Healthcare and decision-making in dementia
Consent to medical treatment
Article 8 (the right to refuse treatment) of the Law on the Rights of Patients and Compensation of the Damage to their Health of 1996 (RPCDH) states that patients may not be treated or provided with any other health or nursing care against their will, unless otherwise established by the laws of the Republic of Lithuania. If the possibility exists, patients must be offered other treatment or other health care services (§1).
§4 of the same article states that „the Law on Mental Health Care shall establish the nature of treatment of a patient, mental patient, who is unable to correctly assess the condition of his/her own health.“
Consent to treatment in case of incapacity
Article 6.744 (3) covers consent to treatment in cases where a patient lacks the necessary capacity to consent and does not have a curator or guardian. In such cases, there is a hierarchy of people authorised to consent on the person’s behalf: first, the person authorised in writing by the patient with incapacity to act on his/her behalf, second, the spouse or partner. If the spouse or partner is not available or refuses to consent, the obligation goes to a parent or child unless they refuse.
Consent in case of emergency
§3 allows for patients to be treated without their consent in case of emergency. It states that vital (first or urgent) medical assistance can be given to a patient who is unconscious or whose will is not known for another reason without his/her consent if there is a serious threat to his/her life. Article 8 (5) of the RPCDH states that healthcare services can be provided with the consent of a person‘s legal representative if the latter cannot be contacted in time and immediate action must be taken in order to save the patient‘s life (Nys et al., 2007).
The right to refuse treatment
Paragraphs 5 and 6 of article 1 of the Law on the Rights of Patients and Compensation of the Damage to their Health of 1996 (RPCDH) address the issue of refusal of treatment by legal representatives. It is not stated whether this is referring to legal representatives of incapable adults or just minors. The paragrahs are as follows:
§5. In the course of providing required (first aid or urgent) medical assistance, which requires the consent of the legal representative of the patient, such may be provided also without the legal representative’s consent, if this can not be obtained in time or if the legal representative refuses to give his consent, while according to the treating physician or nursing staff member, the rendering of medical assistance is in keeping with the interests of the patient. The case history of the illness of the patient must include a record of this.
§6. Should the legal representative of a patient refuse to give his consent for treatment, which is not urgent and the treating physician be of the opinion that the treatment being provided is in keeping with the interests of the patient, the medical commission of the health care institution or the Committee for Medical Ethics of Lithuania, has the right to give consent for such treatment. The administration of the health care institution or the treating physician shall have the right to appeal to this commission or committee.
The right to withdraw consent
Article 8 (4) further states that patients have the right to withdraw consent in written form at any time. Article 6.739 (2) of the Civil Codes grants patients the right to “terminate the contract at any time” and no formal requirements are mentioned.
Consent to the donation of organs and/or human tissue
Article 6.746 states,
“Human tissues and organs taken from an anonymous person during the provision of personal healthcare services may be used in cases and pursuant to the procedure prescribed by laws.”
Consent to research and clinical trials
The Law on Ethics of Biomedical Research of 11 May 2000 states that biomedical research can only be carried out on people who have given their free and informed consent (article 6). The law also contains a list of vulnerable subjects which includes people with mental disorders who are nevertheless able to give their consent to take part in biomedical research as well as people living in nursing homes. Article 7 of this law sets conditions which must be met before such research can be carried out i.e.
- it can only be carried out on vulnerable people
- the results have the potential to produce real and direct benefit to the health of the research subjects
- it does not pose a risk to the health or life of the research subject.
Furthermore, the free and informed consent of the reserach subject must be attested by 2 witnesses and the head of a health care establishment where biomedical research is being conducted. The approval fo the Medical Ethics Commission must also be obtained.
Article 7 of the Law on the Rights of Patients and Compensation of the Damage to their Health of 1996 states that people cannot be used for training or scientific or medical experiments without their consent.
There are no legal provisions relating to previously expressed wishes in Lithuania (Nys et al., 2007).
However, according to the Law on Human Death and Critical Care, a person should not be resuscitated if he/she has expressed a wish to this effect and provided that there is approval from a doctors’ committee (Council of Europe, 2003).
Access to information/diagnosis
Article 6 of the Law on the Rights of Patients and Compensation of the Damage to their Health of 1996 (RPCDH) deals with the right to information. Information is also contained in section 2 of the Civil Code.
The right to be informed
The following paragraph deals with the patient‘s right to be informed about his/her state of health:
§4. The patient shall have a right to information on the condition of his/her health, disease diagnosis, medical examination results, treatment methods and treatment prognosis. The information must be supplied to the patient in a form comprehensible to him/her, with an explanation of the special medical terms involved. In providing information regarding the treatment, the physician must explain to the patient the course of treatment, possible results of the treatment, possible alternative methods of treatment and other circumstances, which may have an effect upon the patient’s decision to accept or refuse the proposed treatment. The information should not be supplied to the patient against his/her will, however, his/her will must be clearly expressed and the history of his illness should contain a mention of this wish of his/hers.
§9 further specifies that a patient has the right to learn of the specialist’s opinion concerning the condition of his/her health and the proposed treatment.
According to article 727 of the Civil Code healthcare providers are obliged to provide patients with information in a form that is comprehensible to the latter, explaining special medical terms used, outliing possible treatment methods, prognosis of treatment and other circumstances which might effect the patient‘s decision whether or not to consent to the proposed treatment, as well as the likely effects of refusing the proposed treatment.
Access to medical files
§6 of the RPCDH covers the patients right to access their medical files. It states:
The patient shall have the right to request that copies of the case history of his disease and (or) of other documents, be made at his expense. This right of the patient may only be limited by the procedure established by the laws of the Republic of Lithuania. The physician must explain the significance of the notes included in the case history of his illness. If the patient’s request is justified, the physician must correct, complete, remove, explain and (or) change inaccurate, incomplete, ambiguous data or data not related to the diagnosis, treatment or nursing. If the treating physician fails to agree with such a request by the patient, the consilium of physicians will then decide the validity of the patient’s request.
Article 6.735 of the Civil Code grants patients the right to be provided with all their medical documents unless this would be harmful to their health or endanger their lives. If information is withheld, this must be noted in the medical file. The patient is also entitled to ask for copies of the information in his/her medical file at his/her own expense. The healthcare provider must explain the meaning of the information and be willing to make any reasonable corrections or amendments suggested by the patient.
The doctor’s right to withhold information
According to §5 of the RPCDH, information can be withheld from the patient:
If the patient so desires, s/he must be supplied with the history of his/her illness or other medical documents of his/hers, with the exception of instances, wherein this may have a basic effect upon the patient’s health and even endanger his/her life (this shall be decided by the physician treating him/her, or a physicians’ consilium). In such instances, the treating physician shall note in the disease case history, the limitations of the supply of information.
Article 6.727 of the Civil Code states that providers of healthcare services may withhold information if such information would have a detrimental effect on the patient‘s health or endanger his/her life. However, the information should then be submitted to the patient‘s representative and later given to the patient if and when the risk of causing harm no longer exists.
The patient’s right to refuse information
The right not to be informed is covered by article 6.728 of the Civil Code which states that information should not be provided against the person’s will which was clearly expressed and attested by his/her signature. The same right can be found in the RPCDH in article 6 (4). However, in the Civil Code, it is stipulated that the right to refuse information is not applicable if such refusal is likely to be harmful to the patient or to other people.
Confidentiality/disclosure of information to other people
Article 10 of the RPCDH deals with the inviolability of personal privacy. The relevant articles are as follows:
1. The private life of patients shall be inviolable. Information concerning the facts of the patients’ personal existence may be collected for the case history of the illness, with the patients’ consent and if, in the opinion of the treating physician, this shall be deemed necessary for diagnosing the illness, treatment or nursing.
2. All of the information concerning the condition of the patient’s health, diagnosis, prognosis and treatment, and also, all of the other information of personal nature concerning the patient, must be held as confidential, even after the patient’s death. The laws of the Republic of Lithuania and legal acts of the Ministry of Health shall determine the procedure of safe keeping of such confidential information. Confidential information may be furnished for other individuals, only upon the written consent of the patient, or if this is stipulated by this and other laws of the Republic of Lithuania.
3. Consent is not required, if the information is provided to individuals who are direct participants in the treatment or nursing of patients, performing expert examinations of the patients’ health, and also to institutions, which are given the right by the laws of the Republic of Lithuania to inspect the activity of health care institutions.
Article 13 of the same law deals with the use of information in medical files for research and student instruction:
The Lithuanian Committee on Medical Ethics of Lithuania shall establish the procedure for use of the information contained in the patients’ documents, for medical research work and student instruction. The personal privacy of the patient must be respected in using information for these purposes.
It is stated in article 6.736 of the Civil Code that healthcare providers may not give information about the patient without his/her consent to other people. Similarly, they may not give copies of official documentation about the patient to other people unless required by law to do so. Information may be provided to people who are involved in the care of the patient if such information is necessary for the provision of such care.
End-of-life care and issues
Article 3, §6 of the Law on the Rights of Patients and Compensation of the Damage to their Health of 1996 states, “Patients shall have the right to be cared for and to die with dignity.“
Euthanasia and assisted suicide
There is no law against euthanasia but there are legal sanctions against killing. These sanctions are more severe for the killing of a vulnerable person (Council of Europe, 2003).
According to the European Association for Palliative Care (2006), there are no initiatives in Lithuania to seek the legalisation of euthanasia or assisted suicide at the present time.
European Association for Palliative Care (2006), Report on palliative care in Lithuania: http://www.eapcnet.org/download/forPolicy/Lithuania.pdf
Council of Europe (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: mercredi 27 avril 2011