Healthcare and decision-making in dementia
Act No. 576/2004 Coll. of 21 October 2004 on healthcare, health-related services and on the amendment and supplementing of certain laws (hereafter referred to as the Act of Health Care) seems to be the main law governing patients’ rights and decision making in the context of health care. Unless otherwise stated, the references in this report on healthcare and decision making in the Slovak Republic will be to the relevant sections and paragraphs in the Act on Health Care.
Consent to medical treatment
Informed consent must be given prior to the provision of healthcare (§4.4). It should be given by person to whom the healthcare is to be provided or by a legal representative if that person lacks the capacity to give informed consent. Patients with incapacity should participate in the decision-making process to the greatest extent possible (as determined by their level of capacity) (§6.5)
Details of the informed consent including a statement made by patients’ with incapacity should be recorded in the medical file.
Consent in the case of emergency
Emergency care can be provided without informed consent if it is impossible to obtain in time and if such consent could be presumed. Inpatient care can be provided without informed consent if the person is a danger to him/herself or to his/her environment due to a mental illness or if he/she has symptoms of a mental defect or if there is a risk of serious deterioration of the person’s state of health (§6.8).
The right to refuse treatment
If a legal representative refuses treatment for a patient who is unable to give informed consent, and doctors are of the opinion that such treatment is in the patient’s best interests, they must submit an application to the relevant court to override the legal representative’s refusal. Whilst this is being decided, only life-saving treatment can be provided (§6.6).
The right to withdraw consent
Any person who gave valid informed consent can freely withdraw it at any time (§6.7).
Consent to innovative treatment and participation in clinical teaching
Consent to participation in clinical teaching is perhaps what is meant by §11.8 (e) which states that every person has the right to decide whether to take part in education.
Consent to blood donation
A blood donation (for the purposes of transfusion and the preparation of medications for transfusion) can only be made by a person who is over 18 years of age (§39.1) and fully capable of executing legal acts specified in §39.2.
Consent to the donation of organs and/or human tissue
Paragraphy 11.8 (f) grants people the right to refuse the removal and transfer of organs, tissue or cells after death.
Chapter 2 of part 4 of the Act on Health Care deals with the removal, conservation and transfer of organs, tissue and cells. Living donors must be fully capable of executing legal acts and have given written informed consent. A person who is incapable of giving informed consent can become a donor provided that informed consent is given by his/her legal representative subject to the following conditions:
- The removal relates to regenerative tissue.
- A suitable donor capable of giving informed consent is not available.
- The potential recipient is a brother or a sister of the donor.
- The donation has a life-saving potential for the recipient (§36.2-d).
With regard to the removal of organs, tissue and cells after a person’s death, this is permitted unless before dying the person made a written declaration disapproving of such an intervention. For people who are unable to object to such removal of organs, tissue and cells, their legal representative may make a written declaration on their behalf during their lifetime (§37.2).
Disapproval can be withdrawn at any time. Statements of disapproval must have a certified signature and be sent to the registry of persons declaring their disapproval with the post-mortem removal of their organs, tissue and cells, which is maintained by the Ministry of Health.
Consent to biomedical research
According to §11.8 (e), every person is entitled to decide whether or not to take part in educational or biomedical research.
Chapter 1 of part 4 of the Act on Health Care is dedicated to the issue of biomedical research. Such research cannot be carried out on a person who has been involuntarily interned. Otherwise, the following provisions apply (§32):
“(1) Medical indication based research with participation of a person incapable of giving an informed approval can be performed only in case that
(a) the research with comparable effectiveness cannot be performed with the participation of a person capable to give an informed approval,
(b) the person was informed about this research and about his/her rights and legal measures for their protection in a way adequate to his/her health condition and mental abilities,
(c) the person does not express evident disapproval with his/her participation in this research in a way adequate to his/her abilities to express disapproval regarding his/her physical and mental condition.
(2) Research without medical indication with participation of the person incapable of giving an informed approval can be exceptionally performed in the case that, besides conditions as per subsection 1, the following conditions are met:
(a) the objective of the research is to achieve results bringing benefit for other persons in the same or similar condition, suffering from the same or similar illness or handicap,
b) the research represents for the participant only
1. a risk that according to the current state of scientific knowledge constitutes only low and short-term negative influence on the health condition of the research participant (hereinafter “minor risk”) or
2. a burden with only a low and short-term inconvenience (hereinafter “minor burden”).
(3) Bio-medical research with the participation of a person incapable of giving an informed approval can only be performed on the basis of an informed approval of the legal representative of the future research participant.”
According to Defloor et al. (2008), there is no legislation in the Slovak Republic covering previously expressed wishes.
Access to information/diagnosis
The right to be informed
Doctors must provide information on the purpose, nature, impact and risks of healthcare provision, as well as on proposed alternative provisions and on the risks of rejecting healthcare. This information must be provided to the patient or another designated person. It should be given to the legal representative or tutor of people with incapacity. The information should be provided in a way that is comprehensible and appropriate to the person’s intellectual level and health condition. The person should be given enough time to be able to give informed consent (§6.1-6.2).
Access to medical records
Part 3 of the Act on Health Care deals with medical records. Medical records may be in written or electronic form. Anyone handling medical records is obliged to ensure that they are treated with confidentiality and to protect them against loss or abuse. The patient (or his/her legal representative in the case of incapacity) has the right to examine his/her medical record and to make excerpts or copies. Doctors can refuse access to medical records to patients receiving psychiatric care if they believe that this would negatively affect their treatment. According to paragraph 25.1, the patient, his/her legal representative and/or a person previously appointed by means of a power of attorney are entitled to access the patient’s medical file (to the extent determined by the power of attorney for the latter).
The right to designate another person to be informed on one’s behalf
According to §6.1-a, information must be provided to the patient or moreover to another person determined by the patient.
The doctor’s right to withhold information
Paragraph 25.3 of the Act on Health Care refers to the right to withhold access to the medical file but only in the domain of psychiatry or in the domain of clinical psychology and only if this would negatively affect the patient’s treatment
The right to refuse information
Whoever has the right to be informed also has the right to refuse to be informed. A written record of such refusal must be made (§6.3).
Confidentiality/disclosure of information to other people
Patients have the right to confidentiality with regard to all information regarding their health condition and circumstances related to their health condition. Attending physicians and other healthcare professionals must have access to medical files to the extent that this is necessary (§22.3) and so must an inspector doctor from a pertinent health insurance, the Surveillance Authority, a court advisor in the case of criminal proceedings, a health insurance company inspecting the provision of healthcare linked to insurance, and professional organisations inspecting medical profession performance (§25.1).
End-of-life care and issues
According to §11.8-h of the Act on Health Care, every person is entitled to palliative care, as well as a humane, ethical and dignified approach from healthcare professionals (§11.8-i).
There is no legislation directly concerning euthanasia in the Slovak Republic. However, the Ethical Code of the Slovak Chamber of Physicians prohibits it. This Code is, in the form of an appendix, part of Act No. 219/2002 Coll. on Profession of Physician, the Slovak Chamber of Physicians, Profession of Dentist, the Slovak Chamber of Dentists and amending and supplementing certain other acts (Council of Europe, 2003).
Assisted suicide is considered a serious criminal act according to § 230 of the Penal Law No. 141/1961 (as later amended) (Council of Europe, 2003).
Non assistance to a person in danger
Paragraph 11 (11) of the HHS states that every person is obliged to provide or mediate necessary help to anyone in danger of death or anyone showing severe health damage unless one’s own life or health would be severely endangered by such help.
Other legal provisions can be found in the Penal Law (Law No. 141/1961 as later amended). Under this law (paragraph §219), euthanasia would be considered as the taking of an innocent human life (i.e. as murder) and/or as not providing necessary professional (life-saving) help, thereby failing to honour important professional obligations on the part of the physician or other health professional (§224) (Council of Europe, 2003).
Defloor, S et al. (2008), Patient Rights in the EU – Slovakia: European Ethical-Legal Papers N°14, 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