Nový pohľad na realizáciu ľudských práv u zdravotne postihnutých osôb? | Medicínske právo
              

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Nový pohľad na realizáciu ľudských práv u zdravotne postihnutých osôb?


 | 18.9.2012 | komentárov: 783

Ľudské práva – naozaj „prebádaná“ oblasť?Spoločnosť počas posledných sto rokov absolvovala v oblasti právnej úpravy ľudských práva a slobôd obrovský posun. Katalyzátorom širokého definovania ochrany ľudských práv v mnohých medzinárodných zmluvách či dohovoroch bola predovšetkým skúsenosť ľudstva s dvoma zničujúcimi globálnymi konfliktami. Ľudské práva a ich vyjadrenie ústami zákonodarcov alebo ústami právnej filozofie však nie sú výlučnou doménou dvadsiateho storočia. Knap et al. (2004) uvádzajú: „První základy všeobecného osobnostního práva, ktoré nelze z historického hlediska odtrhovat od ideje lidských a občanských práv a svobod vůbec, lze v dlouholetém vývoji lidské společnosti spatřovat již v antické filosofii a v myšlení o přirozeném právu u sofistů a stoiků.“[1]

Obrazok Môže sa zdať, že aktuálny stav a definovanie ľudských práv (z pohľadu ich kvality, rozsahu a vymožiteľnosti) odpovedali spoločnosti na všetky otázky a v tejto rovine už ako právnici, či filozofi nemáme „čo povedať“. Svák (2011) v tejto súvislosti poznamenáva: „Ľudské práva v chápaní univerzality svojho pojmu sa stali bežnou súčasťou nielen slovníka politikov, právnikov či filozofov, ale osvojili si ho aj tí, ktorým patria a z ktorých vychádzajú, teda „obyčajní“ ľudia.“ [2]

Základné ľudské práva sú garantované viacerými medzinárodnými dohovormi, a ktoré sa týkajú aj práv bezprostredne súvisiacich s poskytovaním zdravotnej starostlivosti. Zdravotná starostlivosť sa priamo dotýka základných a najdôležitejších hodnôt chránených právom a prostredníctvom nej zdravotnej sa chráni život a zdravie fyzickej osoby. Medicínske činnosti ex natura sua zasahujú do základných práv fyzickej osoby, pretože s ich realizáciou je neoddeliteľne spojený zásah do telesnej a psychickej integrity fyzickej osoby.

Z uvedeného vyplýva, že práva prijímateľa zdravotnej starostlivosti pramenia a sú chránené právnymi dokumentmi najvyššej právnej sily. [3] Vzťah medzi poskytovateľom zdravotnej starostlivosti (zdravotníckym pracovníkom) a pacientom je reláciou, ktorá je charakteristická vzájomným „pnutím“, je vzťahom v rámci ktorého dochádza ku stretu práv pacienta a práv poskytovateľa zdravotnej starostlivosti/zdravotníckeho pracovníka. Vzhľadom na určitú asymetriu vzťahu je pacient vždy v slabšom postavení, a preto je nevyhnutné, aby štát ako garant dodržiavania ľudských práv zabezpečil ich efektívne uplatňovanie a ochranu. [4]

Medzi ľudské práva, ktoré sú pri poskytovaní zdravotnej starostlivosti zvlášť zasahované, možno zaradiť:
•    právo na život,
•    právo na slobodu pohybu a bezpečnosť,
•    právo na ochranu súkromia,
•    právo na humánne zaobchádzanie (zákaz mučenia a ponižujúceho zaobchádzania) a
•    právo (upravené v rôznych modifikáciách) na zdravotnú starostlivosť.

 Uvedené práva možno nájsť v celom rade dôležitých dokumentov
- Všeobecná deklarácia ľudských práv (uznesenie Valného zhromaždenia OSN DE01/48).
- Medzinárodný pakt o občianskych a politických právach a Medzinárodný pakt o hospodárskych, sociálnych a kultúrnych právach (vyhláška MZV č. 120/1976 Zb.).
- Dohovor Rady Európy o ochrane ľudských práv a základných slobôd vrátane dodatkových protokolov (publikované ako oznámenie MZV č. 209/1992 Zb.)- ďalej len „Dohovor o ľudských právach“.
- Dohovor o právach dieťaťa  (OSN 1989, publikovaný ako oznámenie MZV č. 104/1991 Zb.)
- Dohovor  o ochrane ľudských práv a dôstojnosti človeka v súvislosti s aplikáciou biológie a medicíny - Dohovor o ľudských právach a biomedicíne, v znení Dodatkového protokolu zo dňa 25. 1. 2005 (oznámenie MZV SR č. 40/2000 Z. z. a oznámenie MZV SR č. 494/2007 Z. z.).

Ľudské práva a ich premietnutie do parciálnych súčastí existencie a fungovania spoločnosti sú „živým organizmom“. Obsah, či lepšie povedané rozsah ľudských práv sa mení a prispôsobuje stavu v ktorom sa spoločnosť nachádza. [5]  Rovnako dôležito na úroveň realizácie ľudských práv v životnej realite vplývajú charakteristiky/možnosti/obmedzenia osoby, ktorá svoje práva uplatňuje. [6]

Inak svoje práva realizuje zdravá osoba a iný rozmer ich realizácia je pri osobách, ktoré trpia zdravotným postihnutím. Sme názoru, že uvedené konštatovanie platí napriek tomu, že všetky významné dokumenty obsahujú princíp nediskriminácie a princíp rovnosti pri uplatňovaní ľudských práv.

Predmetom záujmy medicíny je človek v zdraví aj v chorobe. Prevažne sa však medicína zaoberá človekom ktorý má nejakú chorobu alebo trpí určitou zdravotnou vadou. Právo na zdravotnú starostlivosť je síce upravené v medzinárodných dohovoroch, ako aj v čl. 40 Ústavy Slovenskej republiky, no na národnom, ako aj medzinárodnom poli dlho neexistoval dokument, ktorý by sa orientoval na úpravu práv zdravotne postihnutých osôb nielen v nadväznosti na právo prístupu k zdravotnej starostlivosti, ale ktorý by komplexne zohľadňoval špecifiká života zdravotne postihnutej osoby.

Zdravotné postihnutie je skutočnosťou, ktorá postihnutú osobu akoby automaticky znevýhodňuje oproti zdravým osobám, pričom miera/podoba znevýhodnenia je priamo závislá od viacerých faktorov (povaha postihnutia, sociálne pomery v ktorých osoba žije, postoj spoločnosti voči zdravotne postihnutým osobám, sociálna politika štátu, a pod.). Aj keď boli ľudské práva komplexne ustanovené v už spomenutých medzinárodných dokumentoch, odborná verejnosť a organizácie, ktoré sa venujú osobám so zdravotným postihnutím dlhodobo naliehali, aby bol prijatý  dokument, ktorý by postavenie zdravotne postihnutých osôb upravoval špeciálne.

V roku 2006 bol na pôde OSN prijatý Dohovor o právach osôb so zdravotným postihnutím (ďalej len „Dohovor o PZP“), ktorý pre Slovenskú republiku nadobudol platnosť 25. 6. 2010 a má povahu medzinárodnej zmluvy,  ktorá má prednosť pred zákonmi a Ústavou SR. [7] Nejde o dokument malého významu, jeho schváleniu predchádzali dlhoročné prípravy a jeho prijatie vyvoláva veľké očakávania. Kayess (2008) sa v súvislosti s prijatím Dohovoru o PZP vyjadril, že tento dokument konečne umožňuje „najväčšej svetovej minorite“ žiadať rešpektovanie ich ľudských práv a nastoľuje podmienky pre participáciu jej členov na živote spoločnosti. [8]

Birgden a Perlin (2009) obdobne ako Kayess považujú prijatie Dohovoru o PZP za posun v ochrane práv zdravotne postihnutých osôb, a to hlavne preto, že vzhľadom na svoju obsah je Dohovor o PZP oproti iným dokumentom/konvenciám obsiahlejší a komplexnejší a pre zmluvné štáty definuje konkrétne povinnosti, ktorých praktická realizácia a transpozícia do národných poriadkov môže viesť k prijatiu doteraz nebývalej pro-handicapovaným zameranej právnej reglementácie. [9, 10]

Nová optika uplatňovania ľudských práv zdravotne postihnutými osobami

Aký je obsah Dohovoru o PZP, a ako by mal ovplyvniť národnú politiku voči zdravotne postihnutým osobám? Skôr, ako sa nad touto otázkou zamyslíme, treba zdôrazniť, že Dohovor o PZP neupravuje akési „nové práva“, ale ľudské práva, ktoré sú priznané ľudskej bytosti (upravené v iných dokumentoch), interpretuje ich pre špeciálne potreby osôb so zdravotným postihnutím.

Podľa čl. 1 Dohovoru o PZP „...Cieľom tohto dohovoru je presadzovať, chrániť a zabezpečovať plné a rovnaké využívanie všetkých ľudských práv a základných slobôd všetkými osobami so zdravotným postihnutím a podporovať úctu k ich prirodzenej dôstojnosti. Osoby so zdravotným postihnutím zahŕňajú osoby s dlhodobými telesnými, mentálnymi, intelektuálnymi alebo zmyslovými postihnutiami, ktoré v súčinnosti s rôznymi prekážkami môžu brániť ich plnému a účinnému zapojeniu do života spoločnosti na rovnakom základe s ostatnými...“

Dohovor obsahuje práva, ktoré majú byť pre osobu so zdravotným postihnutím chránené, a to vo vzťahu k jej základnému právu na sebaurčenie, k právam vo vzťahu spôsobu života, zdravotnej starostlivosti, vzťahom k iným osobám, k práci, a pod.

V č. 31 až 50 sú riešené otázky praktického realizovania záväzkov signatárov Dohovoru o PZP v národných právnych poriadkoch. Práve táto časť je veľmi dôležitá, pretože stanovuje mechanizmus uplatňovania Dohovoru o PZP v živote zdravotne postihnutých osôb, a rovnako stanovuje aj kontrolné mechanizmy. Podľa nášho názoru,  rozsahom povinností, ktoré Slovenská republika prijatím Dohovoru o PZP prijala, nemá tento dokument v posledných desaťročiach (pre oblasť ľudských práv) konkurenciu.

Súčasne vzniká otázka, či Slovenská republika bude v zmysle čl. 33 schopná zabezpečiť podmienky na to, aby sa záväzky pretransformovali do konkrétneho života spoločnosti.  [11] Ako signatár, je Slovensko  tiež povinné do dvoch rokov predložiť Výboru pre práva osôb so zdravotným postihnutím správu o opatreniach ktoré boli prijaté na realizovanie Dohovoru o PZP v spoločnosti. [12]

Vybrané články Dohovoru o PZP

Aplikácia Dohovoru o PZP má pre prax a život spoločnosti ďalekosiahle následky. Dohovor o PZP je prelomovým dokumentom, a preto je ťažké vybrať len určité, t. j. ustanovenia... Napriek tomu sa pokúsime upozorniť na dva články,  pri ktorých už možno badať jasné prepojenie na poskytovanie sociálnych služieb a na vnímanie „schopnosti“ postihnutej osoby samostatne rozhodovať o jej osude.

Právo byť súčasťou komunity, v ktorej si želám žiť

Podľa Hammarberga (2012), osoby so zdravotným postihnutím boli dlhodobo odrezané od života a nútené žiť svoj život v izolácii od „normálneho“ sveta. Tento jav bol čiastočne ovplyvnený pôvodne „dobrým“ úmyslom vytvoriť pre tieto osoby odlišné podmienky, ktoré však často viedli k ich segregácii a internácii do špeciálnych zariadení, a takto ich obmedzovali v styku s vonkajším svetom. Tento aspekt diskriminácie postihnutých osôb je riešený prostredníctvom Dohovor o PZP, a to v čl. 19:

„Zmluvné strany uznávajú rovnaké právo všetkých osôb so zdravotným postihnutím žiť v spoločenstve s rovnakými možnosťami voľby na rovnoprávnom základe s ostatnými, prijmú účinné a primerané opatrenia, ktoré umožnia plné využívanie tohto práva osobami so zdravotným postihnutím a ich plné začlenenie a zapojenie do spoločnosti a zabezpečia, aby
a.    osoby so zdravotným postihnutím mali možnosť zvoliť si miesto pobytu, ako aj to, kde a s kým budú žiť na rovnakom základe s ostatnými a aby neboli nútené žiť v určitom konkrétnom prostredí;
b.    osoby so zdravotným postihnutím mali prístup k celému spektru podporných služieb, či už domácich alebo pobytových a ďalších komunitných podporných služieb vrátane osobnej asistencie, ktoré sú nevyhnutné pre nezávislý život v spoločnosti a pre začlenenie sa do nej a ktoré zabraňujú izolácii a segregácii v spoločnosti;
c.    komunitné služby a zariadenia pre širokú verejnosť boli za rovnakých podmienok prístupné osobám so zdravotným postihnutím a aby zohľadňovali ich potreby.“ [13]

Ako uvádza Hammarberg (2012) v spoločnosti existuje mnoho spôsobov, ktorými sa porušuje právo osôb so zdravotným postihnutím (zvyčajne ide o osoby s duševnou poruchou) byť súčasťou „zdravej“ spoločnosti. Osoby s postihnutím sú systémom často nútené vzdať sa svojho súkromia preto, aby mohli prijať pomoc – služby (akýsi druh „barteru“), ktoré vzhľadom na svoje postihnutie potrebujú. Vzdaním sa súkromia následne dochádza k strate kontroly nad svojím osudom. Systém sociálnych služieb často stavia postihnuté osoby do pozície, kedy za účelom pomoci zbavuje tieto osoby aj zvyšku možností postarať sa o seba, a tým ich vydáva na milosť – nemilosť úradníkov a byrokracii. Hlavným negatívom vžitých mechanizmov štátnej pomoci je to, že od postihnutých osôb sa očakáva, že sa systému (ktorý im má pomôcť) prispôsobia, namiesto toho aby sa prispôsoboval systém týmto osobám. [14]

Článok 19 Dohovoru o PZP rozsiahly a vyvoláva otázky o jeho implementácii do nastavení sociálnych služieb štátu – keďže práve medzi povinnosťami štátu, uvedenými v ňom a kvalitou/formou sociálnych služieb existuje zreteľná interferencia. Podľa nášho názoru jeho aplikácia by mala v každom prípade rešpektovať princípy, ktoré sám o sebe obsahuje.

Nosnou ideou je, aby osoby so zdravotným postihnutím mali možnosť žiť v prostredí, ktoré im je známe, a v ktorom sa cítia doma, k čomu by im štát mal zabezpečiť potrebnú podporu od profesionálov. Konkrétna miera a výklad tohto ustanovenia Dohovoru o PZP budú však závislé od prípadu k prípadu. Ako uvedieme v nasledujúcom texte, Európsky súd pre ľudské práva v posledných mesiacoch poskytol v nadväznosti na čl. 19 (resp. na Dohovor o PZP ako celok) svoj názor.

Právo rozhodovať o svojom osude a právne konať


Budeme asi súhlasiť s tým, že život osôb so zdravotným postihnutím, a predovšetkým s postihnutím, ovplyvňujúcim psychické zdravie osoby je v spoločnosti spojený s určitým stereotypným vnímaním. To sa prejavuje v mnohých oblastiach života zdravotnej postihnutej osoby, oblasť poskytovania zdravotnej starostlivosti nevynímajúc.

Ako príklad možno uviesť problematiku informovaného súhlasu u nespôsobilých pacientoch. Aj keď zákon č. 576/2004 Z. z. o zdravotnej starostlivosti, službách súvisiacich s poskytovaním zdravotnej starostlivosti a o zmene a o zmene a doplnení niektorých zákonov v z. n. p. v § 6 ods. 6 písm. b) ukladá povinnosť prihliadať na názor nespôsobilého pacienta, reálne uplatnenie má skôr tendenciu k rešpektovaniu názoru zákonného zástupcu.

Dohovor o PZP prierezovo vo viacerých článkoch (napr. čl. 12, 14, 17, 22, a 25) zdôrazňuje, že zdravotný postih, ktorý je dôvodom na zbavenie spôsobilosti takejto osoby, neoprávňuje poskytovateľa zdravotnej starostlivosti vykonať zdravotný výkon bez toho, aby bola rešpektovaná vôľa samotného (hoc nespôsobilého) pacienta. Samozrejme z uvedených článkov Dohovoru o PZP nemožno  vyvodiť záver, že pri poskytovaní zdravotnej starostlivosti je rozhodujúca za každých okolností len vôľa nespôsobilého pacienta, no filozofia záväznosti pacientovej vôle sa práve v dôsledku Dohovoru o PZP obracia v prospech pacienta. Tento moment si musia poskytovatelia zdravotnej starostlivosti uvedomiť a do procesu informovania a získania súhlasu so starostlivosťou zainteresovať v čo najväčšej miere aj nespôsobilých pacientov.

Ešte dôležitejším odkazom Dohovoru o PZP je však samotné znenie čl. 12, ktoré upravuje rovnosť pred zákonom a obsahuje spojitosť s problematikou spôsobilosti právne konať u osôb so zdravotným postihnutím.

1.    Zmluvné strany opätovne potvrdzujú, že osoby so zdravotným postihnutím majú kdekoľvek právo na uznanie svojej osoby ako subjektu práva.
2.    Zmluvné strany uznávajú, že osoby so zdravotným postihnutím majú spôsobilosť na právne úkony vo všetkých oblastiach života na rovnakom základe s ostatnými.
3.    Zmluvné strany prijmú príslušné opatrenia, ktoré majú umožniť osobám so zdravotným postihnutím prístup k pomoci, ktorú môžu potrebovať pri uplatňovaní svojej spôsobilosti na právne úkony.
4.    Zmluvné strany zabezpečia, aby všetky opatrenia týkajúce sa uplatňovania spôsobilosti na právne úkony poskytovali primerané a účinné záruky s cieľom zabrániť zneužitiu v súlade s medzinárodným právom v oblasti ľudských práv. Tieto záruky zabezpečia, aby opatrenia týkajúce sa uplatňovania spôsobilosti na právne úkony rešpektovali práva, vôľu a preferencie danej osoby, aby zabraňovali konfliktu záujmov a nenáležitému ovplyvňovaniu, aby boli primerané a prispôsobené situácii danej osoby, aby sa uplatňovali čo najkratšie a aby podliehali pravidelnej kontrole zo strany príslušného, nezávislého a nestranného orgánu alebo súdu. Tieto záruky musia byť primerané tomu, do akej miery uvedené opatrenia ovplyvňujú práva a záujmy danej osoby.
5.    V súlade s ustanoveniami tohto článku zmluvné strany prijmú všetky primerané a účinné opatrenia na zabezpečenie rovnakého práva osôb so zdravotným postihnutím vlastniť alebo dediť majetok, spravovať svoje finančné záležitosti a mať rovnaký prístup k bankovým pôžičkám, hypotékam a iným formám finančného úverovania a zabezpečia, aby osoby so zdravotným postihnutím neboli svojvoľne zbavené svojho majetku.“

Znenie ods. 2 je obzvlášť dôležité. Neobsahuje žiadne priame limity vo vzťahu k obmedzeniu spôsobilosti právne konať pre osoby, ktoré trpia zdravotným postihnutím, ovplyvňujúcim ich rozlišovacie schopnosti [15] Podľa mnohých právnych teoretikov čl. 12 Dohovoru o PZP vytvára rámec na tzv. inštitút asistencie pri rozhodovaní (tiež známy ako „podporované rozhodovanie“) osôb trpiacich zdravotným postihnutím, ktoré im znemožňuje plne vnímať následky svojho konania, resp. ktoré z nich robí osoby podliehajúce manipulácii zo strany tretích osôb.

Dohovor o PZP teda zaväzuje štát, aby pre osoby zdravotne postihnuté zabezpečil takú asistenciu pri výkone ich práv (ak je vzhľadom na povahu ochorenia potrebná), ktorá im umožní právo uplatniť. Práve tu sa nachádza rozlišovací znak medzi doteraz uplatňovaným prístupom (zbavenie/obmedzenie určitých práv) a prístupom, ktorý vyžaduje Dohovor o PZP (asistencia pri výkone práva). Uvedené je zároveň paradigmou Dohovoru o PZP, ktorá je budovaná na idei potreby ísť ďalej, ako tomu bolo doteraz – cieľom nie je prispôsobiť postihnutú osobu podmienkam spoločnosti, ale naopak vytvárať podmienky, aby sa spoločnosť sama približovala/prispôsobovala osobám so zdravotným postihnutím [16]
Dosahy uplatnenia Dohovoru o PZP na reálny život postihnutých osôb sa v praxi ukážu hlavne v rozhodovacej činnosti súdov.

V minulom roku rozhodol Okresný súd v Chebe (ČR) o „navrátení“ plnej spôsobilosti na právne úkony pani Renáte H., a to aj napriek tomu, že zdravotné dôvody, ktoré boli titulom na zbavenie spôsobilosti na právne úkony stále trvajú. Okresný súd v Chebe založil svoje revolučné rozhodnutie ťažiskovo na Dohovore o PZP a po vykonaní dokazovania zaujal názor, že neexistuje právna prekážka, ktorá by pani Renáta H. bránila v plnej miere právne konať, pričom ako asistenciu jej v súlade s § 29 Občianskeho zákonníka ustanovil opatrovníka. Jeho úlohou je pomáhať pani Renáte H. pri rozhodovaní a nie rozhodovať za ňu. 

Dohovor o PZP a Európsky súd pre ľudské práva

Dôležitosť Dohovoru o PZP a jeho dopad na politiky štátov už v niekoľkých rozhodnutiach zdôraznil aj Európsky súd pre ľudské práva (ďalej len „Súd“). Napríklad v rozhodnutí Glor proti Švajčiarsku [17]dal do súvisu porušenie čl. 14 Dohovoru o ľudských právach (zákaz diskriminácie) s nedostatočnou implementáciou Dohovoru o PZP do právneho poriadku Švajčiarska (aj keď Švajčiarsko nie je signatárom Dohovoru o PZP) [18] Uvedené rozhodnutie je dôležité práve v spôsobe jeho odôvodnenia. Súd upozornil členské štáty Rady Európy na to, aby svoj právny poriadok prispôsobili Dohovoru o PZP. Súčasne Súd akcentoval nevyhnutnosť rešpektovania Dohovoru o PZP ako dokumentu, ktorý má byť prenesený do reálneho života spoločnosti. [19]

V nadväznosti na zmienené právo na rovnosť upravené v čl. 12 Dohovoru o PZP je dôležité rozhodnutie vo veci Alajos Kiss proti Maďarsku ,v ktorom Súd konštatoval porušenie volebného práva garantovaného v Protokole č. 1, čl. 3. [20]  Pán Kiss bol vzhľadom na svoje psychické ochorenie čiastočne zbavený spôsobilosti na právne úkony. Vo februári 2006 pán Kiss zistil, že jeho meno chýba vo voličských zoznamoch pre jeho volebný okrsok. Napriek jeho žiadostiam o zaradenie do zoznamu mu nebolo vyhovené.

Súd zistil porušenie práva chránené v tom, že maďarský právny poriadok nerozlišoval medzi dôvodmi ktoré vo svojej podstate plne diskvalifikujú osobu na právne úkony (vzhľadom na závažnosť psychiatrického ochorenia) a do jednej kategórie zaraďujú všetky osoby, teda tie s najťažšími diagnózami ako aj tie,  ktoré boli zbavené spôsobilosti čo aj len čiastočne.

Obdobne Súd postupoval aj pri rozhodovaní vo veci D.D. proti Litve, v ktorom riešil sťažnosť štátnej príslušníčky Litvy, ktorá bola v dôsledku svojho mentálneho postihnutia umiestnená do zariadenia pre duševne postihnutých a automaticky bola zbavená spôsobilosti na právne úkony a obmedzená v slobode pohybu. [21] 

Súd vyhodnotil, že skutočnosť, že osoba je zbavená spôsobilosti samostatne konať, ju ešte nezbavuje práva vyjadrovať svoj názor na veci, ktoré sa dejú okolo nej (napr. aj vo vzťahu k zdravotnej starostlivosti) a jej názor má byť v čo najväčšej miere rešpektovaný. Z rozhodnutia vyplýva, že podstatným momentom pre posúdenie „záväznosti“ vôle takejto osoby nie je skutočnosť zbavenia spôsobilosti ale povaha ochorenia (to či ovplyvňuje jej rozoznávaciu schopnosť). V súvislosti s posudzovaním sťažnosti súd poukázal aj na Dohovor o PZP a princípy, ktoré sú v ňom stanovené vo vzťahu k právnej spôsobilosti zdravotne postihnutých osôb (čl. 12). [22]

Z rovnakých pozícií vychádza aj ďalšie nedávne rozhodnutie Európskeho súdu pre ľudské práva vo veci Stanev proti Bulharsku. [23] Aj v tomto prípade Súd zdôraznil, že súčasný trend na poli ochrany práv osôb so zdravotným postihnutím smeruje k tomu, aby bola osobám so psychickým postihnutím priznaná spôsobilosť v čo najväčšom rozsahu, ako to v danom (ich) prípade prichádza do úvahy [24].  V prípade Stanev Súd konštatoval porušenie skoro všetkých významných článkov, ktoré sa vzťahujú na ochranu pred neľudským zaobchádzaním (čl. 3), slobodu pohybu (čl. 5 ods. 1, 4 a 5), právo na súdnu ochranu (čl. 6 ods. 1) a právo na účinnú nápravu (čl. 13).

Súd poukázal na obsah Dohovoru o PZP aj vo veci Kiyutin proti Rusku.[25]  V tomto prípade sťažovateľ pán Viktor Kyiutin nezískal povolenie na trvalý pobyt v Rusku, hoci jeho manželka bola ruskej štátnej príslušnosti a z ich manželstva a narodila sa im dcéra. Dôvodom na zamietnutie žiadosti bol fakt, že sťažovateľ bol HIV pozitívny. Súd na jednej strane akceptoval výhradu, že dôvodom na odmietnutie trvalého pobytu môžu byť nákazlivé choroby, no zdôraznil, že uvedené je nevyhnutné vykladať reštriktívne, a takéto ochorenia sa musia vyznačovať vysokou schopnosťou nákazlivosti (napríklad SARS, vtáčia chrípka H5N1), pričom podľa názoru súdu HIV pozitívne osoby do skupiny takéhoto druhu ochorení nepatria. Súd zdôraznil, že odlišné zaobchádzanie s osobou na základe jej zdravotného stavu je v rozpore s čl. 14 Dohovoru o ľudských právach a porušuje aj zásady ustanovené v Dohovore o PZP a preto konštatoval porušenie čl. 14 – zákaz diskriminácie.

Záver

Hoc je problematika ochrany ľudských práv riešená na nadnárodnej úrovni stabilne niekoľko desaťročí je možné konštatovať, že Dohovor o PZP svojím rozsahom, stanovením kontrolných mechanizmov vyplnil medzeru vo vzťahu k špeciálnym potrebám osôb so zdravotným postihnutím. Názory popredných odborníkov z oblasti práva a bioetiky, ako aj nedávne rozhodnutia Súdu dávajú znať, že právne nastavenie fungovania viacerých inštitútov (napr. zbavovanie právnej spôsobilosti, informované súhlasy nespôsobilých osôb, detencie) je potrebné vo svetle tohto Dohovoru o PZP prehodnotiť. Pre oblasť poskytovania zdravotnej starostlivosti je zvlášť dôležité, aby zdravotnícki pracovníci zainteresovali do procesu poskytovania aj osoby, ktoré sú zbavené spôsobilosti na právne úkony, a za ktorých dáva informovaný súhlas zákonný zástupca. Názor týchto osôb by mal byť rešpektovaný v čo najvyššej miere. Uplatnenie Dohovoru o PZP samozrejme môže naraziť aj na extrémne požiadavky a na absurdný výklad jeho jednotlivých článkov .[26]

Aj na takýto scenár sa musí spoločnosť pripraviť. Aby sme sa vyhli nesprávnemu uchopeniu zmyslu a ideí Dohovoru o PZP mali by sme prijať právnu úpravu, ktorá princípy zakotvené v Dohovore v určitej miere rozumnej všeobecnosti rozmení na drobné. Svoju nezastupiteľnú úlohu zohrajú aj sudcovia, ktorí by mali prejaviť schopnosť nájsť správnu cestu pre aplikovanie ustanovení Dohovoru o PZP pre konkrétny prejednávaný prípad tak, aby boli jeho princípy zachované.


Článok bol uverejnený v časopise zdravotníckeho práva a bioetiky Vol 2, No 2 (2012)
Obsah čísla v dispozícii tu

AUTOR: JUDr. Ivan Humeník, PhD., JUDr. Peter Franko

foto: uscpaa.org

Literatúra a poznámky
1.    KNAP, K. - ŠVESTKA, J. et al. Ochrana osobnosti podle občanského práva. 4. vydanie. Praha: Linde Praha, a.s., 2004. 435 s., ISBN 80-7201-484-6, str. 39.
2.    SVÁK, J. Ochrana ľudských práv v troch zväzkoch. Bratislava: EUROKODEX, s.r.o., 2011. 520 s., ISBN 978-80-89447-44-2, str. 13.
3.      HUMENÍK, I.: Medicínske právo a ochrana osobnosti. 1. vydanie - Bratislava: EUROKODEX, s.r.o., 2011. 288 s.,  ISBN 978-80-89447-58-9, 62.
4.    Tým nechceme povedať, že práva sú len na strane pacienta. Ako sme naznačili, aj subjekty na druhej strane vzťahu (teda zdravotnícki pracovníci / poskytovatelia) majú svoje práva, ktoré musia byť rešpektované. Dnes sa mnohokrát paradoxne dostávame do situácie, kedy práva zdravotníckych pracovníkov na ochranu života, zdravia, cti, nie sú dostatočné chránené. Zdravotnícke povolanie sa realizuje mnohokrát v podmienkach, kedy je zdravotník vystavený riziku straty života/poškodenia zdravia (zoberme si napr. zásahy záchrannej zdravotnej služby v rómskych osadách). Právna regulácia na ochranu záujmov a práv zdravotníkov v týchto situáciách podľa nášho názoru reaguje neefektívne a ochrana (napr. hrozbou trestnoprávneho postihu pre útočníka) sa žiaľ realizuje až ex post.
5.    Ešte presnejšie by sa dalo povedať že „výklad obsahu“ toho – ktorého ľudského práva. Uvedené môžeme sledovať napríklad v rozhodovaní Európskeho súdu pre ľudské práva v sťažnostiach ktoré sa týkajú namietaného porušenia Čl. 8 Dohovoru o ľudských právach – práva na súkromie. Európsky súd pre ľudské práva opakovane prezentoval stanovisko, že rozsah práva na súkromie nie je možné ohraničiť.
6.    Samozrejme odhliadnuc od objektívnych determinantov ako sú napríklad samotná kvalita právneho štátu, teda jeho celkového filozoficko-právneho nastavenia, vymožiteľnosť práva, a podobne.
7.    Dohovor o právach osôb so zdravotným postihnutím prijatý na pôde OSN, publikovaný v zbierke zákonov pod číslom 317/2010 Z. z. Na pôde OSN boli 17.12.1991 prijaté aj Princípy pre ochranu osôb s mentálnym postihnutím a pre zlepšenie zdravotnej starostlivosti [online]. 1991 [cit. 2010-12-07].  Dostupné na internete: < http://www2.ohchr.org/english/law/principles.htm>.
8.    KAYESS, R., FRENCH, P. Out of darkness into light? Introducing the Convention on the Rights of Persons with Disabilities. In Human Rights Law Review, 2008. No. 8, pp. 1–34, p. 4.
9.    Porovnaj PERLIN, M. L., BIRGDEN, A. “Where the home in the valley meets the damp dirty prison”: A human rights perspective on therapeutic jurisprudence and the role of forensic psychologists in correctional settings. In Aggression and Violent Behavior. 2009, Vol. 14 , pp. 256–263, p. 257.
10.        Pozri tiež bližšie: HUMENÍK, I.: Ochrana práv duševne chorých osôb pri nútenom poskytovaní zdravotnej starostlivosti. In Časopis zdravotnického práva a bioetiky (Journal of medical law and bioethics) Vol. 1, No. 1,  Ústav státu a práva ČR (2011), ISSN 1804-8137, str. 38.
11.    V zmysle čl. 33 ods. 1 (cit.): „1. zmluvné strany v súlade so svojou vlastnou sústavou riadenia v rámci štátnej správy ustanovia jedno alebo viac kontaktných miest pre problematiku vykonávania tohto dohovoru a budú venovať náležitú pozornosť určeniu koordinačného mechanizmu v rámci štátnej správy s cieľom uľahčiť realizáciu s tým súvisiacich činností v jednotlivých oblastiach a na rôznych úrovniach.“
12.     Pozri napr. Závery z diskusie pri okrúhlom stole: Dohovor o právach osôb so zdravotným postihnutím, jeho implementácia a monitorovanie. [online]. 2011 [cit. 2012-12-04].  Dostupné na internete: < http://www.nrozp.sk/index.php/uvodna-stranka-nrozp/181-zavery-z-diskusie-pri-okruhlom-stole-dohovor-o-pravach-osob-so-zdravotnym-postihnutim-jeho-implementacia-a-monitorovanie>.
13.    Pozri HAMMARBERG, T. Persons with disabilities have a right to be included in the community – and others must respect this principle. [online]. 2012 [cit. 2012-05-05]. Dostupné na internete: < http://commissioner.cws.coe.int/tiki-view_blog_post.php?postId=211>.
14.    HAMMARBERG, T. Persons with disabilities have a right to be included in the community – and others must respect this principle. [online]. 2012 [cit. 2012-05-05].  Dostupné na internete: < http://commissioner.cws.coe.int/tiki-view_blog_post.php?postId=211>.
15.      Hammarberg v jedno zo svojich príspevkov dokonca prezentuje názor, že dikcia uvedeného ustanovenia Dohovoru nevytvára žiaden priestor pre proces v ktorom by či už sudca alebo zdravotnícky pracovník (psychiater) mal kompetenciu skúmať či posudzovaná osoba má alebo nemá schopnosť „uplatniť“ samostatne svoje právo. Porovnaj HAMMARBERG, T. Persons with disabilities must not be denied the right to vote. [online]. 2012 [cit. 2012-05-05]. Dostupné na internete: < http://commissioner.cws.coe.int/tikiview_ blog_post.php?postId=127>.
16.    Porovnaj HAMMARBERG, T. Persons with disabilities must not be denied the right to vote. [online]. 2012 [cit. 2012-05-05]. Dostupné na internete: < http://commissioner.cws.coe.int/tiki-view_blog_post.php?postId=127>.
17.    Vec Glor v. Switzerland (Application No. 13444/04, judgment 30. April 2009).

18.    Vec Glor je zaujímavá z viacerých dôvodov. Pán Glor totiž opakovane žiadal o vykonanie povinnej vojenskej služby, no vojenská správa mu opakovane jeho žiadosť zamietla na základe toho že trpí ochorením diabetes melitus. Táto minca mala aj druhú stranu. Kedže typ ochorenia nebol v zmysle švajčiarskej judikatúry dostatočne závažný, pán Glor bol povinný každoročne platiť špeciálnu daň za nevykonanie vojenskej služby. Paradox celej situácie tkvel teda v tom, že zdravotné postihnutie bránilo sťažovateľovi vykonať vojenskú službu a na druhej strane bolo dôvodom na zaťaženie sťažovateľa špeciálnou daňou. Súd v odôvodnení poukázal aj na to, že štát by mal aj v prípade vojenskej služby vytvoriť také podmienky, aby splnenie tejto povinnosti mohli v prípade záujmu vykonať aj osoby so zdravotným postihnutím.
19.      Pozri napr.: Court of Human Rights case: A promising ruling on disability at European Court of Human Rights case. [online]. 2012 [cit. 2012-12-04].  Dostupné na internete: < http://www.e-include.eu/en/legal-network-news/non-discrimination/13...ising-ruling-on-disability-at-european-court-of-human-rights-case->.
20.    Vec  Alajos Kiss v. Hungary  (Application No. 38832/06).
21.    Pomerne čerstvé rozhodnutie D.D. V Lithuania, (Application No. 13469/06, judgment, 14 February 2012).
22.    Tiež pozri European National Human Rights Institutions welcome Judgment of the European Court of Human Rights on mental capacity and human rights. [online]. 2012 [cit. 2012-12-04].  Dostupné na internete: < http://www.ihrc.ie/newsevents/press/2012/02/14/european-national-human-rights-institutions-welcom/>.
23.    Vec Stanev v. Bulgaria (Application no. 36760/06, judgment, 17 january 2012).
24.    Porovnaj Europe’s highest human rights court issues landmark disability rights ruling. [online]. 2012 [cit.2012-06-05]. Dostupné na internete: <  http://mdac.info/en/17/01/2012/Europe_s_highest_human_rights_court_issues_landmark_disability_rights_ruling->.
25.    Kiyutin v. Russia (Application No. 2700/10, konečné rozhodnutie zo dňa 15. septembra 2011)
26.    Viď napríklad nedávne rozhodnutie Spolkového sociálneho súdu v ktorom rozhodol, že Ústava SRN ani Dohovor o PZP neukladá štátu povinnosť zabezpečiť „právo na erekciu“. Žalobu podával muž trpiaci ochorením sklerózy multiplex, ktoré sa prejavuje aj poruchami erekcie. Keďže zdravotné poistenie nekryje preplácanie nákladov na lieky podporujúce erekciu, žalobca namietal, že jeho právo na kvalitu života je zo strany štátu v dôsledku jeho ochorenia porušované. Spolkový sociálny súd sa s touto argumentáciou nestotožnil. Pozri ONDERKOVÁ, L. Nemecko: rozhodnutie BSG o rozsahu práv postihnutých osôb. [online]. 2012 [cit. 2012-06-05].  Dostupné na internete: < http://www.pravo-medicina.sk/detail-aktuality?new_id=514&caller_site=2&PHPSESSID=ac3a75812d2bb5b7888fcbd76d342b43





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