Općeprihvaćen stav da sloboda pacijentove volje ima prevlast nad medicinskim
razlozima, ipak, nije apsolutan jer
se u novije vrijeme smatra da je načelo apsolutne
prednosti prava na samoodređenje što ...se tiče života, tijela i zdravlja potrebno
ograničiti. U radu se prikazuju međunarodni i domaći pravni okviri za pravo na
odbijanje dijagnostičkog/terapijskog postupka te u kojim je slučajevima i pod
kojim uvjetima to pravo ograničeno. Posebno se analizira postupanje liječnika i
drugih zdravstvenih radnika te
rješenje pitanja krše li oni prihvaćanjem odbijanja pravnu normu i pravila svoje struke ili
postoji njihova obveza na neodgodivu intervenciju čije bi nepoduzimanje
ugrozilo život i zdravlje ili izazvalo trajna oštećenja pacijentova zdravlja.
Autorica obrađuje i pravne aspekte složene problematike odbijanja liječenja kod
određenih kategorija vulnerabilnih osoba, djece, osoba s duševnim smetnjama, u
odlukama o okončanju života umirućih bolesnika te štrajka glađu zatvorenika. U
radu se naglašava da konflikt
između prava na odbijanje medicinskog tretmana i interesa države za očuvanje
života i zdravlja može otvoriti
pitanja različitih vrsta odgovornosti zdravstvenih radnika, od nesavjesnog
liječenja ili nepružanja hitne medicinske pomoći do odštetne i/ili disciplinske odgovornosti.
Autorica posebno ističe neusklađenu i nejasnu pravnu regulativu koja dovodi zdravstvene radnike do njihove pravne nesigurnosti
zbog dileme kojem propisu u praksi dati prednost.
It is
generally accepted that the free will of the patient prevails over medical
reasons, but this is neither absolute nor should be unconditionally accepted.
The paper presents the international and domestic legal frameworks for the
right to refuse treatment, and discusses cases and conditions in
which this right can be limited. In
particular, the behaviour of physicians and other healthcare professionals is
analysed, as well as the answer to the question of whether they violate the
legal norm and rules of their profession by accepting a patient’s refusal, or
whether they breach their obligation to undertake emergency intervention. The author also deals
with the legal aspects of the complex issue of refusing to treat certain
categories of vulnerable people, such as children, people with mental disorders, dying patients in decisions
to end their lives and prisoners on
a hunger strike. The paper points out
that the conflict between the right to refuse treatment and the state's
interest in preserving life and health can raise issues of various types of
liability of healthcare workers, from negligent treatment and failure to render medical aid in an emergency, to compensation and/or
disciplinary liability. The author focuses especially on inconsistent and
unclear legal regulations that can result in legal uncertainty due to the
dilemma on the part of healthcare
workers over which regulation should be given priority in practice.
The purpose of the present study was to clarify how mothers of children with Down syndrome accompanied by intellectual disabilities perceive mental disorders and people with such disorders. ...Semi-structured interviews were conducted with nine mothers who were members of the group for the parents of children with Down syndrome and qualitative analysis was performed. The results showed that the subjects held negative perceptions regarding people with mental disorders and that their perceptions regarding parents of persons with disabilities were similar to that of the general public. Thus, it became clear that it was difficult for them to understand people with mental disorders, to feel affectionate towards them, and to eradicate their prejudice. Additionally, the mothers and children each formed their own connections, and the mothers feed the challenges of raising children with intellectual disabilities while receiving peer support. Furthermore, we believe that the attitude of the subjects in this study who do not hide their children from the society and stand in contrast to the mothers who have children with mental disabilities can be explained by the difference between Down syndrome and mental disorders in terms of the nature of the comorbid disabilities, and in the way in which they are raised.
To improve the community life of people with mental disorders, job support is an important task. However, measures and policies for people with mental disorders have yet to be implemented, and no ...sufficient support methods have been established for these patients. We performed a survey to clarify the needs and actual situations of people with mental disorders in Kashiwara City. The items of the survey included local exchange activities, motivation in life, and willingness to work. The survey was completed by 27 subjects. Most of the subjects were welfare-related workers accounting for 41%; none were regular workers. No local exchange activities were noted in 74% of the subjects, while 89% hoped to work. Although the number of subjects in this survey was insufficient to extrapolate the survey results beyond the present situations in Kashiwara City, Osaka Prefecture, there are many people with mental disorders who have a strong willingness to work. So, the trial of employing such people should be done, first of all. The job support for people with mental disorders will be needed in their daily life. It is important that they can feel fulfilled by working in the community and being able to become economically independent.
In penal law, persons with mental disorders most often receive attention as potential perpetrators of criminal acts. Persons who commit unlawful act provided under law as a criminal offence in the ...state of mental incompetence are subjected to a primary sanction - security measure of compulsory psychiatric treatment and confinement in a medical institution. This measure, as well as the security measure of compulsory psychiatric treatment at liberty may be also ordered to a person who committed a criminal offence in a state of substantially impaired mental capacity. In the new Serbian Penal Code 2005 few changes has been done respecting the conditions for imposing the security measures of compulsory psychiatric treatment and confinement in a medical institution and compulsory treatment at liberty, even though these provisions needed to be brought into accord with the changed concept of guilt. Especially, these changes are not properly expressed in the new Code of Criminal Procedure (special procedure for application of security measures). It is therefore even more distinct the contradictory position of a mentally incompetent person accused of a crime. One way of solving this issue, supported by the author, includes a separate legislation on protection of persons with mental disorders (including those persons who, in the state of mental incompetence, commit unlawful acts provided under law as criminal offences). The position of persons in the state of substantially impaired mental capacity does not need necessarily to be changed, since their guilt is not excluded. The entire complexity of protection of these persons? human rights is additionally pointed out in the section referring to execution of security measure of compulsory treatment and confinement in a medical institution, which naturally includes deprivation of liberty and compulsory psychiatric treatment.
Sa stanovista krivicnog prava lica sa mentalnim poremecajima izazivaju interesovanje najcesce kao moguci ucinioci krivicnih dela. Ako se radi o licima za koja se u krivicnom postupku ustanovi da su u neuracunljivom stanju izvrsila protivpravno delo sa obelezjima krivicnog dela, prema njima se kao osnovna sankcija moze izreci mera bezbednosti obaveznog psihijatrijskog lecenja i cuvanja u zdravstvenoj ustanovi. Takodje, ova sankcija ili druga mera obaveznog psihijatrijskog lecenja na slobodi moze se izreci prema licu u stanju bitno smanjene uracunljivosti. U novom Krivicnom zakoniku Republike Srbije iz 2005. godine ucinjene su neznatne izmene u pogledu uslova za izricanje mera bezbednosti psihijatrijskog lecenja i cuvanja u zdravstvenoj ustanovi i lecenja na slobodi, iako je bilo neophodno uskladiti ova resenja sa promenjenim konceptom krivice. Pogotovo ove izmene nisu dosle do izrazaja u Zakoniku u krivicnom postupku (poseban postupak za izricanje mera bezbednosti). Zbog toga se u jos vecoj meri uocava protivrecnost u polozaju neuracunljivog lica optuzenog za izvrsenje krivicnog dela. Jedan od nacina razresenja ovog problema, za koji se zalaze autorka, jeste odvojeno zakonsko regulisanje zastite mentalnih bolesnika (ukljucujuci tu i lica koja u neuracunljivom stanju ucine delo sa obelezjima krivicnih dela). Polozaj bitno smanjeno uracunljivih lica, buduci da njihova krivica nije iskljucena, ne mora se menjati. Na svu osetljivost zastite ljudskih prava ovih lica autorka dodatno ukazuje u delu rada koji se tice izvrsenja mere bezbednosti obaveznog lecenja i cuvanja u zdravstvenoj ustanovi, koja po svojoj prirodi ukljucuje lisenje slobode i prinudno psihijatrijsko lecenje.
We discuss the quantitative indicators, the analysis of which gives an idea of the strengths and means at the disposal of forensic health care. We discuss the possibility of using the existing ...statistical monitoring system for a dynamic assessment of the quality of the measures for primary prevention of socially dangerous acts and implementation of compulsory medical measures at the regional and federal levels. We emphasize the quality indicators of the process for specialized assistance: security environment, organizational culture, training and upgrading the skills of staff, completeness and quality of psychosocial interventions, the degree of profiling the psycho-educational work, the quality of psychotherapeutic contact and its dynamics. We discuss the problem of the validity of the criteria of rehabilitation interventions success by compliance with the methodological principles for the evaluation of their effectiveness. We suggest ways to improve the effectiveness of regional mental health services for the prevention of socially dangerous acts, approaches to peer review and monitoring of the work
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