comparable efficacy or in those phases of research in which it is essential."

The bearer of this request and / or their family members, in the event that the healthcare center and / or its physicians refuse to provide the requested treatment, reserve the right to demand criminal and civil liability for breach of international and national standards. Against the fundamental right to the preservation of life, before the commission of possible crimes of omission of the duty to help and crimes against the right to life.


_______________________, on ____ of ______________ of 20__. 

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