Restrictions of freedom
The conditions for involuntary internment
The Act on Civil Procedure Code no. 99/1963 Sb. (CPC) deals with involuntary internment.
According to §191a (CPC), a person can be admitted into an institution without his/her written consent for any one of a few reasons(Health Care Act no 20/1966 Sb. § 23 subsection 4).One such reason is that the person has a mental disorder which renders him/her a danger to him/herself or to other people and the environment. Another reason is that the patient is in an acute or life-threatening situation and it is not possible to obtain his/her consent due to the severity of the health impairment.
The procedure for involuntary internment
In such cases, the institution must inform the court in which the institution is located within 24 hours. Similarly, if a person is held against his/her will in an institution, having originally entered into the institution on the basis of written consent, the court must be informed within 24 hours.
If the person who has been involuntarily interned has no legal representative, the court shall appoint a curator for the proceedings. The court then carries out an investigation to determine whether the involuntary internment is lawful. The court may examine the person and consult the attending doctor (§191b CPC).
The court must decide whether the person was lawfully interned within 7 days of that person’s entry into the institution. The person concerned, his/her curator and the institution must be informed of the decision. The institution may then decide to release the person even if the court ruled that the internment was lawful. Otherwise, the court determines whether the person should be held longer (§191b CPC).
In practice, it is likely that many people with dementia who are not able to express themselves are admitted into healthcare establishments simply on the basis of presumed consent. Moreover, the above-mentioned procedure only applies to health care institutions and not social care institutions (Holmerová et al., 2008).
The duration of involuntary internment
After the initial involuntary internment, the court may decide to prolong the person’s stay for up to one year. After this time, the court must decide again on the lawfulness of keeping the person in the institution against his/her will for a longer period of time. Decisions regarding the duration of the involuntary internment do not prevent the institution from releasing the person earlier (§191e CPC).
The right to appeal and suspension of the ruling
The person who has been involuntarily interned and who is capable of legal acts, his/her representative (the curator) and people who are close to him/her may request a new examination and decision before the expiry of the duration of the involuntary internment if there are reasons to believe that continued detention is unnecessary (§191f CPC).
In 2006 the amended Law on the Czech ombudsman came into force (no. 349/1999 Sb). The ombudsman is responsible for checking the well-being of people whose freedom has been restricted irrespective of whether such restriction is the result of a legal ruling or, on the other hand, due to other circumstances. This is ensured by visits to the place where the person is staying/being held. The ombudsman checks what kind of treatment they are receiving, tries to ensure that their fundamental rights are being respected and takes measures to protect them from mistreatment (Holmerová et al., 2008).
The Czech legal rules are now based on the principal that personal freedom of everybody should be granted (in considerable contrast to previous communist legislature). Therefore, the restriction of personal freedom has been made possible only in cases and under conditions explicitly stated by the Law. This pertains to §89 of the Law of Social Services, which permits the use of measures restricting the freedom of movement only in cases where the heath or life of the person involved is endangered (or the health and life of other people). When applying the measures which restrict the freedom of movement, the least restrictive ones should be used. If verbal reassurance is of no avail, physical measures should be used. Furthermore, according to the Law, placing the patient in a room designed to ensure safety should be arranged. Only after this delay is the attendant/invited doctor authorised to prescribe sedative medication. This should be administered in his/her presence.
According to the Regulation of the Ministry of Health of the Czech Republic on the use of restrictive devices in the health facilities of the Czech Republic, any of these restrictive measures can be used
a) restricting the patient’s freedom of movement by belts,
b) placing the patient in the net bed,
c) placing the patient in a safe room,
d) the use of a strait- jacket, restricting the movement of the upper limbs,
e) acute parenteral (tranquillizing) drug application,
Restrictive measures can be applied, either individually or combined, but only to avert the threat to the life, health or security of the patient or of other people. In any case, only the measure with optimal effectiveness and with the lowest risk to the patient should be used. The measures used should not exceed the time justified. The use of measuers and the sort of device used will be decided by the treating doctor or by the doctor on emergency duty in the medical facility involved.
According to § 198 of the Penal Code:A person, who torments an individual who is in his/her care or education, will be imprisoned, depending on the resulting injury, for the term of one to twelve years.
Since 2004, domestic violence has been considered a penal offence. Since 2007, the police can prevent a violent person from entering the household where s/he committed the violent act and since 2009, the police are permitted to prevent this person from all contact with the abused person. Comprehensive measures, taken by municipal social departments together with doctors and the police etc., are necessary. Abuse is still largely hidden and only a few studies have been carried out on this issue.
General practitioners are obliged to report to the driving authorities any patient whose capacity to drive could be affected by their medical condition. In addition, drivers over the age of 60 have to have regular medical check-ups and this can be controlled by the police (Act no. 361/2000 Sb., Traffic Act).
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.
Last Updated: mercredi 14 mars 2012