Healthcare and decision-making in dementia
Consent to medical treatment
Article 12 of the Code of Medical Ethics of 2005  states: “the physician shall not proceed with the execution of any medical act, unless consent has been secured” (Goffin et al., 2007). However, for consent to be considered as valid, certain conditions must be fulfilled. The patient must have been fully informed (according to article 11) and have the capacity to consent. The consent must not have been made under duress or as a result of fraud or a mistake. However, for trivial interventions which do not involve any risk, consent can be presumed (Goffin et al., 2007).
Consent to treatment (for people with incapacity)
Consent in the case of people with incapacity is covered by Article 11 of the Code of Medical Ethics which states, “if a patient is not competent, consent for a medical treatment is given by the legal representative if appointed; if this is not the case, consent is given by relatives of the patient. In any case, the physician must try to obtain the voluntary participation and cooperation of the patients, especially of those patients who understand the status of health and their nature, consequences, results and risks of a treatment” (Goffin, 2007, p.18).
Consent in case of emergency
In emergency situations where the doctor cannot obtain informed consent s/he is obliged to provide the necessary treatment without consent. This is covered by articles 441 and 473 of the Penal Code.
The right to refuse treatment
Article 47 (3) of the Hospital Act of 1992 grants every patient the right to refuse consent to any diagnostic or therapeutic procedure but this is presumably limited to patients who have the capacity to consent and presumably extends to the legal representatives of those who do not.
Article 9 of the Biomedicine Convention is applicable with regard to previously expressed wishes because article 12 of the former Code of Medical Deontology, which forbade doctors from taking into account previously expressed wishes, was not included in the Code of Medical Ethics of 2005 which replaced it, and as Greece had ratified the Convention without any reservation regarding article 36.
Consent to the donation of organs and/or human tissue
The guardian may consent to the donation of the brain of a relative suffering from Alzheimer's disease for post mortem examination at university laboratories (Lecca Marcati, 1999).
Consent to research
Article 47 of the Hospital Law of 1992 (2071) states that the patient must feel free to decide whether he/she wants to take part in research or training. Consequently, consent must be obtained and can be withdrawn at any time. This applies to the patient's proxy if the patient is totally or partially incapacitated (Lecca Marcati, 1999).
Advance directives and health care proxies
Doctors were previously not allowed to take advance directives into consideration due to article 12 of the Code of Medical Deontology. However, Greece has ratified the Biomedicine Convention and did not make any reservation about article 9 which states:
The previously expressed wishes relating to a medical intervention by a patient who is not, at the time of the intervention, in a state to express his or her wishes shall be taken into account.
Consequently, according to Goffin et al. (2007), article 9 of the Convention overrules article 12 of the Code of Medical Deontology due to the wider scope of the former. Furthermore, the Code of Medical Deontology was revised in 2005 and ratified by statue thereby becoming Law no. 3418/2005. It does not contain an article which deals with previously expressed wishes. This further confirms the applicability of article 9 of the Biomedicine Convention (Goffin et al., 2007).
Nevertheless, it should be noted that article 9 of the Biomedicine Convention does not render advance directives legally binding but rather states that previously expressed wishes must be taken into account.
Access to information/diagnosis
The right to be informed
According to article 47 of the Hospital Law, patients have the right to request and receive accurate and comprehensive information on their state of health. They must be provided with sufficient information to enable them to form a clear understanding of the medical, social and financial issues surrounding their condition, to enable them to make their own decisions or at least to participate in the decision making process. Thorough information must be given about risks which might arise as a result of unusual or experimental therapeutic procedures. Such information can be provided to a patient's legal representative.
Article 11 of the Code of Medical Ethics of 2005 makes it the doctor’s duty to fully and comprehensibly inform patients about their health status, probable results and risks of treatment, side-effects, alternatives etc. The doctor is obliged to inform people who are unable to consent as much as possible.
Access to medical files
Patients are entitled to access their medical file and to receive a copy of the file (article 14 (8) of the Code of Medical Ethics) but not to written documents covered by medical confidentiality concerning other people (article 16 of the Act 1599/1986 on Citizen/State relations) (Goffin et al., 2007).
The right to designate another person to be informed on one’s behalf
Legal representatives who are authorised to consent on behalf of a person with incapacity must also be informed by the doctor (article 11 (4) of the Code of Medical Ethics, 2005). Patients are entitled to designate a person to receive information on their behalf (Article 11 (2) of the Code of Medical Ethics). The designated person should receive the same information as the patient would have received.
The doctor’s right to withhold information
It is the doctor's duty to tell the patient the truth, although he/she can partly reveal or hide the truth in cases of unfavourable prognoses, the revelation of which could cause serious or irreversible damage to the patient's health. However, the onus would be on the doctor to prove this.
The patient’s right to refuse information
Patients are entitled to refuse information and may ask the doctor to inform a person that they have designated (Article 11 (2) of the Code of Medical Ethics).
Confidentiality/disclosure of information to other people
According to article 2 of the Greek Constitution, respect for and protection of human dignity constitute the primary obligation of the State. This is reinforced by the Hospital Law which states that every patient has the right to receive care with due respect for his/her dignity as a human being. It is further specified that such care should cover not only the practice of medicine and nursing but also extends to other members of the health profession, accommodation, and administrative or technical services. With regard to privacy, this law grants patients the right to the protection of their private life. This includes the right to expect appropriate and confidential treatment of data, documents and files containing personal information, including observations and medical findings.
Doctors have an absolute obligation to ensure that medical information remains confidential (article 13 (1) of the Code of Medical Ethics) and must observe necessary discretion concerning such information with regard to other healthcare and support personnel. There are of course exceptions to this rule which are covered in the Greek Penal Code (e.g. the obligation
End-of-life care and issues
The Penal Code strictly forbids euthanasia. Article 301 of the Penal Code also carries a sentence of imprisonment for anyone who intentionally convinces a person to commit suicide, regardless of whether the suicide was carried out or even attempted.
Non-assistance to a person in danger
Failure to assist a person who is injured or in need of help (or presumably to give treatment in the case of a doctor) would result in prosecution according to article 307 of the penal code for non assistance to a person in danger.
Murder at the request of the victim
Article 300 of the Penal Code carries a punishment of imprisonment for anyone who decides upon and carries out manslaughter after a strong and persistent demand on the part of the victim and out of pity for the victim who was suffering from an incurable disease.
Goffin, T et al. (2007), Patients Rights in the EU – Greece , European Ethical –Legal Papers N°6, Leuven
Lecca-Marcati, E. (1999), speech at the Lawnet conference held in Luxembourg at the European conference on 11 May 1999.
Tsolaki, M. and Tsantali, E. (2008), Practice of competence assessment in dementia: Greece. Ed. Gabriela Stoppe (2008), Competence assessment in dementia, Springer Wien New York.
 Ratified by statute and now Law No. 3418/2005
Last Updated: mercredi 27 avril 2011