HOSŤ MESIACA DECEMBER: JUDr. Maroš Matiaško, LL.M. | Medicínske právo
              

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HOSŤ MESIACA DECEMBER: JUDr. Maroš Matiaško, LL.M.


 | 15.12.2011 | komentárov: 300

Hosťom mesiaca december k téme pacientských práv a úskalí pri ich presadzovaní je JUDr. Maroš Matiaško, LL.M., ktorý od roku 2008 pôsobil ako právnik Centra advokácie duševne postihnutých (MDAC) a v Lige ľudských práv (LLP). V súčasnosti pracuje pre Londýnsku organizáciu Interights, a rovnako pre advokátsku kanceláriu, ktorá úzko spolupracuje s českou mimovládnou organizáciou Liga lidských práv. Viac sa dozviete v rozhovore.

Obrazok MEDIUS: Vyštudovali ste právo na Univerzite v Olomouci, a zároveň obor sociálnej práce, sociálnej politiky a psychológie na Masarykovej univerzite. Pracovali ste pre MDAC.  Čo je predmetom jej činnosti?

Mental Disability Advocacy Center (MDAC) je medzinárodná mimovládna organizácia, ktorá sa zameriava na presadzovanie systémových zmien v oblasti dodržiavania ľudských práv osôb s duševným postihnutím. Svoje ciele dosahuje metódou strategickej litigácie, teda zastupovaním strategických prípadov pred medzinárodnými súdmi a kvázisúdnymi orgánmi, ďalej presadzovaním legislatívnych reforiem, napríklad v oblasti spôsobilosti na právne úkony a vzdelávaním.

MEDIUS: Kde pôsobíte momentálne?

V súčasnosti pôsobím v Londýnskej organizácii Interights. Zároveň pôsobím v advokátskej kancelárii, ktorá veľmi úzko spolupracuje s českou mimovládnou organizáciou Liga lidských práv.

MEDIUS: Akým témam sa venujete?

Venujem sa primárne téme ochrany práv osôb so zdravotným postihnutím, ďalej právu na zdravie, zákazu mučenia, ponižujúceho a neľudského zaobchádzania a v poslednej dobe aj otázke nápravy neprimeraných zásahov do ľudských práv a slobôd na domácej úrovni.  Okrem medzinárodného práva je mojou obľúbenou oblasťou trestné právo.

MEDIUS: Ako dlho sa už zaoberáte problematikou práv osôb s duševným postihnutím?

Tejto téme sa venujem od začiatku roku 2008, teda systematicky už štyri roky.

MEDIUS: Ako by ste definovali najpálčivejšie problémy, s ktorými sa pri uplatňovaní svojich práv stretávajú pacienti s duševným postihnutím?

Zásadné problémy vidím tri, tým prvým je systém systematickej ústavnej starostlivosti a úplná nedostupnosť služieb v komunite. To je na Slovensku najmä prípad sociálnych služieb a v tomto ohľade je na tom Slovensko veľmi zle. V Českej republike je situácia odlišná, tam je problém najmä inštitucionalizácia v mamutích liečebniach s viac ako tisíc lôžkami.

Tým druhým je právny status osôb s duševným postihnutím, konkrétne mám na mysli inštitúty pozbavenia a obmedzenia spôsobilosti na právne úkony. A tretím problémom je absencia inkluzívneho vzdelávania a neprimerane rozšírený systém segregovaného špeciálneho školstva.
 
Na tieto nadväzujú ďalšie problémy. Konkrétne môžem pomenovať systematické porušovanie práva na osobnú slobodu v prípade nedobrovoľných hospitalizácií. V praxi je tento systém extrémne formalistický, a to až do takej miery, že to hraničí s absurditou a ponúka sa otázka vôbec po zmysluplnosti celého konania. Veľmi problematické sú automatické dôsledky pozbavenia a obmedzenia spôsobilosti na právne úkony. Ľudia pod opatrovníctvom automaticky prichádzajú o celé spektrum základných práv a slobôd, od viacerých aspektov práva na rodinný život, cez majetkové práva, až po práva politické. Slovenský systém je veľmi staromódny a rigidný a z právneho hľadiska jednoznačne v rozpore s medzinárodným právom.
 
MEDIUS: Aké sú z Vášho hľadiska najväčšie nedostatky súčasnej právnej úpravy, ktoré majú vplyv na život
duševne postihnutých osôb?

Právna úprava je čiastková a je roztrieštená do niekoľkých predpisov. To je dedičstvo prístupu k tejto marginalizovanej skupine, ktorá stála a doposiaľ bohužiaľ stojí na okraji záujmu praktizujúcich právnikov i teoretikov. V zahraničí sú bežné komplexné právne predpisy upravujúce otázky právneho postavenia osôb so zdravotným postihnutím. Môžem spomenúť napríklad veľmi komplexný americký zákon Americans with Disabilities Act. Takže prvý nedostatok je chýbajúca právna úprava, ideálne ucelená.

A konkrétne, kde vidím nedostatky? V prvom rade je nutné reformovať systém opatrovníctva, inštitúty pozbavenia a obmedzenia spôsobilosti na právne úkony musia nahradiť menej reštriktívne a na mieru šité opatrenia založené na myšlienke tzv. podporovaného rozhodovania. S tým súvisí otázka automatických dôsledkov pozbavenia a obmedzenia spôsobilosti na právne úkony. Tieto zásahy je potrebné zrušiť, ide napríklad o prekážku výkonu volebného práva, nemožnosť uzavrieť manželstvo, či vylúčenie testamentárnej spôsobilosti. V súčasnosti sa vedie diskusia, či je vhodné automatické dôsledky opatrovníctva nahradiť individualizovaným rozhodnutím súdu. Inými slovami, či napríklad automatickú prekážku výkonu volebného práva založenú na pozbavení spôsobilosti na právne úkony nahradiť možnosťou v individuálnych prípadoch rozhodnúť o nespôsobilosti voliť. Niektoré súdy prijali tento opatrný postoj, ktorý bol, ale na druhej strane ostro odmietnutý orgánmi OSN a Rady Európy. Budeme si musieť počkať na prípadné ďalšie rozhodnutie medzinárodného súdu.
 
Ďalej si myslím, že je vhodné legislatívne upraviť deinštitucionalizáciu, a to ako v podobe vymožiteľného práva na život v komunite, tak v podobe konkrétneho legislatívneho záväzku transformovať pobytové inštitúcie a vytvárať služby v komunite.
 
Otáznikom je pre mňa systém nedobrovoľných hospitalizácií. Dohovor OSN o právach osôb so zdravotným postihnutím je jasný, pozbavenie osobnej slobody založené na zdravotnom postihnutí, teda aj „duševnej poruche“,  je v rozpore s článkom 14 tohto Dohovoru. Je evidentné, že bude nutné upustiť od súčasného systému nedobrovoľných hospitalizácií.

MEDIUS: Mohli by ste porovnať situáciu v Českej republike a na Slovensku?

Situácia je v mnohým ohľadoch odlišná. Začnem opatrovníctvom, najmä vďaka mimovládnym organizáciám a aktívnym sudcom, ako je napríklad pani doktorka Wagnerová, je problém zásahov do spôsobilosti na právne úkony veľmi dobre judikovaný Ústavným súdom. To je prvý obrovský rozdiel, pretože na Slovensku chýba relevantná judikatúra a toto téma je stále akoby zabudnuté.

Tiež je nutné spomenúť nový český občiansky zákonník, ktorý ruší pozbavenie spôsobilosti na právne úkony a zavádza menej reštriktívne opatrenia. Bohužiaľ, ale zostáva inštitút obmedzenia spôsobilosti na právne úkony. Na Slovensku sa nový zákon pripravuje, Ministerstvo spravodlivosti zatiaľ paragrafové znenie nezverejnilo.

Ďalší rozdiel je v politike deinštitucionalizácie sociálnych služieb. V Českej republike naplno beží pilotný projekt financovaný zo zdrojov EU, vďaka ktorému bude transformovaných niekoľko desiatok ústavov vo všetkých krajoch. Okrem toho tento projekt vytvára predpoklady a motivuje zriaďovateľov, najmä kraje, aby politiku transformácie prijali a rozvíjali vlastnými silami za podpory Ministerstva práce. Toto je príklad veľmi dobrej praxe. Bohužiaľ v Českej republike, na rozdiel od Slovenska, nedošlo k žiadnej transformácii inštitucionálnej psychiatrickej starostlivosti. Psychiatrická starostlivosť je poskytovaná v obrovských kolosoch ako sú Dobřany pri Plzni, Černovice v Brne alebo Bohnice v Prahe.
 
Rozdiel je aj v politike inklúzie žiakov so zdravotným postihnutím. České Ministerstvo školstva počas vlády Mirka Topolánka vypracovalo Národní akční plán inkluzivního vzdělávání, ktorý mal byť základom reformy systému segregovaného školstva. Na Slovensku sa len tieto mesiace rozbieha diskusia, ktorá konečne začína pokrývať aj osoby so zdravotným postihnutím a nie len sociálne znevýhodnené deti. Celkovo môžem povedať, že Česká republika môže byť pre Slovensko určitým vzorom, a to dobrými aj zlými príkladmi. Pre slovenské orgány je to výhodné, pretože môžu aplikovať to, čo sa osvedčilo u našich susedov a zároveň sa vyhnúť chybám, ktoré tieto reformy brzdia.

MEDIUS: Akej téme sa hodláte venovať ako hosť mesiaca a prečo?

Ako hosť mesiaca by som sa venoval dvom témam. Konkrétne sa zameriam na situáciu osôb vo výkone trestu odňatia slobody alebo výkonu väzby. A to z hľadiska absolútneho zákazu mučenia, ponižujúceho alebo neľudského zaobchádzania podľa článku 3 Európskeho dohovoru o ľudských právach.

V prvom príspevku sa budem zaoberať otázkou dostupnosti a prístupnosti zdravotnej starostlivosti. V druhom príspevku sa viac špecificky pozriem na koncept tzv. primeraných opatrení (angl. reasonable accommodation) vo vzťahu k osobám so zdravotným postihnutím pozbavených osobnej slobody. Dôvod je ten, že bohužiaľ stále dochádza k tomu, že osoby pozbavené osobnej slobody nedosiahnu na adekvátnu zdravotnú starostlivosť, resp. podmienky výkonu trestu alebo väzby nerešpektujú ich špecifické potreby vyplývajúce zo zdravotného postihnutia. V súčasnosti sa podobným prípadom z Českej republiky bude zaoberať Európsky súd pre ľudské práva  a na domácej úrovni v inom prípade pripravujeme žalobu na náhradu imateriálnej ujmy proti Českej republike.

Ďakujem za rozhovor.

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