Healthcare and decision-making in dementia
In this section, the Regulations of 1998 of the Ministry of Health on Patients’ Rights (1 August 1998, No. 23420) will be referred to as the Patients’ Rights Act.
Consent within the healthcare contract
Consent is covered in two places in the Patients’ Rights Act. Firstly, in article 5(d)
“except in cases of medical necessity or in cases provided for by law, there shall be no infringement of the physical integrity of a person or of other rights inherent in the individual without the consent of the person concerned.”
and secondly, in article 22 which states:
“No person may be subjected to a medical procedure without his/her consent or in a manner that s not in keeping with the consent that he is given, subject to exceptions laid down by law.”
Consent in case of emergency
This is covered by article 5(d) of the Patients’ Rights Act and also in article 22 which states that a medical procedure can be carried out at the request of the State Prosecutor in cases where delay would be detrimental.
Consent to non-conventional treatment
Patients are entitled to receive diagnosis, treatment and care that is in keeping with modern science and technological requirements. It is prohibited to give a diagnosis or administer treatment that runs counter to the principles of medicine or the legal provisions governing medicine, which is of doubtful quality (article 11 of the Patients’ Rights Act). Whilst this article is not directly about consent, it seems that non-conventional treatment is not allowed irrespective of whether a person consented to it or not.
Consent to clinical trials
This is covered by article 36 of the Patients’ Rights Act.
Consent to research
Under article 5(e) of the Patients’ Rights Act, no one may be subjected medical research without his/her consent or an authorization from the Ministry.
Article 17 of the Constitution of the Republic of Turkey also states:
“The physical integrity of the individual shall not be violated except under medical necessity and in cases prescribed by law; and shall not be subjected to scientific or medical experiments without his or her consent.”
There is a section (in Chapter VI Medical Research in the Patients’ Rights Act) on “modalities and forms of consent” and one on “cases involving minors and incompetent persons”.
There are no legal regulations governing the use of advance directives in Turkey.
Access to information/diagnosis
Unless otherwise stated, the articles quoted in this sub-section are from the Patients’ Rights Act of 1998.
The right to be informed
Under article 15, patients are entitled to request to be informed (either orally or in writing) about their state of health, medical treatment envisaged, foreseeable advantages and disadvantages, possible alternative treatment, the possible consequences of not accepting treatment, and his/her prognosis.
If the person is under guardianship, his/her guardian or legal representative may request such information.
Article 18 covers the need to provide information to the patient in a comprehensible manner taking into account his/her physical state and with due consideration for his/her feelings. There is no mention of his/her mental state.
Access to medical records
Article 16 states:
“The patient may check, directly or through the intermediary of his/her agent or legal representative, his/her medical file and the data contained therein and make a copy thereof. The said data may only concern the patient’s treatment.”
The right to designate another person to be informed on one’s behalf
Patients may authorise another person to be informed on their behalf. If necessary, the power of attorney may be requested. Please also see “access to medical records” below.
The doctor’s right to withhold information
Doctors have the right to withhold a serious prognosis/diagnosis if revealing such information would be likely to jeopardize the patient’s mental state, aggravate his/her condition. A diagnosis that does not result in treatment may be withheld by a doctor or revealed with considerable tact. Such a diagnosis is nevertheless communicated to the patient’s family provided that the patient did not personally express in advance an objection to this (article 19).
The patient’s right to refuse information
Patients have the right to refuse information about their state of health and/or that such information be communicated to their family or associates (except in certain cases and for certain diseases as laid down by law) (article 20).
Confidentiality/disclosure of information to other people
Patients have the right to request that their privacy be respected and for their request to be respected. Every medical procedure must be carried out in such a way as to respect the patient’s privacy. However, a patient may request the presence of a “close associate” as long as this would not interfere with the treatment and may also request that people not directly involved in his/her treatment are not present. Confidentiality shall be maintained even after the death of the patient (article 21).
End-of-life care and issues
Euthanasia/murder at the request of the victim
It is stated in the Patients’ Rights Act that euthanasia shall be prohibited. More precisely, article 13 states:
“It shall be prohibited to take life, by medical methods or in any other manner whatsoever. The taking of a person’s life shall not be permitted, either at his request or at the request or another person”.
Non-assistance to a person in danger
Failure to render assistance to an old, disabled or injured person or to notifiy the relevant authorities is punishable by up to one year’s imprisonment or a fine. If failure to provide assistance or to contact the relevant authorities results in the person’s death, the sentence is from one to three years’ imprisonment (article 98 of the Turkish Penal Code).
Intentional harm resulting in the death of the victim is punishable by 8 to 16 years’ imprisonment (article 87.4 of the Turkish Penal Code).
Ornek Buken, N. and Buken, E. (2004), Patient’s Rights in Turkey, http://www.ishim.net/ishimj/5/10.pdf (accessed online on 7 July 2009)
Last Updated: mercredi 27 avril 2011