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Nútená liečba bez možnosti odvolať sa porušuje Dohovor o ľudských právach


 | 31.8.2012 | komentárov: 462

Začiatkom júla tohto roku bol v Štrasburgu rozhodnutý zaujímavý prípad, ktorý má čo-to povedať aj nášmu zákonodarcovi. I keď rozhodnutie ESĽP ešte nie je konečné, stojí za to si ho v krátkosti priblížiť a predovšetkým ho dať do súvisu s právnym stavom, ktorý vo veci detencie a nútenej liečby psychiatrických pacientov na Slovensku vládne.

Rozhodovanie v kauzách, ktorých základ tkvie v obmedzení osobnej slobody osobám, ktoré boli v dôsledku duševnej poruchy označené za nebezpečné sebe, či okoliu, nie je Európskemu súdu pre ľudské práva (ďalej „ESĽP“) vôbec cudzie. Každý z prípadov, ktorý sa následne stal súčasťou etalónu smerodajných rozhodnutí sa týkal niektorého z aspektov zadržania pacienta proti jeho vôli. Či už sa ESĽP zaoberal vymedzením pojmu „duševná porucha“, alebo „povahou zariadenia“, v ktorom môže byť osoba zadržaná, alebo povahou orgánu, ktorý rozhoduje o oprávnenosti zadržania, prevažne sa v základe posudzovalo či postup štátu neporušoval čl. 5 Dohovoru (právo na slobodu a bezpečnosť).

Prípad X. proti Fínsku (Application no. 34806/04, JUDGMENT July 3, 2012) je odlišný v tom, že okrem otázky oprávnenosti zadržania pacienta sa ESĽP zaoberal aj otázkou núteného poskytovania konkrétnej liečby (teda starostlivosti bez informovaného súhlasu) osobe s psychickým postihnutím proti jej vôli. V tomto prípade sa ESĽP vyslovil, že aj keď proces posúdenia zákonnosti prevzatia sťažovateľky do psychiatrickej liečebne spĺňal všeobecné podmienky vyžadované Dohovorom o ľudských právach (posúdenie súdom, povaha miesta zadržania + ďalšie podmienky definované v judikatúre ESĽP), vo veci zaručenia oprávnenosti aplikovania konkrétnej liečby (aplikovania liekov injekciami) štát nenaplnil svoj pozitívny záväzok stanovený Dohovorom, predovšetkým Čl. 8. (Právo na ochranu súkromia). Súd sa vyslovil, že nedostatkom je absencia možnosti pacienta domáhať sa preskúmania rozhodnutia lekára o aplikovaní konkrétnej liečby.

V nadväznosti na okolnosti prípadu X. proti Fínsku som názoru, že aj slovenská právna úprava obsahuje len povinnosť preskúmať zákonnosť zadržania, no nechráni pacienta v prípade, že nesúhlasí so samotnou liečbou. Občiansky súdny poriadok síce stanovuje osobitné konania (detenčné), v ktorom súd v zákonom uložených lehotách rozhoduje o zákonnosti prevzatia pacienta do starostlivosti (do 5 dní od obmedzenia slobody - § 191b ods. 4 OSP), ako aj o zákonnosti držania pacienta (do 3 mesiacov od výroku o prípustnosti prevzatia - § 191d ods. 4 OSP), no tam súdny dohľad končí. Otázky konkrétnej liečby, zváženia rizík, ktoré pre pacienta môžu mať, sú de facto ponechané na rozhodovanie ošetrujúceho lekára. To, že možnosť poskytovať zdravotnú starostlivosť bez informovaného súhlasu pacienta umožňuje § 6 ods. 9 písm. c/ zákona o zdravotnej starostlivosti podľa môjho názoru nestačí a naopak (bez potrebného doplnenia) vytvára priestor pre istý druh „odbornej svojvôle“ ošetrujúceho zdravotníckeho personálu. Práve tento aspekt ESĽP akcentuje v rozhodnutí X. proti Fínsku. Situácia, kedy pacient nemá zákonom vytvorený dostupný mechanizmus, cez ktorý by sa vedel odvolať voči liečbe, nie je v súlade s Čl. 8 Dohovoru.
I keď situácia v slovenskom zdravotníctve bije na poplach vo všetkých možných smeroch a prvé husle hrajú otázky finančného krytia systému, nemala by vláda, či parlament nechať bokom oblasť zabezpečenia ochrany práv duševne chorých osôb. Rezignácia na témy, ktoré nie sú možno politicky až tak atraktívne, sa totiž môže nakoniec vypomstiť aj tým, ktorí o nich mali kompetenciu rozhodnúť.

Stručný sumár rozhodnutia X. proti Fínsku nájdete vďaka prekladu od Ingrid Tonhauserovej na tomto linku.

JUDr. Ivan Humeník, PhD.
Komora pre medicínske právo – MEDIUS
Advokátska kancelária h&h PARTNERS


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