Vybrané otázky ochrany súkromia a spracúvania osobných údajov účastníkov klinického skúšania liekov (2. časť) | Medicínske právo
              

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Vybrané otázky ochrany súkromia a spracúvania osobných údajov účastníkov klinického skúšania liekov (2. časť)


 | 11.12.2012 | komentárov: 1547

II. ZAINTERESOVANIE FYZICKEJ OSOBY DO KLINICKÉHO SKÚŠANIA

Obrazok II. 1. Účastník klinického skúšania

Postavenie a práva účastníka klinického skúšania liekov sú upravené v Zákone o zdr. starostlivosti (16) a v Zákone o lieku. Pre Slovenskú republiku je mimoriadne dôležitým Dohovor  o ochrane ľudských práv a dôstojnosti človeka v súvislosti s aplikáciou biológie a medicíny - Dohovor o ľudských právach a biomedicíne (ďalej len ako „Dohovor o biomedicíne“), ktorý bol dňa  04.04. 1997  v Oviede otvorený na podpis pre členské štáty Rady Európy a členov Európskeho spoločenstva. K tomuto Dohovoru bol dňa 25.01.2005 v Štrasburgu prijatý Dodatkový protokol k Dohovoru o ľudských právach a biomedicíne, týkajúci sa biomedicínskeho výskumu (ďalej tiež len ako „Protokol“), ktorý pre Slovenskú republiku nadobudol platnosť 01.09.2007.Tento právny dokument je pre oblasť medicínskeho práva (a pre všetky subjekty zainteresované do realizácie biomedicínskeho výskumu) o to dôležitejší, že Národná rada SR ho svojím uznesením 1493/2005 zaradila v zmysle čl. 7 ods. 5 Ústavy SR medzi medzinárodné zmluvy majúce prednosť pred vnútroštátnymi zákonmi. Dohovor  a jeho dodatky sú vzhľadom na ich právnu povahu významným formálnym prameňom medicínskeho práva. Protokol sa na základe rozhodnutia NR SR považuje za medzinárodnú zmluvu, ktorá má v zmysle čl. 7 ods. 5 Ústavy SR prednosť pre zákonmi, teda na jej aplikáciu nie je nutné prijať zákon, pretože je samoaplikovateľná. Ako uvádza Procházka (17), prednosť medzinárodnej zmluvy je tzv. aplikačnou prednosťou, t.j. povinnosťou orgánu aplikácie práva použiť v prípade konfliktu medzi medzinárodnou zmluvou a zákonom zmluvu. Je preto nevyhnutné, aby sa hodnotenie splnenie  podmienok zainteresovania fyzickej osoby do klinického skúšania hodnotilo nielen na základe vnútroštátnej zákonnej úpravy, ale aj na základe Dohovoru o biomedicíne a jeho Protokolu (18).

Klinické skúšanie liekov sa vykonáva v štyroch etapách (§ 29 ods. 5 Zákona o lieku), pričom v prvej etape sa vykonáva na účastníkovi bez zdravotnej indikácie. Účastníkom druhej až štvrtej etapy (zdravotne indikovaného klinické skúšanie) môže byť akákoľvek fyzická osoba. Zákon ani Protokol neobsahuje v tomto prípade žiadne obmedzenie a zaradenie do skúšania viažu na splnenie všeobecných podmienok (informovanosť, súhlas a podobne). Naopak, okruh účastníkov v prípade prvej etapy (bez zdravotnej indikácie) Zákon o zdr. starostlivosti vymedzuje negatívne. V zmysle § 26 ods. 10 Zákona o zdr. starostlivosti môže byť a contrario účastníkom takéhoto výskumu ktokoľvek okrem (alternatívny výpočet):
a)    osoby vo väzbe a vo výkone trestu odňatia slobody
b)    vojaka základnej služby, náhradnej služby a prípravnej služby a osoby vykonávajúcej civilnú službu (19)
c)    osoby v ústavnej starostlivosti, ktorá je hospitalizovaná z dôvodu ochorenia na prenosnú chorobu, ktorá ohrozuje jej okolie.
Zákon zároveň zakazuje, aby sa neindikovaný výskum realizoval na ľudskom plode alebo ľudskom zárodku.

V otázke vylúčenia určitej skupiny osôb z neindikovaného výskumu ide národná úprava nad rámec stanovený Protokolom (20). Ten totiž možnosť participácie osôb vymenovaných v § 26 ods. 10 Zákona o zdr. starostlivosti na neindikovanom výskume nezakazuje. Protokol sa v čl. 20 osobitne vyjadruje k osobám, ktoré sú pozbavené osobnej slobody. Protokol umožňuje, aby signatári vo svojej vnútroštátnej úprave upravili vykonávanie zdravotnej indikovaného výskumu aj na osobách zbavených slobody v prípade, ak (kumulatívne):
a)    výskum porovnateľnej účinnosti nemožno uskutočniť bez účasti osôb zbavených slobody,
b)    cieľom výskumu je prispieť ku konečnému dosiahnutiu výsledkov, ktoré môžu priniesť prospech osobám zbaveným slobody,
c)    výskum je spojený iba s minimálnym rizikom a minimálnou záťažou.

Zapojenie osôb, ktoré sú nespôsobilé do klinického skúšania je samozrejme viac problematické ako zapojenie právne spôsobilých jednotlivcov. Dôvod je pochopiteľný - za nespôsobilé osoby koná iná osoba - ich zákonný zástupca (zástupcovia) - ktorý by mal byť vedený „záujmom“ zastúpeného. Ustálenie toho čo je pre nespôsobilého účastníka „dobré“ je problematické a preto zákon a Protokol koncipujú rozlišovací znak ktorý nezáleží na posúdení nespôsobilého/jeho zástupcu ale v posúdení pomeru medzi potenciálnym benefitom plynúcim z výskumu pre účastníka a rizikami, ktoré sú s jeho účasťou spojené (21). Toto pomerovanie sa v prípade osôb nespôsobilý posúva na stranu prospechu a obmedzuje možnosť potenciálneho zaťaženia zdravia účastníka. Uvedené vyplýva aj z terminológie Protokolu, ktorý pri osobách nespôsobilých kladie podmienku (Čl. 15 ods. 2 písm. ii/), aby bol spojený len (cit.): „... s minimálnym rizikom a minimálnou záťažou pre dotknutého jednotlivca; a na ospravedlnenie zvýšenej úrovne rizika alebo záťaže sa nesmú použiť žiadne úvahy o dodatkovom možnom prospechu výskumu.“

II. 2. Súhlas s účasťou v klinickom skúšaní liekov

Základom pre zaradenie fyzickej osoby do klinického skúšania je jej písomný informovaný súhlas. Z tejto podmienky Zákon o zdr. starostlivosti, ako aj Protokol definujú výnimku, ktorá sa týka klinického skúšania na osobách v núdzových klinických situáciách (22). Filozoficko-etický základ využitia fyzickej osoby pre účely klinického skúšania však musí stáť na princípe autonómie jednotlivca (v spojení s princípom beneficiencie a non-maleficiencie) (23). Akékoľvek obmedzenie tohto princípu by malo byť vnímané reštriktívne. Otázka rozhodovania o zapojení sa do klinického výskumu spadá do súkromnej sféry fyzickej osoby a je chránené prostredníctvom práva na súkromie. Svojím rozhodovaním tak potenciálny účastník klinického skúšania disponuje svojou integritou. Podľa Čl. 5 Dohovoru  o biomedicíne (cit.): „Zásah v oblasti zdravia sa môže vykonať iba vtedy, ak osoba, ktorej sa týka, bola informovaná a so zásahom vyjadrila súhlas.“ Rovnako aj Zákon o zdr. starostlivosti (§ 6 ods. 4) ako conditio sine qua non pre vykonanie zákroku predpokladá (cit.): „... preukázateľný súhlas s poskytnutím zdravotnej starostlivosti, ktorému predchádzalo poučenie podľa tohto zákona.“ a pre oblasť biomedicínskeho výskumu ako jednu z obligatórnych podmienok vyžaduje jeho písomnú formu (24).

Súhlas dáva spôsobilá fyzická osoba až po poučení o rôznych aspektoch klinického skúšania. Udelenie súhlasu bez poučenia (aj v prípade, že by poučenie chcela samotná osoba odmietnuť) je neplatné (pozri § 27 ods. 1 Zákona o zdr. starostlivosti). Som názoru že udelenie informovaného súhlasu je jednostranným právnym úkonom a preto by okrem osobitných podmienok uvedených v Zákone o zdr. starostlivosti a v Zákone o lieku mal spĺňať aj podmienky, ktoré pre platný právny úkon stanovuje Občiansky zákonník v § 37 a nasledujúcich ustanoveniach. Podľa § 38 ods. 1 (cit.): „Právny úkon sa musí urobiť slobodne a vážne, určite a zrozumiteľne; inak je neplatný.“ Podmienka „slobodnej vôle“ je v prípade poskytovania zdravotnej starostlivosti a často aj v prípade rozhodovania fyzickej osoby o zapojení sa do klinického skúšania liekov problém. Do slobodnej vôle pacienta vstupujú rôzne vplyvy, ktoré jeho vôľu ovplyvňujú – napr. samotné ochorenie, bolesť, strach, doterajšie skúsenosti a zážitky z choroby a podobne. Vzhľadom na uvedené nebude mať rozhodnutie zapojiť do klinického skúšania nikdy prvky ničím nezaťaženého prejavu slobodnej vôle.  Z toho dôvodu je namieste, aby bol poskytovateľ zdravotnej starostlivosti pri získavaní súhlasu opatrný a snažil sa čo najviac eliminovať rôzne vplyvy, ktorú sú spôsobilé „rozhodnúť“ za potenciálneho účastníka výskumu.

Informovaný súhlas je zložený z dvoch stavebných prvkov – (i) z informácií ktoré je skúšajúci povinný poskytnúť potenciálnemu účastníkovi a zo (ii) samotného prejavu vôle potenciálneho účastníka výskumu.

Ad (i)
Rozsah informácií ktoré je povinný fyzickej osobe poskytnúť poskytovateľ zdravotnej starostlivosti je upravený § 27 ods. 2 Zákona o zdr. starostlivosti, no je potrebné ho vnímať v kontexte § 29 ods. 14 Zákona o lieku, ktorý upravuje osobitosti informácií práve pri klinickom skúšaní liekov. V zmysle uvedeného zákonného ustanovenia musí informovaný súhlas (25) obsahovať:
a)    informácie o klinickom skúšaní a jeho cieľoch,
b)    možný prínos klinického skúšania pre účastníka,
c)    možné riziká a nevýhody vyplývajúce pre účastníka,
d)    poučenie o iných možnostiach liečby,
e)    zabezpečenie dôvernosti osobných údajov,
f)    informáciu o právach účastníka,
g)    informáciu o možnosti kedykoľvek odstúpiť od klinického skúšania a o spôsobe a následkoch jeho prípadného prerušenia.
Povinnosť riadne poučiť účastníka nie je splnená jednoduchým poskytnutím písomnej dokumentácie, ktorá obsahuje vyššie definované informácie. Informácie musia byť poskytnuté takým spôsobom a v takej forme, aby im potenciálny účastník výskumu rozumel, aby ich bol schopný vyhodnotiť a na základe nich formovať svoje rozhodnutie výskumu sa zúčastniť alebo nie (26). Povinnosť poučiť potenciálneho účastníka klinického skúšania má skúšajúci (27) – teda poskytovateľ zdravotnej starostlivosti u ktorého sa na základe povolenia Štátneho ústavu pre kontrolu liečiv realizuje klinické skúšanie. Ak má byť účastníkom skúšania nespôsobilá osoba, je skúšajúci povinný poučiť nielen zákonného zástupcu ale primeraným spôsobom aj samotného nespôsobilého (28).

Ad (ii)
Súhlas sa udeľuje v písomnej forme. Ako som naznačil v predošlom texte, osobitnou kapitolou je udeľovanie súhlasu za nespôsobilých pacientov, za ktorých v zmysle právnych predpisov v týchto prípadoch koná ich zákonný zástupca (29).
Otázkou je, či by platnosť takéhoto súhlasu nemala byť schválená uznesením súdu. Podľa môjho názoru by tomu tak malo byť, keďže v prípade udeľovania súhlasu s účasťou zastúpeného na klinickom skúšaní nejde o rozhodovanie bežných záležitostí, ale o vec ktorá do takéhoto rámca nespadá. Podobný prípad môže nastať, ak má byť účastníkom klinického skúšania neplnoletá osoba, pričom jeden z jej rodičov súhlas udelil, no druhý rodič je proti. V tomto prípade by mal taktiež na základe návrhu jedného z rodičov rozhodnúť súd (§ 35 zákona o rodine v platnom znení). V prípade klinického skúšania na neplnoletých účastníkoch sa v súčasnej dobe odporúča, aby bola participácia takejto osoby zo strany skúšajúceho v nadväznosti na zvyšujúci sa vek účastníka opakovane potvrdzovaná. Napriek tomu, že súhlas za dieťa (do 18 rokov) udeľuje jeho zákonný zástupca, názor neplnoletého účastníka musí byť braný do úvahy (30). Niektorí autori dokonca zastávajú názor, že vôľa dieťaťa má byť za každých okolností rešpektovaná – teda mala by mať prednosť pred rozhodnutím zákonného zástupcu (zvyšujúca sa úmera vo vzťahu k zvyšujúcemu sa veku dieťaťa) (31). Dá sa povedať že aj aktuálna právna úprava klinického skúšania aspekt názoru nespôsobilej osoby berie do úvahy a kladné vyjadrenie takejto osoby považuje za jednu z podmienok, ktoré musia byť splnené pre zapojenie nespôsobilej osoby do klinického skúšania.

II. 3. Ochrana súkromia účastníkov výskumu a ochrana ich osobných údajov

Údaje o zdravotnom stave tvoria najintímnejšiu súčasť súkromia fyzickej osoby. Knap a Švestka k predmetu práva na osobné súkromie uvádzajú (cit.): „Predmet práva na osobné súkromie tvorí vnútorná intímna sféra života fyzickej osoby vytváraná skutočnosťami jej súkromného života. Účelom tohto práva je poskytnúť ochranu pre tým aby tieto skutočnosti súkromného života neboli sprístupňované verejnosti (vonkajšiemu svetu) bez súhlasu dotknutej fyzickej osoby či bez dôvodu uznaného zákonom...“ (32). Právo na súkromie je chránené prostredníctvom viacerých medzinárodných dokumentov a zákonite našlo svoje vyjadrenie aj v základných právnych predpisoch SR. Základnou normou je Dohovor o ochrane ľudských práv a základných slobôd v znení jeho protokolov (ďalej len ako „Dohovor“) - (Čl. 8) (33), Dohovor o  a biomedicíne (Čl. 10 ods. 1) a Čl. 16 ods. 1 a Čl. 19 ods. 2 Ústavy Slovenskej republiky. Drgonec sa v jednom zo svojich článkov zamýšľa, ktorý z týchto dvoch článkov ústavy môže upravovať medicínske činnosti, ktoré zasahujú do súkromia pacienta (34). Je pravdou, že Ústava SR nám k tejto otázke nedáva jednoznačnú odpoveď. Vzhľadom na obsah týchto článkov a bohatosť činností v medicíne, ktoré sú spôsobilé zasiahnuť do práva na súkromie môžeme pod oba články subsumovať ochranu súkromia jednotlivca pri poskytovaní zdravotnej starostlivosti. Ako poznamenáva Knapp, spracovanie osobných údajov vo veľkých centralizovaných informačných systémoch je ohrozením občianskych práv fyzickej osoby, predovšetkým jej práva na súkromie, ochranu mena, spoločenského postavenia, či cti (35). Preto je nevyhnutné, aby bol vytvorený právny rámec zabezpečujúci ochranu súkromia dotknutej osoby.

Oproti právnej úprave biomedicínskeho výskumu je právna úprava ochrany osobných údajov pomerne mladým právnym odvetvím – prvé zákony, ktoré sa zaoberali spracúvaním a tokom údajov boli prijímané v 70. rokoch minulého storočia. Ako hovoria Matoušová a Hejlík, osobitné zákony týkajúce sa ochrany osobných údajov vznikajú ako reakcia na možnosti jednotlivca ovplyvniť využívanie osobných údajov o ňom samom (36). Cieľom právnej reglementácie nie je absolútne brániť spracúvaniu osobných údajov, ale zabrániť ich zneužívaniu a vytvoriť podmienky na ich legálne používanie (37).

Za prvý dôležitý dokument s povahou medzinárodného dohovoru môžeme považovať Dohovor  o ochrane jednotlivca pri automatizovanom spracovaní osobných údajov prijatý na pôde Rady Európy v roku 1981 v znení jeho Dodatkového protokolu (38). Na pôde Rady Európy boli Výborom ministrov prijaté viaceré odporúčania, ktoré sa týkali ochrany osobných údajov v súvislosti s prevádzkovaním zdravotníckych databánk, či v súvislosti s poskytovaním zdravotnej starostlivosti (39) a vedeckého výskumu (40). Posledným odporúčaním Výboru ministrov členských krajín Rady Európy je odporúčanie č. 2006/4 o výskume biologického materiálu ľudského pôvodu. V rámci (pôvodného komunitárneho práva) EU bola v roku 1995 prijatá smernica Európskeho parlamentu a Rady č. 95/46/ES o ochrane jednotlivcov pri automatizovanom spracovaní osobných údajov a o voľnom pohybe týchto údajov, ktorá bola v roku 2002 transponovaná do zákona č. 428/2002 Z.z. o ochrane osobných údajov. Ochrane osobných údajov v súvislosti s klinickým skúšaním liekov (resp. všeobecne s biomedicínskym výskumom) sa venujú čiastočne (v rámci všeobecnej ochrany účastníkov výskumu) aj predpisy, ktoré sa ťažiskovo zameriavajú na komplexné otázky klinického skúšania (predovšetkým generálna smernica pre klinické skúšanie č. 2001/20 (ES)  (41) ale aj ďalšie predpisy (42)).

Zaoberať sa ochranou osobných údajov v dnešnej dobe je nevyhnutné. Informácie ako také sa už pred dlhším časom stali obchodovateľnou hodnotou a  to sa týka o to viac informácií, ktoré sú nevyhnutné pre podporu, či vyvrátenie výskumných hypotéz v oblasti farmácie. O fyzickej osobe, ktorá je účastníkom klinického skúšania sa zhromažďujú informácie, s ktorými sa ďalej pracuje a ktoré sa v modifikovanej podobe sprístupňujú ďalším subjektom. Má účastník výskumu právo na zabezpečenia ochrany svojich osobných údajov? Čo všetko môžeme označiť za osobné údaje a kto ich môže spracúvať?

V prvom rade je nevyhnutné zdôrazniť že osobné údaje fyzickej osoby tvoria časť jej súkromia (forum internum). Bäumen et al. uvádza, že európska legislatíva týkajúca sa ochrany osobných údajov ako časti práva na súkromie začala byť koncipovaná aj na základe impulzu Ústavného súdu Nemeckej spolkovej republiky, ktorý vydal svojím rozhodnutím v roku 1983, keď „konštituoval“ právo fyzickej osoby na informačné sebaurčenie (right to informational self-determination). Obsahom tohto práva je to, že fyzická osoba má právo určiť kto a za akým účelom bude spracúvať jej osobné údaje a súčasne má mať právo vedieť ktoré subjekty jej osobné údaje spracúvajú (43). Aké je ústavné zakotvenie práva na súkromie?

Ustanovenie Čl. 19 Ústavy Slovenskej republiky  hovorí (cit.):
Čl.19

(1) Každý má právo na zachovanie ľudskej dôstojnosti, osobnej cti, dobrej povesti a na ochranu mena.
(2) Každý má právo na ochranu pred neoprávneným zasahovaním do súkromného a rodinného života.
(3) Každý má právo na ochranu pred neoprávneným zhromažďovaním, zverejňovaním alebo iným zneužívaním údajov o svojej osobe.

Ochrana súkromia zaručuje, že žiaden subjekt nemôže neoprávnene zhromažďovať osobné údaje o inej fyzickej osobe.  Ústavný súd SR v náleze PL. ÚS 43/95 vyslovil, že (cit.): „Právom na súkromie sa zaručuje ochrana hodnôt uznaných za súkromné pred verejnou mocou, fyzickými aj právnickými osobami.“ (44) V ďalšom rozhodnutí Ústavný súd SR  konštatuje (cit.): Ochrana nemateriálnych hodnôt súkromnej povahy sa zaručuje podľa čl. 19 ods. 2 Ústavy SR. Týmto ustanovením sa nezaručuje absolútna ochrana súkromného a rodinného života, ale priznáva sa len ochrana pred neoprávneným zasahovaním do súkromného a rodinného života. Ústava teda umožňuje také zásahy do súkromného a rodinného života, ktoré sú oprávnené.“(45) Obdobne sa súd vyjadril k možnosti zasahovania do súkromia fyzických osôb v rozhodnutí č. I. ÚS 13/2000, kde uviedol (cit.):  „Ústava v čl. 19 ods. 2 nezaručuje ochranu súkromného a rodinného života pred akýmkoľvek zasahovaním. Zaručuje ochranu len pred takým zasahovaním, ktoré je neoprávnené. V súlade s účelom práva na súkromie môžu orgány verejnej moci, fyzické osoby aj právnické osoby zasahovať do súkromného a rodinného života iných vtedy, ak ich zasahovanie možno hodnotiť ako oprávnené.“ (46)

Uvedené rozhodnutia majú presah aj na nami rozoberanú problematiku ochrany osobných údajov účastníkov klinického skúšania liekov. Ústava v citovanom článku pracuje s dvoma kľúčovými pojmami a to „osobný údaj“ a „neoprávnené zhromažďovanie“. Na to, aby sme dokázali určiť, ktoré údaje o pacientovi je možné spracúvať a akým spôsobom, musíme  pomenovať čo všetko osobným údajom je a ktoré subjekty európska a v nadväznosti na ňu národná legislatíva oprávňuje s osobnými údajmi disponovať.

Jedným zo základných právnych predpisov (niekdajšieho komunitárneho práva) týkajúcich sa ochrany osobných údajov je smernica Európskeho parlamentu a Rady 95/46/ES o ochrane jednotlivcov pri automatizovanom spracovaní osobných údajov a o voľnom pohybe týchto údajov zo dňa 24. októbra 1995 (ďalej len „smernica o osobných údajoch“). Týmto predpisom bol určený rámec pre legálne spracúvanie osobných údajov. Podľa Čl. 2 písm. a/ smernice osobným údajom je akákoľvek informácia (cit.): ...., ktorá sa týka identifikovanej alebo identifikovateľnej fyzickej osoby ("údajového subjektu"); identifikovateľná osoba je osoba, ktorú možno identifikovať, priamo alebo nepriamo, najmä pomocou overenia identifikačného čísla alebo jedného alebo viacerých faktorov špecifických pre jeho fyzickú, fyziologickú, duševnú, hospodársku, kultúrnu alebo sociálnu identitu;. Obdobne pojem „osobný údaj“ vysvetľuje aj zákon č. 428/2002 Z.z. o ochrane osobných údajov (ďalej len „Zákon o ochrane OÚ“) v § 3 (cit.): „Osobnými údajmi sú údaje týkajúce sa určenej alebo určiteľnej fyzickej osoby, pričom takou osobou je osoba, ktorú možno určiť priamo alebo nepriamo, najmä na základe všeobecne použiteľného identifikátora alebo na základe jednej či viacerých charakteristík alebo znakov, ktoré tvoria jej fyzickú, fyziologickú, psychickú, mentálnu, ekonomickú, kultúrnu alebo sociálnu identitu.“
Na základe týchto definícií nie je možné s istotou konštatovať čo presne osobným údajom je, pretože vo svojej podstate je nemožné vylúčiť, aby akákoľvek informácia o fyzickej osobe použitím ďalších pomocných informácií nenadobudla povahu „osobného údaju“. Osobnými údajmi sa stávajú aj informácie, ktoré by sme pred niekoľkými desaťročiami za osobné údaje nepovažovali.  Otázky spojené s ochranou osobných údajov sa netýkajú len dát získaných v klinickom skúšaní (resp. všeobecne pri poskytovaní zdravotnej starostlivosti), ale sú riešené v celom spektre medicínskom činností. Zvlášť silný akcent sa v posledných rokoch kladie na zabezpečenie ochrany osobných údajov v súvislosti s prevádzkovaním tkanivových baniek (47).
Smernica o osobných údajov v Čl. 8 upravuje spracúvanie osobitných kategórií osobných údajov, medzi ktoré zaradzuje aj informácie o zdravotnom stave fyzickej osoby. Zároveň na jednej strane formuluje zásadu, že osobitné kategórie osobných údajov nie je možné spracovávať, no okamžite z tejto zásady definuje široké výnimky a konkrétny režim pre spracúvanie osobitných kategórií prenecháva na národné úpravy. Smernica o osobných údajov je z dôvodu viacerých vágnych pojmov a voľného režimu transpozície jej obsahu častokrát kritizovaná (48) a celkom oprávnene. Ak sa v dnešnej európskej spoločnosti predpokladá nevyhnutnosť medzištátneho toku osobných údajov je potrebné, aby boli základné pojmy a základný rámec ich ochrany  stanovený jednoznačne.

Ako sa k otázke spracúvania osobných údajov účastníkov biomedicínskeho výskumu stavia Rada Európy? Výbor ministrov členských štátov Rady Európy prijal odporúčanie RE č. 97/5 na ochranu zdravotných údajov (platné od 13. februára 1997), ktorým nahradil obdobné odporúčanie z roku 1981 týkajúce sa zásad ochrany osobných údajov v súvislosti s prevádzkou zdravotníckych databánk. Zásady formulované v základných dohovoroch a ďalších právnych normách majú svoje vyjadrenie aj v tomto dokumente. V súvislosti so spracúvaním osobných údajov sa odporúča rozšíriť statusovú povinnú mlčanlivosť zdravotníckych pracovníkov aj na nezdravotníckych pracovníkov, ktorí prichádzajú do styku so zdravotnými údajmi (49) – aj tieto osoby by v zmysle odporúčania 97/5 mali byť viazané mlčanlivosťou (čoby stavovskou povinnosťou u zdravotníckych pracovníkov) (50). Pre naše účely je podstatný čl. 12 kde sa definuje povinnosť anonymného spracúvania osobných  údajov dotknutých osôb. Koncepcia spracúvania osobných údajov pri výskumnej medicínskej činnosti je teda postavená na anonymite dotknutého subjektu (51), pričom z nej odporúčanie stanovuje výnimky (52). Dôvodom na neanonymné spracúvanie osobných údajov je nastavenie výskumného projektu – teda, ak by bol výskumný zámer znemožnený anonymným spracúvaním, usmernenie umožňuje neanonymné spracúvanie osobných údajov. Aj v tomto prípade však odporúčanie požaduje výslovný súhlas účastníka výskumu (skúšania) s tým, aby v súvislosti s jeho účasťou na výskume boli jeho osobné údaje spracúvané neanonymne (53). Vysvetľujúca správa k odporúčaniu č. RE 97/5 (54) upozorňuje na viaceré praktické otázky, ktoré by vo vzťahu k spracúvaniu osobných údajov účastníkov výskumu mala riešiť národná legislatíva – ako napríklad súhlas členov rodiny osoby, ktorá sa zúčastňuje výskumu (ak sú aj ich dáta pre výskum potrebné), spôsoby publikovania výsledkov výskumu (ak majú byť osobné údaje osoby v nejakej forme spomenuté), ako aj otázky spracúvania údajov o zomrelých osôb a nenarodených (55).

Je zrejmé, že národná, ako aj nadnárodná legislatíva vníma požiadavku zabezpečenia ochrany osobných údajov pri poskytovaní zdravotnej starostlivosti a pri biomedicínskom výskume. Podmienka zabezpečenia ochrany súkromia je uvedená ako condition sine qua non pre povolenie a realizovanie klinického skúšania aj v generálnej smernici o klinickom skúšaní (2001/20/ES) a to v Čl. 3 ods. 2 písm. c/ kde je stanovené, že klinické skúšanie je možné uskutočniť len ak (cit.): „... práva subjektu na fyzickú a mentálnu integritu, súkromie a ochranu údajov o jeho osobe v súlade so smernicou 95/46/ES sú zabezpečené“. Ochrana osobných údajov účastníkov sa akcentuje aj v smernici č. 2005/28/ES (56), Čl. 5  a to v súvislosti s povinnosťou správneho nakladania s dokumentáciou klinického výskumu (cit): „Všetky informácie o klinických pokusoch treba evidovať, spravovať a uchovávať tak, aby sa mohli správne nahlasovať, vykladať a overovať, pri súčasnom zachovaní ochrany dôvernosti záznamov o subjektoch pokusu“. Záväzok zabezpečiť ochranu osobných údajov vyplýva aj z § 30 ods. 1 písm. c/ Zákona o lieku. Rovnako ustanovenie  § 44 písm. i/ Zákona o lieku zaväzuje skúšajúceho (cit.): „...evidovať, spravovať a uchovávať údaje a informácie o klinickom skúšaní takým spôsobom, aby sa správne oznamovali, interpretovali a overovali a aby sa zároveň zabezpečila ochrana osobných údajov“.

Problém právnej úpravy je v tom, že ukladá povinnosť spracúvať osobné údaje v súlade so štandardami upravenými v osobitných predpisoch, no tieto osobitné predpisy (smernica 95/46/ES a Zákon o ochrane OÚ) neobsahujú explicitnú úpravu spracúvania osobných údajov pri klinickom skúšaní. Na dôvažok ako som spomenul vyššie, aj samotné pojmy, s ktorými tieto predpisy pracujú majú mnohoznačný obsah, čo celú situáciu ešte viac komplikuje. Ako by teda malo vyzerať spracúvanie osobných údajov pri klinickom skúšaní liekov?     

II. 4.  Spracovanie osobných údajov účastníka klinického skúšania liekov    

Pri klinickom skúšaní vystupuje niekoľko druhov subjektov. V prvom rade zadávateľ skúšania (sponzor), skúšajúci/pracovisko klinického skúšania a samotný účastník skúšania. Ďalšími subjektmi sú:
a)    etická komisia
b)    Štátny ústav pre kontrolu liečiv (ďalej len „ŠUKL“)
c)    poisťovňa ktorá poisťuje zadávateľa (§ 43 písm. h/ časť 3 Zákona o lieku)
d)    poisťovňa ktorá poisťuje poskytovateľa zdravotnej starostlivosti (pracovisko klinického výskumu) u ktorého sa výskum realizuje (§ 43 písm. h/ časť 4 Zákona o lieku)
e)    zdravotná poisťovňa účastníka výskumu (§ 43 písm. g a § 44 písm. h/  Zákona o lieku).

Z koncepcie Zákona o lieku vyplýva, že „subjektom prvého kontaktu“ voči účastníkovi klinického skúšania je skúšajúci. Skúšajúcim je v zmysle § 29 od. 11  Zákona o lieku lekár alebo zdravotnícky pracovník s odbornou spôsobilosťou na poskytovanie zdravotnej starostlivosti, ktorý za realizáciu klinického skúšania zodpovedá na danom pracovisku a ktorý je uvedený v Protokole. Pracoviskom klinického výskumu je poskytovateľ zdravotnej starostlivosti, ktorý má na klinické skúšanie schválenie zo strany ŠUKL.  Povinnosť poskytovateľa zdravotnej starostlivosti spracúvať osobné údaje účastníka klinického skúšania vyplýva primárne zo Zákona o ochrane OÚ (57), no môžeme ju dedukovať aj z § 27 ods. 2 písm. f/ Zákona o zdr. starostlivosti a § 30 ods. 1 písm. c/ Zákona o lieku, ktorými sa medzi podmienky pre vykonávanie klinického skúšania zaraďuje aj povinnosť zaručiť práva účastníkov z hľadiska ich fyzickej integrity a duševnej integrity, právo na súkromie a na ochranu osobných údajov podľa osobitného predpisu (Zákona o ochrane OÚ).
Je skúšajúci povinný získať na spracovanie osobných údajov účastníka jeho súhlas? Zákon o ochrane OÚ v § 8 zakazuje spracovanie osobitných kategórií osobných údajov, medzi ktoré patria aj informácie o zdravotnom stave – čo je prípad spracúvania osobných údajov pri klinickom skúšaní liekov. V § 9 sú uvedené výnimky z generálneho zákazu (cit.):
§ 9

(1) Zákaz spracúvania osobných údajov ustanovený v § 8 ods. 1 neplatí, ak dotknutá osoba dala písomný súhlas na ich spracúvanie alebo ak
a)    spracúvanie vyžaduje osobitný zákon, ktorý ustanovuje zoznam osobných údajov, účel ich spracúvania a okruh dotknutých osôb; spracúvané osobné údaje o dotknutej osobe možno z informačného systému poskytnúť, sprístupniť alebo zverejniť len vtedy, ak osobitný zákon ustanovuje účel poskytovania, sprístupňovania alebo zverejňovania, zoznam osobných údajov, ktoré možno poskytnúť, sprístupniť alebo zverejniť, ako aj tretie strany, ktorým sa osobné údaje poskytujú, prípadne okruh príjemcov, ktorým sa osobné údaje sprístupňujú, ak tento zákon neustanovuje inak, alebo
b)    spracúvanie je nevyhnutné na ochranu životne dôležitých záujmov dotknutej osoby alebo inej fyzickej osoby, ktorá nemá spôsobilosť na právne úkony alebo je fyzicky nespôsobilá na vydanie písomného súhlasu, a ak nemožno získať písomný súhlas jej zákonného zástupcu, alebo
c)    spracúvanie vykonáva v rámci oprávnenej činnosti občianske združenie, nadácia alebo nezisková organizácia poskytujúca všeobecne prospešné služby, politická strana alebo politické hnutie, odborová organizácia, štátom uznaná cirkev alebo náboženská spoločnosť a toto spracúvanie sa týka iba ich členov alebo tých fyzických osôb, ktoré sú s nimi vzhľadom na ich ciele v pravidelnom styku, osobné údaje slúžia výlučne pre ich vnútornú potrebu a nebudú poskytnuté tretej strane bez písomného súhlasu dotknutej osoby, alebo
d)    spracúvanie sa týka osobných údajov, ktoré dotknutá osoba zverejnila alebo sú nevyhnutné pri uplatňovaní jej právneho nároku, alebo
e)    ide o spracúvanie na účely poskytovania zdravotnej starostlivosti a na účely vykonávania verejného zdravotného poistenia, ak tieto údaje spracúva poskytovateľ zdravotnej starostlivosti, zdravotná poisťovňa alebo Úrad pre dohľad nad zdravotnou starostlivosťou alebo
f)    ide o spracúvanie v sociálnom poistení, v sociálnom zabezpečení policajtov a vojakov, na účely poskytovania sociálnej pomoci alebo pomoci v hmotnej núdzi, alebo je spracúvanie nevyhnutné na účely plnenia povinností alebo uplatnenie zákonných práv prevádzkovateľa zodpovedného za spracúvanie v oblasti pracovného práva a v službách zamestnanosti a ak to prevádzkovateľovi vyplýva z osobitného zákona.

Som názoru, že poskytovateľ zdravotnej starostlivosti (pracovisko) vo vzťahu k účastníkovi klinického skúšania vystupuje v pozícii prevádzkovateľa (pozri § 4 ods. 2 Zákona o ochrane OÚ). Z dikcie vyššie citovaného ustanovenia § 9, predovšetkým z písm. e/ a podporne z písm. a/ môžeme dedukovať, že:
a)    zdravotné údaje (ktoré sú osobitnou kategóriou) je možné spracovávať a
b)    pre ich spracovanie poskytovateľ zdravotnej starostlivosti nepotrebuje účastníkov osobitný súhlas.
Tento názor však neostáva bez interpretačných problémov. Predovšetkým znenie § 9 ods. 1 písm. a/ je široké a z pohľadu zabezpečenia ochrany súkromia účastníkov výskumu by sme mohli namietať že umožňuje až príliš extenzívny výklad. Aj využitie písm. e/ cit. ustanovenia je po zmene zákona č. 577/2004 Z.z., ktorý momentálne vylučuje z verejného zdravotného poistenia náklady spojené s klinickým skúšaním, ako aj náklady spojené s odstraňovaním komplikácií vzniknutých v dôsledku klinického skúšania liekov problematické (58). Podporným ustanovením, ktoré umožňuje spracovávať osobné údaje bez súhlasu účastníka výskumu je § 18 ods. 2 Zákona o zdr. starostlivosti (cit.): „Súhlas dotknutej osoby na spracúvanie, poskytovanie a sprístupňovanie údajov zo zdravotnej dokumentácie sa za podmienok ustanovených týmto zákonom nevyžaduje.“

V nadväznosti na citované časti dotknutých právnych predpisov som názoru, že skúšajúci (za poskytovateľa zdravotnej starostlivosti) nepotrebuje explicitný súhlas účastníka výskumu pre spracúvanie jeho osobných údajov. Keďže je však skúšajúci povinný účastníka pred získaním jeho informovaného súhlasu oboznámiť s prostriedkami, ktoré zabezpečujú jeho súkromie a osobné údaje (59), je vhodné, aby mu v rámci informovaného súhlasu pacient udelil špeciálny súhlas na spracovanie svojich osobných údajov – ako naznačím nižšie, tento súhlas by sa mal týkať aj osobitných situácii.

Dôležité otázky vo vzťahu k sprístupneniu údajov účastníka klinického skúšania ďalším subjektom a to predovšetkým zadávateľovi a poisťovniam formuluje Zákon o lieku. Skúšajúci je v zmysle § 44 písm. h/ povinný (cit.): „bezodkladne oznamovať zadávateľovi a zdravotnej poisťovni, ktorá vykonáva verejné zdravotné poistenie účastníka, každú závažnú nežiaducu udalosť a každý neočakávaný závažný nežiaducu účinok, ak nebolo v povolení uvedené inak, a prijímať potrebné opatrenia na ochranu života a zdravia účastníkov vrátane prerušenia klinického skúšania“. Je dôležité si uvedomiť, že skúšajúci je viazaný povinnou mlčanlivosťou (60), ktorej ho môže zbaviť len pacient, alebo orgán príslušný na vydanie povolenia, a to na žiadosť orgánov činných v trestnom konaní a súdov (61). I keď zdravotná poisťovňa je oprávnená na nahliadanie do zdravotnej dokumentácie pacienta a rovnako aj sprístupňovanie údajov vo forme nahliadania a robenie si výpiskov – situácia uvedená v § 44 písm. h/ Zákona o lieku je odlišná. Tu sa totiž ukladá povinnosť aktívne oznamovať zákonom predpísané informácie – pričom tieto údaje majú bezpochyby povahu osobných údajov. Pomocnú barličku na aprobovanie takéhoto postupu nám ponúka jedine  § 9 ods. 1 písm. a/ Zákona o ochrane OÚ. Som však názoru, že znenie § 44 písm. h/ nenapĺňa podmienky uložené § 9 ods. 1 písm. a/ momentálne platný právny stav rieši otázku prenosu osobných údajov na zadávateľa a zdravotnú poisťovňu pacienta nedostatočne.

V klinickom skúšaní je jedným z jeho inherentných predpokladov poskytnutie získaných údajov o výsledkoch klinického skúšania zadávateľovi. Aký je právny titul na to, aby poskytovateľ zdravotnej starostlivosti/skúšajúci osobné údaje účastníka skúšania zadávateľovi sprístupnil? Mám za to, že súčasný právny stav túto otázku dostatočne nerieši a riešenia skôr vyplývajú z dokumentov, ktoré majú odporúčací alebo podporný charakter. Na základe výkladu dotknutých právnych noriem nadnárodnej alebo domácej úpravy si myslím, že poskytovateľ zdravotnej starostlivosti/skúšajúci nemôže zadávateľovi, ako ani žiadnemu inému subjektu poskytnúť osobné údaje účastníka klinického skúšania. Jedinou zákonnou výnimkou je už spomenutá povinnosť skúšajúceho informovať zadávateľa a zdravotnú poisťovňu o nežiaducich následkoch klinického skúšania. V tomto prípade je pre naplnenie účelu predmetného ustanovenia nemožné, aby skúšajúci poskytoval zadávateľovi anonymné údaje. Keďže aj zadávateľ má obdobnú povinnosť (viď § 43 písm. f/ a g/ Zákona o lieku) musí disponovať osobnými údajmi účastníka výskumu, ktorého sa nežiaduce účinky klinického skúšania týkajú. Splnenie notifikačnej povinnosti zadávateľa voči poisťovni bez nutnosti poznať identitu účastníka klinického skúšania by predpokladala, že identifikačným kľúčom by disponovala zdravotná poisťovňa a zadávateľ by na základe informácie od skúšajúceho oznamoval len kód účastníka klinického skúšania.

II. 5. Vybrané špecifiká pri spracúvaní osobných údajov v klinickom skúšaní liekov

Trendy v oblasti spracovania osobných údajov v klinickom skúšaní smerujú k anonymizácii údajov účastníkov klinického skúšania, no nedá sa vylúčiť, že špecifické druhy klinického skúšania anonymizáciu nebudú umožňovať. Absolútnu ochranu osobných údajov účastníkov klinického skúšania by zabezpečilo spracovanie v takej forme, aby výstupom zo strany skúšajúceho boli neidentifikovateľné údaje (tzv. unlinked anonymised data), ktoré by nebolo možné ani spätne použitím kľúča zidentifikovať s konkrétnou fyzickou osobu. V tejto súvislosti by však skúšajúci mal získať od účastníka výskumu súhlas na takýto postup, keďže po odstránení identifikačných znakov údajov nebude možné naplniť právo účastníka výskumu oboznámiť sa s jeho výsledkami (vo vzťahu k jeho osobe) (62). Odstránením identifikačných znakov sa ipso facto znemožní aj výkon ďalších práv, ktoré Zákon o ochrane OÚ priznáva v § 20 dotknutej osobe (v našom prípade účastníkovi skúšania).

Spracúvanie osobných údajov pri poskytovaní zdravotnej starostlivosti a samozrejme pri klinickom skúšaní liekov má aj ďalšie špecifiká (63). Uvedené sa týka možnosti realizácie práv dotknutej osoby – účastníka výskumu, ktoré sú stanovené v § 20 Zákona o ochrane OÚ. Napríklad uplatnenie práva dotknutej osoby žiadať zničenie osobných údajov je v oblasti medicíny zvlášť problematické. I keď obsahom práva dotknutej osoby je aj nárok žiadať zničenie údajov, ktoré sa jej týkajú,  vo vzťahu k výskumu a predovšetkým vo vzťahu k spracúvaniu osobných údajov pri poskytovaní zdravotnej starostlivosti je toto právo obmedzené. Uvedené vyplýva aj zo zákonnej úpravy podmienok spracúvania osobných údajov pri poskytovaní zdravotnej starostlivosti 64). Explicitná úprava obmedzenia tohto práva síce absentuje, obmedzenie práva žiadať o zničenie údajov však podľa môjho názoru implikuje existencia zákonnej povinnosti poskytovateľa zdravotnej starostlivosti uchovávať zdravotnú dokumentáciu po zákonom určenú dobu (65). Rovnako aj vysvetľujúca správa k odporúčaniu výboru ministrov členských štátov Rady Európy č. 97/8 konštatuje, že reálne a praktické aspekty zabezpečenia efektívneho poskytovania zdravotnej starostlivosti uplatnenie práva na zničenie údajov dotknutou osobou znemožňujú (66). Som názoru, že právny režim spracúvania osobných údajov pri poskytovaní zdravotnej starostlivosti právo žiadať o zničenie spracúvaných údajov nevylučuje, len jeho uplatnenie obmedzuje na dobu, počas ktorej je poskytovateľ zdravotnej starostlivosti povinný uchovávať zdravotnú dokumentáciu pacienta.

II. 6. Sprístupnenie osobných údajov ďalším subjektom

V rámci klinického skúšania liekov sa môžu vyskytnúť situácie, ktoré si vyžiadajú zainteresovanie ďalších subjektov. Napríklad, ak v rámci skúšania dôjde k škode na zdraví jeho účastníka do riešenia tejto situácie sa zapája poisťovateľ zadávateľa a poisťovateľ zdravotníckeho zariadenia, no nedá sa vylúčiť aj zapojenie ďalších osôb. Spomenúť môžeme napríklad externých likvidátorov poistných udalostí, externých expertov z oblasti medicíny, farmácie, či práva (advokáti zastupujúci zadávateľa/zdravotnícke zariadenie). Pokrýva oprávnenie spracovávania osobných údajov bez výslovného súhlasu (viď kapitola vyššie) aj možnosť sprístupniť osobné údaje účastníka skúšania (ktorí utrpel škodu – resp. tvrdí že ju utrpel) tomuto širokému spektru osôb? Aj v tomto smere má minca dve strany – na jednej je otázka či sprístupnením osobných údajov nedochádza k porušeniu povinnej mlčanlivosti a na druhej strane mince je otázka či aj keby o porušenie mlčanlivosti nešlo sprístupnenie údajov neporušuje zákon o ochrane OÚ.

Súčasná koncepcia mlčanlivosti de facto vylučuje , aby zdravotnícky pracovník v prípade sporu s pacientom poskytol svojmu právnemu zástupcovi podklady na výkon právneho zastupovania (napr. zdravotnú dokumentáciu, informácie o priebehu liečby a podobne). Pokiaľ vynecháme zákonom menované výnimky z mlčanlivosti (viď vyššie) je zdravotnícky pracovník zbavený mlčanlivosti buď samotným pacientom, alebo orgánom vydávajúcim povolenie na poskytovanie zdravotnej starostlivosti (ak ho o to požiadal súd konajúci v civilnej alebo trestnej veci). Pre účel účinnej obhajoby/právneho zastúpenia sú tieto možnosti ťažkopádne a neefektívne (67). Zákon o poskytovateľoch zdravotnej starostlivosti (578/2004 Z.z.) taktiež obchádza skutočnosť, že v sporoch o náhradu škody je účastníkom konania (zvyčajne) pacient ako žalobca a na druhej strane je žalovaným poskytovateľ zdravotnej starostlivosti (nie zdravotnícky pracovník). Uvedené vyplýva z § 420 ods. 2 OZ podľa ktorého za škodu spôsobenú fyzickými osobami v rámci ich činnosti pre právnickú osobu/fyzickú osobu (v našom prípade je to poskytovateľ zdravotnej starostlivosti)  zodpovedá priamo poskytovateľ zdravotnej starostlivosti. Tu opätovne narážame na nedostatočnosť právnej úpravy, ktorá mlčanlivosťou zaväzuje len zdravotníckych pracovníkov a nie poskytovateľa zdravotnej starostlivosti. Aj keby sme vychádzali z predpokladu, že poskytovateľ, ktorý nie je viazaný mlčanlivosťou (68) by potenciálne mohol svojmu právnemu zástupcovi poskytnúť potrebné informácie potrebné pre zastupovanie, zistíme, že legálne sa k týmto údajom nemôže dostať, keďže ich môže získať len od zdravotníckeho pracovníka (v našom prípade skúšajúceho), ktorý je viazaný mlčanlivosťou. Na základe uvedeného som názoru, že právne zastúpenie v civilnom spore (resp. v rámci predsúdneho vyjednávania), v ktorom právny zástupca poskytovateľa zdravotnej starostlivosti disponuje s údajmi účastníka klinického skúšania (napr. zo zdravotnej dokumentácie pacienta, ústne podanými informáciami) na dispozíciu ktorými táto osoba nedala súhlas je porušovaním zákona (vo vzťahu k zákonu č. 578/2004 Z.z. a k Zákonu o ochrane OÚ). Tieto závery platia pomerne aj pre prípady sprístupnenia osobných údajov účastníka klinického skúšania poisťovni zadávateľa/poskytovateľa zdravotnej starostlivosti, resp. pre ich sprístupnenie iným subjektom.

III. ZÁVERY A ODPORÚČANIA

Pred viac ako desiatimi rokmi uviedli Gulcher et al. v jednom zo svojich článkov (69), že i keď moderná spoločnosť dáva pozor kto a akým spôsobom spracúva osobné údaje pri konvenčnom poskytovaní zdravotnej starostlivosti, v otázke  spracúvania osobných údajov v rámci biomedicínskeho výskumu je stále benevolentná.  Zmenil sa tento konštatovaný stav za obdobie od odpublikovania tohto príspevku?

Snaha formulovať zásady správneho spracúvania osobných údajov ktoré by rešpektovalo ochranu súkromia fyzickej osoby bola korunovaná prijatím viacerých právnych predpisov, ktoré som v rámci tejto práce spomenul. Som však názoru, že pri skoncipovaní zásad a všeobecných pravidiel zákonodarca zotrval a nereflektoval konkrétne výzvy, ktoré pred neho stavia moderná informačná spoločnosť – a to aj v oblasti klinického skúšania liekov. Práve vysoká miera všeobecnosti je hlavným handikapom Zákona o ochrane OÚ, ako aj smernice č. 95/46/ES o ochrane jednotlivcov pri automatizovanom spracovaní osobných údajov a o voľnom pohybe týchto údajov (70). Súčasne chýba jasné prepojenie ochrany osobných údajov na otázky sprístupňovania osobných údajov účastníkov klinického skúšania zo strany skúšajúceho ďalším subjektom a to či v užšom kruhu (zadávateľ a zdravotná poisťovňa) alebo v širšom kruhu (poisťovatelia zodpovednosti za škodu, externí experti) (71). Najpálčivejšie otázky týkajúce sa ochrany osobných údajov nerieši ani generálna smernica pre klinický výskum (2001/20/ES), keďže tá vo veciach ochrany osobných údajov zaväzuje postupovať v súlade so smernicou č. 95/46/ES. Je možné a vysoko žiaduce aby zmeny pre danú oblasť priniesla jej pripravovaná novelizácia (72).

Pokiaľ nebude pre oblasť spracovania osobných údajov účastníkov klinického výskumu prijatá podrobnejšia úprava je potrebné, aby skúšajúci v procese informovania účastníka klinického skúšania a získania jeho informovaného súhlasu pokryl potenciálnu potrebu sprístupnenia jeho osobných údajov osobitným súhlasom. Okrem súhlasu na sprístupnenie jeho údajov by účastník klinického skúšania mal byť informovaný a súhlasiť s tým, že jeho údaje (ak sa to ad hoc vyžaduje) budú anonymizované, resp. zbavené všetkých identifikačných znakov a rovnako by mal byť podrobne informovaný o ďalších špecifikách spracúvania jeho osobných údajov oproti všeobecnej úprave upravenej v Zákone o ochrane OÚ. Týmto spôsobom skúšajúci splní svoju povinnosť ktorú mu ukladá v § 27 ods. 2 písm. f/ Zákon o zdr. starostlivosti ako aj Zákon o lieku v § 30 ods. 1 písm. c/. Mimo toho, že takto skúšajúci naplní (i keď nejasnú) literu zákona, zabezpečí pre seba (poskytovateľa zdravotnej starostlivosti a zadávateľa) možnosť efektívnej obrany voči nárokom na náhradu škody vznesených zo strany účastníka klinického skúšania.

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(16) Ustanovenie § 26 ods. 2 Zákona o zdr. starostlivosti kumuluje pre realizáciu výskumu povinnosti uložené nielen týmto zákonom, ale aj osobitným predpisom – Zákonom o lieku (cit): „Biomedicínsky výskum možno vykonávať len za podmienok ustanovených týmto zákonom a osobitným predpisom.“
(17) PROCHÁDZKA, R. Postavenie a účinky medzinárodných zmlúv v právnom poriadku SR. In Justičná revue, 2003, roč. 55, č. 10, str. 867
(18) Porovnaj HUMENÍK, I.: Medicínske právo a ochrana osobnosti. 1. vydanie - Bratislava: EUROKODEX, s.r.o., 2011. 288 s.,  ISBN 978-80-89447-58-9, str. 136.
(19) Vzhľadom na zmenu právnej úpravy ktorá sa prejavila profesionalizáciou armády SR sa v tejto časti ustanovenie § 26 ods. 10 stalo obsolétnym.
(20) HUMENÍK, I. Biomedicínsky výskum - pojem, podmienky jeho realizovania a ochrana jeho účastníkov (stav slovenskej právnej úpravy vo svetle Dodatkového protokolu k Dohovoru o ľudských právach a biomedicíne týkajúceho sa biomedicínskeho výskumu. In: Zdravotnictví a právo: právní a daň
(21) Pozri aj Čl. 17 Helsinskej deklarácie v znení prijatom v októbri 2008 na 59. valnom zhromaždení WMA v Soule.
(22) Pozri Čl. 19 Protokolu. Z čl. 19 ods. 2 písm. iv) dokonca vyplýva, že Protokol umožňuje vykonávať na osobách v núdzových klinických situáciách aj neindikovaný výskum. Zákon o zdr. starostlivosti umožňuje realizovať biomedicínsky výskum so zdravotnou indikáciou bez informovaného súhlasu dotknutej osoby za podmienok uvedených v § 34 ods. 1 a to v prípadoch poskytovania neodkladnej zdravotnej starostlivosti.
(23) Porovnaj: Riadiaci výbor pre bioetiku (CDBI). Príručka pre členov etických komisií. CDBI/INF(2011)2, [online]. 2011 [cit. 2012-03- 10]. Dostupné na internete: , ako aj Council for International Organizations of Medical Sciences. International Ethical Guidelines for Biomedical Research Involving Human Subjects . Geneve, 2002. [online] 2002 [cit. 2012-03- 10] Dostupné na internete < http://www.cioms.ch/publications/guidelines/guidelines_nov_2002_blurb.htm >
(24) Ustanovenie § 6 ods. 5 písm. a/ Zákona o zdr. starostlivosti a § 29 ods. 13 Zákona o lieku.
(25) Zákonodarca použil nesprávne vyjadrenie. Zmienené informácie nemá obsahovať informovaný súhlas, ale informácie, ktoré je povinný poskytovateľ zdravotnej starostlivosti poskytnúť pacientovi pred udelením informovaného súhlasu majú mať takýto obsah. V legislatíve sa vo všeobecnosti pojem informovaný súhlas nepoužíva správne. Informovaný súhlas je potrebné chápať ako prejav vôle, ktorý je oprávneným subjektom urobený po vyhodnotení informácií získaných od príslušného zdravotníckeho pracovníka. Zákonodarca pojem „informovaný súhlas“ (spôsobom jeho použitia) v právnych predpisov spája s podobou jeho zachytenia – teda s jeho formou ktorá je charakterizovaná ďalšími znakmi, napríklad s rozsahom informácií.   
(26) Ako uvádzajú Šustek a Holčapek, pri posudzovaní otázky či bol pacient riadne poučený je rozhodujúcim nie to, čo lekár pacientovi povedal, ale to čo pacient pochopil. Pozri ŠUSTEK, P. - HOLČAPEK, T. Informovaný souhlas. Praha: ASPI, 2007, ISBN 978-80-7357-268-6, str. 69. Obdobne aj znenie § 31 ods. 1 písm. b/ Zákona o lieku zaväzuje skúšajúceho aby poučenie pre neplnoletého účastníka poskytla osoba, ktorá má skúsenosti s účasťou neplnoletých osôb na klinickom skúšaní. Obdobne je táto povinnosť zakotvená aj v prípade poučenia poskytovaného osobám zbavených spôsobilosti (§32 ods. 1 písm. b/)
(27) Pozri § 44 ods. b Zákona o lieku.
(28) MERLO, D. F. - KNUDSEN, L. E. - MATUSIEWICZ, K. - NIEBRÓJ, L. - VÄHÄKANGAS, K. H. Ethics in studies on children and environmental health. In J Med Ethics. 2007;33:408–413. Doi: 10.1136, str. 410, 412.
(29) Pozri § 6 ods. 1 písm. b/ Zákona o zdr. starostlivosti, ako aj § 31 ods. 1 písm. a/ Zákona o lieku.
(30) Pozri Čl. 28 Helsinskej deklarácie v znení prijatom v októbri 2008 na 59. valnom zhromaždení WMA v Soule
(31) Porovnaj MERLO, D. F. - KNUDSEN, L. E. - MATUSIEWICZ, K. - NIEBRÓJ, L. - VÄHÄKANGAS, K. H. Ethics in studies on children and environmental health. In J Med Ethics. 2007;33:408–413. Doi: 10.1136, str. 410, 412.
(32) KNAP, K. - ŠVESTKA, J. Ochrana  osobnosti  podle občanského práva. 4. vydanie. Praha: Linde Praha, a.s., 2004, str. 335.
(33) Európsky dohovor o ľudských právach plní predovšetkým funkciu ochrany práv osôb pre činnosťou štátu a jeho orgánov. Jeho ustanovenia majú však nielen negatívny význam -  teda zákaz konania, ale aj výrazne pozitívny význam vo vzťahu k štátu. Na základe Dohovoru majú štáty aktívne vystupovať tak (aj v legislatívnej oblasti), aby sa vytvorili podmienky pre realizovanie práv priznaných v Dohovore.
(34) Pozri DRGONEC, J. Ústavné práva a zdravotníctvo. Bratislava: Archa s.r.o., 1996, str. 119.
(35) KNAPP, V. Teorie práva. 1. Vydání. C.H.Beck. Praha, 1995, s. 245. ISBN 80-7179-028-1, str. 225 a nasl.
(36) MATOUŠOVÁ, M. – HEJLÍK, L. Osobní údaje a jejich ochrana. ASPI Publishing, s.r.o., I. vydanie, Praha, 2003, s. 416, ISBN 80-86395-50-2, str. 10
(37) Ibidem.
(38) Uverejnené v zbierke zákonov SR pod číslom 49/2001 Z.z. a Dodatkový protokol pod číslom 20/2005 Z.z..
(39) Odporúčanie Výboru ministrov členských krajín RE č. 97/5 na ochranu zdravotných údajov (platné od 13. februára 1997) ktoré zrušilo odporúčanie Výboru ministrov o zdravotníckych databankách z roku 1981.
(40) Odporúčanie Výboru ministrov členských krajín RE č. 83/10 na ochranu osobných údajov na účely vedeckého výskumu a štatistiky (platné od 23. septembra 1983) -  v časti týkajúcej sa štatistiky bolo nahradená odporúčaním č. 97/18.
(41) Smernica 2001/20/ES Európskeho parlamentu a Rady o aproximácii zákonov, iných právnych predpisov a správnych opatrení členských štátov týkajúcich sa uplatňovania dobrej klinickej praxe počas klinických pokusov s humánnymi liekmi.
(42) Napríklad smernica Komisie 2005/28/ES ktorou sa ustanovujú zásady a podrobné usmernenia pre správnu klinickú prax týkajúcu sa skúmaných liekov humánnej medicíny, ako aj požiadavky na povolenie výroby alebo dovozu takýchto liekov.
(43) Pozri BÄUMEN, T.S. - PACI, D. - IBARRETA, D. Data Protection and Sample Management in Biobanking – A legal dichotomy. In Genomics, Society and Policy, Vol.6, No.1 (2010) ISSN: 1746-5354 33, str. 38.
(44) Nález PL. ÚS 43/95 – nález USSR, citovaný aj v DRGONEC, J. Ústava Slovenskej republiky – Komentár. Heuréka, Šamorín 2007, s. 1197, ISBN 80-89122-38-8, str. 224.
(45) Pozri II. ÚS 1/97 s. 17-18 in DRGONEC, J. Ústava Slovenskej republiky – Komentár. Heuréka, Šamorín 2007, s. 1197, ISBN 80-89122-38-8, str. 224.
(46) Pozri I. ÚS 13/2000  in DRGONEC, J. Ústava Slovenskej republiky – Komentár. Heuréka, Šamorín 2007, s. 1197, ISBN 80-89122-38-8, str. 219.
(47) Medzi osobné údaje je možné zaradiť aj genetické informácie získané zo vzoriek uložených v tkanivových bankách, resp. získaných počas výskumu. Ako upozorňuje Andrews, neoprávneným nakladaním s genetickými informáciami o fyzickej osobe môžu tejto osobe vzniknúť obrovské finančné, či statusové škody. ANDREWS, L.B. Legal Aspects ofGenetic Information. In THE YALE JOURNAL OF BIOLOGY AND MEDICINE 64 (1991), 29-40, str. 33.  Pozri tiež BEIER, K. The Ethical and Legal Regulation of Human Tissue and Biobank Research in Europe. In Confidentiality and Personality Rights in Biobanking and Genetic Research with Human Tissue (Second International Conference, Göttingen). [online]. 2011 [cit. 2012-03- 10]. Dostupné na internete: .
(48) Pozri napríklad RAHMOUNI, H.B. – SOLOMONIDES, T. -  MONT. M.C. – SHIU, S. Modelling and Enforcing Privacy for Medical Data Disclosure across Europe. In Medical Informatics in a United and Healthy Europe. IOS Press, 2009,  European Federation for Medical Informatics. doi:10.3233/978-1-60750-044-5-695, str. 696.
(49) Napríklad na osoby ktoré sa venujú administratíve informačného systému v ktorom sa osobné údaje nachádzajú (pozn. autora).
(50) Viď Čl. 3 ods. 2 odporúčania.
(51) Obdobne pristupuje k spracúvaniu osobných údajov pri vedeckej a výskumnej činnosti odporúčanie výboru ministrov Rady Európy č. 83/10 na ochranu osobných údajov na účely vedeckého výskumu a štatistiky (platné od 23. septembra 1983) -  v časti týkajúcej sa štatistiky bolo toto odporúčanie nahradená odporúčaním č. RE 97/18. Napríklad v Čl. 2 ods. 2 sa rovnako ako v odporúčaní RE 97/5 upravuje priorita anonymného spracúvania osobných údajov (cit.): „Whenever possible, research should be undertaken with anonymous data. Scientific and professional organisations, as well as public authorities, should promote the development of techniques and procedures securing anonymity.”
(52) Uvedený koncept je dôležitý. Primárne je nevyhnutné zabezpečiť anonymitu dotknutej osoby a za určitých podmienok prichádza do úvahy spracúvanie umožňujúce identifikáciu tejto osoby.  
(53) Pokiaľ by získanie takého súhlasu bolo spojené s neprimeranými ťažkosťami a dotknutý subjekt nevyjadril vyslovený nesúhlas s neanonymným spracúvaním osobných údajov a za podmienky, že výskum je schválený príslušným orgánom štátneho dozoru prichádza do úvahy aj spracúvanie osobných údajov bez súhlasu dotknutej osoby (pozri Čl. 12, ods. 2 odporúčania RE 97/5).
(54) Pozri časť 211 a nasl. Vysvetľujúcej správy. Explanatory Memorandum: Recommendation No.R (97)5 od the Commitee of Ministers of members states on the protection of medical data. [online]. 2012 [cit. 2012-03- 10]. Dostupné na internete: .
(55) Nie je celkom jasné či mali tvorcovia pod nenarodenými deťmi (unborn) na mysli plody ktoré boli potratené, alebo plody, ktoré v čase získavania a spracúvania údajov ešte neboli narodené (keďže aj to prichádza do úvahy v prípade spracúvania údajov z genetického materiálu plodu). Skôr sa prikláňam k druhej možnosti a to aj s poukázaním na znenie Čl. 4 ods. 4.5. odporúčania RE 97/5.
(56) Smernica Komisie 2005/28/ES ktorou sa ustanovujú zásady a podrobné usmernenia pre správnu klinickú prax týkajúcu sa skúmaných liekov humánnej medicíny, ako aj požiadavky na povolenie výroby alebo dovozu takýchto liekov
(57) A z tohto právneho predpisu vyplývajú aj jeho povinnosti pri spracúvaní osobných údajov účastníka klinického skúšania. Porovnaj BARTÍK, V., JANEČKOVÁ, E. Ochrana osobních údajů v aplikační praxi (vybrané otázky). Praha: Linde Praha, a.s., 2009, 277 s., ISBN 978-80-7201-740-9, str. 118.
(58) Gramatické vyjadrenie § 9 ods. 1 písm. e/ je podľa môjho názoru možné vnímať ako kumuláciu dvoch účelov spracovania – poskytovanie zdravotnej starostlivosti a účel verejného zdravotného poistenia. Po zmene zákona 577/2004 Z.z. sa na klinické skúšanie verejné zdravotné poistenie nevzťahuje, teda druhá podmienka pre umožnenie spracúvania zdravotných údajov je nesplniteľná.
(59) Pozri § 27 ods. 2 písm. f/ Zákona o zdr. starostlivosti.
(60) Ustanovenie § 80 ods. 2 zákona č. 578/2004 Z.z. o poskytovateľoch zdravotnej starostlivosti, zdravotníckych pracovníkoch, stavovských organizáciách v zdravotníctve a o zmene a doplnení niektorých zákonov
(61) Ibidem, § 80 ods. 3. Právny poriadok umožňuje výnimku z povinnej mlčanlivosti aj v konaní pred Ústavným súdom SR.
(62) Otázky spracúvania osobných údajov účastníkov klinického skúšania rieši aj Riadiaci výbor pre bioetiku (CDBI)zriadený na pôde Rady Európy a to v Príručke pre členov etických komisií. Bližšie pozri: Riadiaci výbor pre bioetiku (CDBI). Príručka pre členov etických komisií. CDBI/INF(2011)2, [online]. 2011 [cit. 2012-03- 10]. Dostupné na internete: str. 34.
(63) K problematike spracovania osobných údajov pacienta pozri aj BURIÁNEK, J. Lekářské tajemství, zdravotnická dokumentace a související právní otázky. Praha: Linde Praha, a.s., 2005, 208 s., ISBN 80-7201-544-3, str. 42 – 53, ako aj BARTÍK, V., JANEČKOVÁ, E. Ochrana osobních údajů v aplikační praxi (vybrané otázky). Praha: Linde Praha, a.s., 2009, 277 s., ISBN 978-80-7201-740-9, str. 95 – 118.
(64) Predovšetkým generálne ustanovenie § 18 ods. 2 zákona č. 576/2004 Z.z. (cit.): „Súhlas dotknutej osoby na spracúvanie, poskytovanie a sprístupňovanie údajov zo zdravotnej dokumentácie sa za podmienok ustanovených týmto zákonom nevyžaduje.“
(65) Ustanovenie § 22 ods. 2 zákona č. 576/2004 Z.z. stanovuje (cit.): „Zdravotnú dokumentáciu, ktorú vedie všeobecný lekár, uchováva poskytovateľ 20 rokov po smrti osoby; ostatnú zdravotnú dokumentáciu 20 rokov od posledného poskytnutia zdravotnej starostlivosti osobe.“
(66) Explanatory Memorandum: Recommendation No.R (97)5 od the Commitee of Ministers of members states on the protection of medical data. [online]. 2012 [cit. 2012-03- 10]. Dostupné na internete: .
(67) HUMENÍK, I.: Medicínske právo a ochrana osobnosti. 1. vydanie - Bratislava: EUROKODEX, s.r.o., 2011. 288 s.,  ISBN 978-80-89447-58-9, str. 117.
(68) Zo zákona mu mlčanlivosť vyplýva jedine z § 18 ods. 3 Zákona o zdr. starostlivosti.
(69) GULCHER, J.R. -  KRISTJÁNSSON, K. – GUDBJARTSSON, H. - STEFÁNSSON, K. Protection of privacy by third-party encryption in genetic research in Iceland. In European Journal of Human Genetics. 2000- 8, 739–742.
(70) Porovnaj aj Robinson, N. -  Graux, H. -  Botterman, M. - Valeri, L. Review of the European Data Protection Directive. [online]. 2009 [cit. 2012-03- 10]. Dostupné na internete: < http://www.rand.org/content/dam/rand/pubs/technical_reports/2009/RAND_TR710.pdf >,  str. 27.
(71) Vzhľadom na tendencie smerujúce k zdieľaniu údajov klinického výskumu pre ďalšie výskumy je nevyhnutné riešiť aj otázky týkajúce sa využitia osobných údajov (pokiaľ nebudú neidentifikovateľné) pre potreby viacerých klinických výskumov. V nadväznosti na problematiku zdieľania údajov bol roku 2007 publikovaný výskum, ktorý vyhodnocoval postoj verejnosti k využívaniu osobných údajov získaných pri biomedicínskom výskume z ktorého vyplynulo, že aj keď respondenti nemali zásadný problém so spracovaním ich osobných údajov pre účley jedného výskumu, väčšina z nich si želala mať kontrolu nad tým, kto ich údaje bude chcieť využívať pre potreby iných výskumov. Pozri: WILLISON D.J. - SCHWARTZ, L. et al. Alternatives to Project-specific Consent for Access to Personal Information for Health Research: What Is the Opinion of the Canadian Public? In Journal of the American Medical Informatics Association. Volume 14 - Number 6, Nov / Dec 2007.
(72) Požiadavku anonymizácie údajov v nadväznosti na ich medzinárodné zdieľanie uviedla vo svojom odporúčaní napríklad European Science Foundation. Pozri European Science Foundation. Investigator-Driven Clinical Trials. Published by the European Science Foundation, March 2009, str. 53



Tento Článok bol publikovaný v Zborníku BIOMEDICÍNSKY VÝSKUM právne, eticky, filozoficky.

Ivan HUMENÍK: Vybrané otázky ochrany súkromia a spracúvania osobných údajov účastníkov klinického skúšania liekov. In Zborník BIOMEDICÍNSKY VÝSKUM právne, eticky, filozofickyr, čísla strán 9 - 38, ISBN:


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