Healthcare and decision-making in dementia
Consent to medical treatment
In Chapter VI of the Medical Treatment Law of 1997, the emphasis is on the doctor’s obligation to obtain the patient’s consent. According to section 41, a doctor must obtain the consent of the patient for medical treatment.
Article 70 states that a written request by the guardian or his or her approval must be obtained for mental treatment for people who are deemed not to be of active capacity (except in the case of compulsory treatment).
Consent in case of emergency treatment
Section 49 of the Medical Treatment Law deals with cases where a delay might endanger the life of the patient and it is impossible to obtain the consent of family members, closest relatives or lawful representatives. In such cases, medical professionals have a duty to take emergency measures within the scope of their competence. If there is enough time, they should get the examination and treatment plan approved and let a doctor’s council taken the necessary decision.
The right to refuse treatment
Section 23 of the Medical Treatment Law of 1997 concentrates on the patient’s right to refuse treatment. It states:
A patient has the right to refuse, in full or in part, examination or medical treatment offered by certifying such refusal with his or her signature. If a patient is a minor or a person who due to his or her state of health is unable to understand the consequences of his or her actions, family members, but if such do not exist, the closest relatives or lawful representatives of the patient (trustees, guardians) have such rights and liability for the decisions taken. The doctor has a duty to explain to the patient, his or her family members, closest relatives or lawful representatives (trustees, guardians) the consequences of such refusal. If the person has accepted a treatment plan, he or she is responsible for observing all instructions of the medical practitioner related to the medical treatment and care.
Consent to participation in research
Informed consent is required for participation in research activities (European Commission, 2006) - (is this general or specifically referring to Latvia?)
Access to information/diagnosis
Access to information
According to section 20 of the Medical Treatment Law, “Patients have the right to receive information from a doctor in a way that they can comprehend regarding the diagnosis of their illness, examination and medical treatment plan, as well as regarding other medical treatment methods and the prognosis.”
Section 41, which deals with the doctor’s obligation to obtain the patient’s consent, further stipulates that the doctor has a duty to provide information to the patient in a comprehensive way regarding the diagnosis of the illness, the planned examination and medical treatment, as well as regarding other medical treatment methods and prognosis. The doctor has a duty to explain and inform the patient of the possible effects and complications of the disease, as well providing information about possible side effects of the prescribed medical substances or medical treatment methods.
The doctor’s right to withhold information
Section 41 of the Medical Treatment Law also permits the doctor to provide incomplete information to the patient regarding the diagnosis and prognosis of the disease if he or she considers that such information may cause deterioration of the state of health of the patient.
Confidentiality/disclosure of information to other people
According to section 145 of the Criminal Law, it is an offence to intentionally disclose personal confidential information about another person which was entrusted or communicated to the offender as a result of his/her position or employment. The sentence for such an offence is custodial arrest, community service or a fine not exceeding twenty times the minimum monthly wage.
The obligation to respect confidentiality can also be found in section 50 of the Medical Treatment Law of 1997. This covers both medical information (e.g. the diagnosis and prognosis) and information about the private life of the patient and of his/her close relatives.
Section 50 of the Medical Treatment Law also states that information regarding a patient may be used in scientific research if the anonymity of the patient is guaranteed or his or her consent has been received.
End-of-life care and issues
The Alpha & Omega Society is established as a non-governmental organisation proposing the legalisation of euthanasia or medically-assisted suicide (EAPC Palliative Care Euro-Barometer 2005). According to the Ministry of Justice, there have not been any court cases linked to euthanasia yet (Council of Europe, 2003)
Section 124 of the Criminal Code addresses the issue of assisted suicide. It states that a person who causes another person to commit or attempt suicide by cruel treatment or systematic demeaning of his or her personal dignity shall be sentenced to deprivation of liberty for a term of up to three or five years (depending on whether the person was financially or in some other way dependent on him/her).
It is not clear what the sentence would be in case of assisted suicide without cruel treatment or systematic demeaning of the other person.
According to section 116 of the Criminal Code (Chapter XII):
For a person who commits intentional illegal homicide (murder) of another person, the applicable sentence is deprivation of liberty for a term of not less than five years and not exceeding fifteen years, with or without police supervision for a term not exceeding three years.
The sentence is longer if there are aggravating circumstances e.g. the offender knows that the person is in a state of helplessness (section 117). The sentence is shorter if the homicide was committed through negligence (section 123).
European Association for Palliative Care, Country Report on Latvia: http://www.eapcnet.org/download/forPolicy/Latvia.pdf
European Commission (2006), High level group on health services and medical care - summary paper on common principles of care, from mapping exercise of the high level group on health care services 2006, Health and consumer protection Directorate-General
Steering committee on bioethics (2003), Results of questionnaire, Council of Europe: http://www.coe.int/T/E/Legal_Affairs/Legal_co-operation/Bioethics/Activities/Euthanasia/Answers%2520Euthanasia%2520Questionnaire%2520E%252015Jan03.asp#TopOfPage
Last Updated: Wednesday 27 April 2011