Healthcare and decision-making in dementia
The following information on consent and information is based on the Health Care Act No. 20 of 1966 (and subsequent amendments). As we had no access to this law, the information in the following two sub-sections is taken from a report on patients’ rights produced by Nys et al. (2006).
In addition, issues related to consent and the provision of information are also covered by the provisions of the Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine (Haśkovcová, 2002). This is because the Convention became part of Czech legislation after it was signed and ratified by the Czech Parliament. However, the general public is largely unaware of this.
Consent to medical treatment
According to article 23, section 2, of the Health Care Act No.20 of 1966, examinations and treatments are provided with the consent of the patient or if such consent can be presumed. In the case of adults lacking legal capacity, who have a legal representative, presumably that legal representative would be able to consent on their behalf as article 26 of the Civil Code states that if individuals are not capable of legal acts, they shall be represented by their legal representatives.
More recently, Regulation no. 385/2006 states that health care institutions must provide documentation about health care provision and obtain informed consent.
People with dementia who do not have the capacity to given informed consent but are not actually legally capacitated are not adequately protected. They may sign a consent form without having fully understood what they are agreeing to (Holmerová et al., 2008).
Consent in case of emergency
Treatment can be provided without the prior consent of the patient if the patient shows signs of a mental illness and is a danger to him/herself or to his/her surroundings or if it is not possible, given the state of health of the patient, to obtain his/her consent and urgent medical treatment is necessary (article 23, section 4).
The right to refuse treatment
A person who refuses a medical intervention, despite having received the necessary information, must give written confirmation of this refusal (Health Care Act No. 20 of 1966, §23, subparagraph section 2).
If the curator of a person lacking the legal capacity to act refuses to consent to treatment that is necessary to save that person’s life, the doctor can (according to §23, subsection 3) decide whether or not to provide treatment. However, it seems that this provision is limited to people lacking legal capacity and for whom a curator has been appointed. The provisions for a person who lacks capacity but has not been declared legally incapacitated by a court of law are unclear (Nys et al. 2006).
Regulation no. 385/2006 Sb. also covers the refusal of health care but again, this only applies to people with capacity (Holmerová et al., 2008).
Consent to research
Written consent must be given by the patient before scientific research can be carried out on him/her. Before giving consent, the patient must have been informed about the nature and purpose of the research, how it will be carried out, how long it will take and whether there are any risks involved (article 27b).
There is no legislative framework for advance directives in the Czech Republic.
Access to information/diagnosis
The right to be informed
Doctors must inform patients in an appropriate manner about the nature of their illness and about any necessary medical procedures so that patients can play an active role in the provision of their medical care (article 23, subsection 1). In the case of incapacitated adults, members of the family should be informed.
Access to medical files
On 20 December 2006, the Hradec Králové Regional Court confirmed that patients in the Czech Republic are entitled to see their medical records and to consult independent experts on their contents. A person cannot be denied this right solely on the basis of a psychiatric diagnosis (Source: Mental Health Europe, 2007).
The doctor’s right to withhold information
The right to withhold information about a patient’s health is not covered by law but is mentioned in the Code of the Czech Medical Chamber as being possible if the diagnosis or prognosis is unfavourable and it would be in the patient’s interests not to be informed. However, this does not have any legal power (Nys et al., 2006).
The patient’s right to refuse information
A patient may refuse information on his/her health status.
Confidentiality/disclosure of information to other people
Article 55 of the Health Care Act of 1966 deals with the obligation of medical professionals to maintain confidentiality with regard to information about the patient obtained in the exercise of their occupation.
End-of-life care and issues
The following extracts are taken from a report by the steering committee on bioethics (Council of Europe, 2003):
“The term “assisted suicide” is clearly defined by current Czech legislation as intentionally assisting a person to terminate his or her life at his or her request and according to Czech Penal Law, it is considered to be a crime with possible criminal sanction of imprisonment for a duration of 6 months to 3 years.
The Ethical Code of The Czech Medical Chamber (professional organisation representing all physicians practising in Czech Republic) from 1.1.1996 declares euthanasia and assisted suicide to be unacceptable. Nevertheless it emphasises that the relevant goal of care in a terminally ill and dying patient is the relief of physical symptoms and of suffering and not only the prolongation of life.”
Euthanasia is an intentional criminal delict according to the penal code. However if the court decides that the penal sanction it too severe it may consider that the purpose could be achieved by a less severe sanction it may decide for sanction under the threshold given by the law. However the minimum is 3 years.
Non-assistance to a person in danger
It is a criminal act according to the penal code not to provide necessary assistance to a person in severe danger to life or health and is subject to a penal sanction up to one year (for health or social care professionals up to 2 years and/or prohibition to exercise their profession).
Haśkovcová H (2002), Léka řská etika , Galén, Praha (cited in the following publication)
Holmerová I, Rokosová M, Jurašková B, Vaňková H, Čvančarová H, Karmelitová P and Provazníková E (2008), Practice of competence assessment in dementia: Czech Republic. Ed. Gabriela Stoppe (2008), Competence assessment in dementia, Springer Wien New York.
Mental Health Europe (2007), Newsletter , Issue N°1-2007
Nys, H. et al. (2006), “Patient Rights in the EU – Czech Republic”, European Ethical-Legal Papers N°1 , Leuven
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