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Hungary

Healthcare and decision-making in dementia

Consent

In the following sections on consent and information, the information is taken from CLIV Act of 1997 on the Health Care Act.

Consent to medical treatment

Except in special cases defined by law, a medical intervention can only be carried out if the patient has given his/her consent based on receipt of the relevant information and without having been misled, threatened or coerced (§15 (3)). This can be given orally, in writing or in another form unless stated otherwise in the Health Care Act. The information shall be individualized.

If a person with incapacity does not have an appointed representative (please see below for details), the right to give or refuse consent and to be informed is given to the patient’s legal representative. If he/she does not have one, the right is given to one of the person’s relatives in order of importance, as mentioned in §16 (2) of the same law.

In decisions relating to the treatment of a person who is incapable or has limited capacity, his/her opinions must be considered even if he/she does not have the right to give or refuse consent (§16 (5)).

Appointment of a healthcare proxy

A person with active legal capacity can appoint another person with active legal capacity to give or refuse consent on his/her behalf. The appointed person must receive the same information as the person would have received. It is also possible for a person with active legal capacity to specify which people should not be granted the right to give or refuse consent or recieve information on his/her behalf (e.g. in case of future incapacity).

Consent in case of emergency

The consent of a patient with incapacity can be substituted by an expert assessment if obtaining consent from the appointed representative would cause delay. In the case of invasive interventions, the same principle applies with the further condition that any delay would cause serious or permanent harm to the patient’s health (§17).

The right to refuse treatment

For people with capacity

Everyone has the right to refuse treatment unless doing so would endanger the lives or physical safety of other people. However, if the refusal of treatment is likely to result in serious or permanent harm to the patient’s health condition, it must be made in an official or private document “with full authenticity”. These documents are regulated in the third Act of 1952 on Civil Procedure.

The right to refuse life saving or life sustaining treatment is restricted to patients suffering from a severe disease which in the opinion of medical science is likely to cause death in the not too distant future and which even with the appropriate medical treatment is not curable (§20). The refusal is only valid if a medical committee examines the patient and reports unanimously in written form that the patient made his/her decision in full awareness of the consequences and that the conditions governing the exercise of this right have been met. The committee is made up of the patient’s attending physician, another doctor from the same field not involved in the treatment and a psychiatrist.

Attempts must be made to identify in private conversation the reasons behind the patient’s refusal of treatment mentioned in the two previous paragraphs and to try to change it. During this conversation and in addition to the standard requirements for the provision of information, patients must be informed of the consequences of such refusal. They can withdraw their refusal at any time without any formal obligations.

For people with incapacity

A person with incapacity does not have the right to refuse treatment which is likely to result in serious or permanent harm to his/her health (§21.1).

If the patient with diminished or precluded legal capacity refuses life-saving or life-sustaining treatment, the health care institution must file an action for consent from the court (i.e. to override the refusal). Until a court judgement has been made, the doctor must continue the treatment. In a direct life threatening situation, consent from the court for the necessary intervention is not required (§21(2)).

The right to withdraw consent

Consent can be withdrawn at any time. If the patient has no substantial reason for withdrawing consent, he/she may be obliged to cover any justifiable resulting expenses (§15(6)).

Consent to non-conventional treatment

No special rules are applicable.

Consent to the donation of organs and/or human tissue

Written consent is required for the removal, during an intervention, of any living cell, plasma, tissue or organs for use other than that related to the person’s treatment. Patients have the right to make arrangements for the use of their body after their death. They can also refuse the post morten removal of organs and body tissue for use in transplantation or other treatment, as well as for studying and teaching purposes (§20). If no statement is made concerning the post-mortem removal of organs, it is presumed that the person consented.

Consent to research and clinical trials

Informed consent is required for participation in research activities (European Commission, 2006).

Advance directive

The legal status of advance directives

Article 22 covers the right for a person with active legal capacity to make an advance statement of refusal of life-saving and life-sustaining interventions if he or she suffers from an incurable illness and due to this illness is unable to physically take care of him/herself or if the suffering of the patient cannot be alleviated with drugs. The patient can also appoint another person with active legal capacity to refuse life-saving and life-sustaining treatment subject to the same conditions.

Conditions surrounding the writing, validity and registering of an advance directive

To write an advance directive, a person must have “full disposing capacity”. The advance directive must be in the form of notarial document. In order to be considered valid, a board-certified psychiatrist must have confirmed in a medical opinion, given not more than a month earlier, that the person had made the decision in full awareness of its consequences. If a person is unable to write, the advance directive must be made in the presence of two witnesses who should also sign the document.

What an advance directive can cover

An advance directive can cover:

 

  • the refusal of specific forms of treatment.
  • life-supporting or life-saving interventions may be refused if the patient suffers from a serious illness which, according to the current state of medical science, will lead to death within a short period of time even with adequate health care, and is incurable.
  • certain life-supporting or life-saving interventions may be refused if a person has an incurable disease and as a consequence of the disease is unable to care for him/herself physically or suffers pain that cannot be eased with appropriate therapy.
  • the refusal to donate organs and human tissue in case of death
  • the appointment of a health care proxy in case of subsequent incapacity
  • a statement as to which people should not be given medical information or granted the right to refuse or consent to treatment on the person’s behalf. This can be done irrespective of whether a health care proxy is appointed.

 

Obligation to comply with instructions contained in an advance directive

For the statement to be valid, a psychiatrist must also have certified no longer than one month ago that the person who made the statement was aware of the possible consequences of it. Refusal of life-sustaining or life-saving treatment in the context of an advance directive does not lead to the automatic referral to a court to contest the decision and should normally result in the treatment being stopped (Hungarian Civil Liberties Union, 2002).

In case of doubt, the patient’s personal declaration made previously must be taken into account. In the absence of such a declaration, the patient’s consent to the life supporting or life-saving intervention must be assumed. (§23(1))

Amending, renewing and cancelling advance directives

Such statements must be renewed every two years. They can be withdrawn at any time regardless of a person’s legal capacity.

Latest developments regarding advance directives

On 21 September 2009, Members of the Hungarian Parliament voted for a new Civil Code which contains references to advance directives. The President of Hungary vetoed the Civil Code which means that the Parliament has to reconsider and vote again. However, the President’s veto was not aimed at eliminating the new rules of legal capacity, even though the process may affect them. According to the current situation, the new Civil Code will come into force in May 2010.

The new Civil Code contains welcome alterations concerning legal capacity and ways to promote decision-making by adults. It overrides the previous rules of precluded legal capacity and general diminished legal capacity. The new act makes it compulsory to state in the court judgement for which issues the person does not have full, but only diminished legal capacity. In addition, the new Civil Code has created rules covering advance directives in which a person with full legal capacity can state their wishes, basically on any kind of civil law issue. Furthermore, the new act introduces rules on supported decision-making, which allows one person to help another in making a decision without this affecting the legal capacity of the latter. The above-mentioned rules can also be combined.

Access to information/diagnosis

The right to be informed

Patients are entitled to full and detailed information about their state of health and possible treatment. Article 13 states that patients are entitled to information about:

 

  • his/her state of health, including its medical evaluation,
  • the recommended examinations and interventions,
  • the possible benefits and risks of performing or not performing the recommended
  • examinations and interventions,
  • the planned dates for performing the examinations and interventions,
  • his right to decide in respect of the recommended examination or intervention,
  • the possible alternative procedures and methods,
  • the course of care and the expected outcome,
  • additional services, and
  • the recommended lifestyle

 

They are also entitled to receive information about the results, possible unsuccessful outcomes or unexpected results (and the reasons for this) during the treatment and after various examinations and interventions.

The patient has a right to ask additional questions when the information is being provided and afterwards.

Information must be provided in a way that is understandable taking into account the age, level of education, knowledge and state of mind of the patient. People with incapacity and those with limited capacity have the right to receive information that corresponds to their age and mental state. Patients who cannot consent also have the right to be informed.

The patient shall have a right to be informed even in cases where his/her consent is not otherwise a condition for initiating medical care. (§14 (3))

If the patient’s legal capacity is diminished or precluded the attending physician shall also inform the persons mentioned in Article 16 of the Health Care Act.

Access to medical files

The patient’s right to become acquainted with the medical record is established in Article 24 of the Health Care Act. A patient shall have the right to become acquainted with the data contained in his/her medical record and shall have the right to request information about his/her health care data.

The health care provider shall dispose of the medical record, while the patient shall dispose of the data contained therein.

The patient shall have the right to:

 

  • be informed of the management of the data related to the medical treatment,
  • become acquainted with the health care data relating to him/her,
  • gain access to the medical record and receive copies thereof at his/her own expense,
  • be given a discharge summary upon discharge from the healthcare institution
  • receive a written summary or abridged opinion of his/her health data for justified purposes, at his/her own expense.

 

The right to inspect the medical record of a person with no disposing capacity shall be exercised by a person as defined in paragraphs (1) and (2) of Article 16.

The access to medical records beside the patient is distinctly regulated in the Health Care Act concerning the state of the medical treatment, if it is in the patient’s lifetime or after his/her death and the person who files for access such records.

The right to designate another person to be informed on one’s behalf

A legally competent patient may waive the right to be informed, except in cases when s/he must be aware of the nature of his/her illness in order not to endanger the health of others. If an intervention takes place at the patient's initiative and not for therapeutic purposes, such waiver of the right to be informed shall only be valid in writing. (§14(1))

The doctor’s right to withhold information

Article 135 states that the attending physician shall be circumspect in informing the patient, and shall do so gradually when necessary, considering the patient’s condition and circumstances. This rule might lead to abuse if it is interpreted in as implying that it is not necessary to inform the patient of his/her condition and if circumstances justify not doing so. This depends on the evaluation of the attending physician.

The patient’s right to refuse information

A legally competent patient may waive the right to be informed, except in cases when s/he must be aware of the nature of his/her illness in order not to endanger the health of others. If an intervention takes place at the patient's initiative and not for therapeutic purposes, such waiver of the right to be informed shall only be valid in writing. (§14(1))

Confidentiality/disclosure of information to other people

Article 25 of the Health Care Act covers the right to medical confidentiality. It states that people who are involved in the treatment of a patient should not disclose health and personal information obtained during treatment to other people unless those people have the right to such information and they shall treat it with confidentiality.

The patient also has the right to decide who should and should not have access to this information and may make a statement as to who is to receive information on his/her illness and the expected outcome thereof and who is to be excluded from becoming partially or fully acquainted with his/her health care data. (§25)

Disclosure of information without the patient’s consent is nevertheless possible if specified by law and necessary to protect the life, physical safety and health of other people. According to the Hungarian Civil Liberties Union, a caregiver may be informed against the expressed will of the patient if care is needed in order to ensure that the health of the patient does not deteriorate.

People involved in the patient’s health care may disclose his/her health care and personal data, which they might learn in the course of delivering such care (called ‘medical secret’), to those entitled thereto and must ensure that such data is treated with confidentiality.

End-of-life care and issues

End-of-life and palliative care

Article 11 paragraph 3 of the Health Care Law allows for patients who are in a serious condition to be accompanied by a specific person. This could be a person who was appointed to be informed and make healthcare decions on their behalf (mentioned in §16). If such a person was not appointed whilst the patient had active legal capacity, this could be the person’s legal representative or another person (listed in order of priority in §16(2)). This right is not limited to end-of-life care but also applies to patients who due to their medical condition are physically unable to take care of themselves, whose pain cannot be alleviated with drugs or who are in a condition of psychological crisis.

According to §23 (2), patients have a right to receive medical care to alleviate their suffering and lessen their pain, even if they have refused life-saving or life-sustaining treatment as permitted by §20 (3) of the Health Care Act.

Euthanasia

There are currently no initatives in Hungary to legalise active euthanasia or assisted suicide (European Association for Palliative Care, 2006). The Constitutional Court of Hungary has stated in its ruling of 22/2003 that the current regulation on the refusal of treatment is not against the Constitution.

Passive euthanasia is legal in Hungary (please see the section on the right to refuse treatment) but advance directives for the refusal of treatment and active euthanasia are completely different matters.

Assisted suicide

Article 168 of the Criminal Code states that it is a crime for a person to persuade somebody else to commit suicide or to help them to commit suicide and that a person who commits this crime may be punished by up to five years’ imprisonment.

Murder

According to Article 166 of the Criminal Code, it is a crime to take the life of another person. The sentence for this crime is between 5 and 15 years’ imprisonment.

Bibliography

European Association for Palliative Care (2006), Report on palliative care in Hungary , http://www.eapcnet.org/download/forPolicy/Hungary.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

Hungarian Civil Liberties Union (undated), Patients Rights in Hungary; a Compilation by the Hungarian Civil Liberties Union : http://www.c3.hu/hclu/

Hungarian Civil Liberties Union (2002), Patients’ Rights in Hungary – rules and practices

 

 
 

Last Updated: mercredi 27 avril 2011

 

 
  • Acknowledgements

    Alzheimer Euriope gratefully acknowledges the support of Fondation Médéric Alzheimer which made possible the data collection and publication of the country reports in our 2009 Yearbook.
  • Fondation Médéric Alzheimer
 
 

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