ROZHOVOR S HOSŤOM MESIACA DECEMBER 2013 JUDr. Ivanom Humeníkom, PhD. | Medicínske právo
              

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ROZHOVOR S HOSŤOM MESIACA DECEMBER 2013 JUDr. Ivanom Humeníkom, PhD.


 | 3.12.2013 | komentárov: 364

Prinášame rozhovor s hosťom mesiaca DECEMBER 2013 JUDr. Ivanom Humeníkom, PhD. Ivan Humeník sa dlhodobo orientuje na problematiku medicínskeho práva. Na Právnickej fakulte UPJŠ v Košiciach vedie predmet "Medicínske právo". Okrem akademickej činnosti vykonáva advokátsku prax v advokátskej kancelárii h&h PARTNERS a podieľa sa na činnosti Komory pre medicínske právo - MEDIUS, ktorej vznik spoluinicioval. Je členom Svetovej asociácie pre medicínske právo (WAML), sudcom Rozhodcovského súdu pre medicínske záležitosti a autorom mnohých odborných článkov z oblasti medicínskeho práva. Ivan Humeník je členom redakčnej rady Časopisu zdravotnického práva a bioetiky (MedLaw Journal) vydávaného Ústavom státu a práva Akademie věd ČR, v.v.i. a členom redakčnej rady odborného recenzovaného časopisu Slovenský lekár. Je autorom monografie “Ochrana osobnosti a medicínske právo” a zostaviteľom ďalších publikácií (Biomedicínsky výskum, Aké princípy vládnu zdravotníctvu?). Okrem advokátskej a akademickej činnosti sa venuje vzdelávaniu v oblasti medicínskeho a farmaceutického práva.

Obrazok MEDIUS:  Pán doktor, môžete priblížiť našim čitateľom Vaše profesijné zameranie?

Moje profesijné zaradenie je „hybridné“, ale v podstate ak sa na seba pozriem z nadhľadu, tak v prvom rade pôsobím v advokácii v advokátskej kancelárii h&h PARTNERS, advokátska kancelária s.r.o., ktorej som spoluzakladateľom. Paralelne pôsobím ako vysokoškolský pedagóg na Právnickej fakulte v Košiciach, kde vediem interaktívny predmet Kliniku medicínskeho práva. No a potom som lektorom vzdelávania v medicínskom práve, odborným redaktorom na portáli pravo-medicina.sk, spoluorganizátorom medzinárodných konferencií, autorom, sudcom Rozhodcovského súdu pre medicínske záležitosti. Uf, vyzerá, že je toho veľa, ale v realite sa to všetko dá krásne skĺbiť a ako jeden celok to vytvára ucelený obraz toho, čo mám rád – právo.

MEDIUS: Prečo ste si vybrali práve medicínske právo?

Dávam odpoveď, ako by dali asi mnohí na podobnú otázku: „Neviem“. Je to trochu paradox, že sa dlhodobo venujem tejto oblasti (nakoniec celá advokátska kancelária sa zameriava na medicínske a farmaceutické právo), pretože nikdo z mojej rodiny nie je lekár, jedine moja sestra má ukončené zdravotnícke vzdelanie, ale v tejto oblasti dnes nepôsobí. Asi to bola na začiatku zvláštna súhra náhod, spôsobila to zaujímavá téma diplomovej práce, ktorá odštartovala môj záujem o túto oblasť. No a potom sa to už viezlo. Keď si to tak zrátam, tak je tomu už pomaly 10 rokov počas ktorých sa odborne profilujem v problematike medicínskeho práva. Dnes vidíme, že otázky právnych vzťahov ktoré vznikajú na poli biomedicínskych vied sú dôležité, aktuálne a extrémne zložité. A predovšetkým majú aj na Slovensku veľký potenciál byť riešené – čo je v konečnom dôsledku aj nevyhnutné. Tiež však chcem upozorniť, že medicínske právo ako právne odvetvie na Slovensku nepoznáme, rovnako nemáme žiaden zákon „medicínskeho práva“ na spôsob kodifikovaného právneho odvetvia (napr. ako sú kódexy – občiansky zákonník, trestný zákon a podobne).

MEDIUS: Čím je toto odvetvie práva špecifické?

Multidisciplinárnosťou, extrémnymi situáciami, pohnutými momentmi v živote osôb (subjektov), ktoré vzťahy vytvárajú, intímnou blízkosťou tomu, čo nás definuje ako ľudí – mohli by sme pokračovať ďalej a ďalej. Odpoveď na Vašu otázku záleží vo veľkej miere na človeku, ktorému ju kladiete. Pre mňa je jednoznačne základom a dôvodom, prečo medicína ako veda existuje, samotná existencia človeka. Osoba a jej život/zdravie sú teda hlavným dôvodom vzniku vzťahov, ktorým sa medicínske právo zaoberá. Akonáhle riešite ľudské „osudy“ ide o veľa, ide o človeka ako takého. Medicínske právo je teda pre mňa špecifické tým, že rieši priame alebo nepriame otázky, ktoré sú veľmi intímne späté s ľudskou osobou, a to v celom spektre, ktoré nám môže napadnúť. Ďalším významným znakom je, že reguluje zložitú oblasť bioemedicínskych vied, ktoré sú pre nás právnikov často ako „krajina zázrakov“, ktorej nie vždy rozumieme, a hlavne, ktorú aj keby sme chceli, nevieme právnym jazykom zadefinovať. Kedže my právnici milujeme exaktné definície, je to istým spôsobom frustrujúce a stavia nás to často do polohy štatistov, ktorý až ex post a s výraznou pomocou odborníkov na konkrétnu oblasť medicíny môžu naformulovať právnu úpravu.

MEDIUS:  Medicínske právo sa často redukuje len na „náhrady škody“.  Je to naozaj tak? Aké sú základné oblasti /témy, ktorými sa medicínske právo zaoberá?

Medicínske právo = náhrady škody na zdraví je častá asociácia, s ktorou sa stretávam. Samozrejme, aj tieto témy patria k „medicínskemu právu“, no oblasť záujmu je omnoho širšia a môžeme do nej zaradiť právnu úpravu vzniku a zániku ľudskej bytosti, starostlivosť o zdravie ľudskej bytosti zahŕňajúce časové obdobie od narodenia človeka až po jeho smrť, otázky dispozícií s embryom a ľudským plodom pred narodením a starostlivosť o mŕtve telo, či dispozíciu týmto telom a jeho časťami. Významnú oblasť tvorí úprava vzťahov vznikajúcich pri poskytovaní zdravotnej starostlivosti a pri výkone akýchkoľvek zásahov do telesnej integrity fyzickej osoby, ktorých cieľom je prinavrátenie zdravia, zlepšenie zdravia tejto osoby, resp. embrya/plodu, ktorej je táto osoba nositeľom. S tým sú spojené otázky podmienok poskytovania zdravotnej starostlivosti (podmienky pre poskytovateľov – personálne, technická vybavenosť, používanie liekov a zdr. pomôcok) ako aj otázky vzťahov medzi subjektmi vystupujúcimi v procese poskytovania zdravotnej starostlivosti – pacient, poskytovateľ, poisťovňa, orgány dozoru (napr. Úrad pre dohľad nad zdravotnej starostlivosti, Úrad verejného zdravotníctva, Štátny ústav pre kontrolu liečiv).  K medicínskemu právu môžeme priradiť aj oblasť zdravotníckych pomôcok, výživových doplnkov farmácie, vývoj liekov a ich skúšanie a následnú registráciu. To všetko, čo som spomenul, je predmetom úpravy národných, ale aj európskych predpisov a vo viacerých prípadoch sa jedná o objemné zoznamy konkrétnych právnych predpisov.

MEDIUS: Sleduje vývoj slovenského medicínskeho práva európske trendy?  Ak áno, v čom konkrétne?

Vzhľadom na to, že sme členom EÚ, sme súčasťou tvorby európskej legislatívy, a tým aj adresátom, voči ktorému táto regulácia smeruje. Či chceme alebo nie musíme (na)sledovať európske trendy. To sa prejavuje už posledných desať rokov a najviac výrazné je to práve v oblasti liekov, zdravotníckych pomôcok, migrácie zdravotníckych pracovníkov. Aktuálnou témou je poskytovanie cezhraničnej ambulantnej starosltivosti, ktorú upravuje osobitná smernica a ktorú sme mali povinnosť implementovať do 25.10.2013. Nielen právna úprava, ktorej autorom je EÚ, ale aj dohovory z dielne Rady Európy či OSN pre Slovensko záväzné vo výraznej miere určujú (alebo by mali) kvalitu a obsah právnej úpravy, ktorá sa týka zdravotnej starostlivosti, jej dostupnosti, ochrany zdravotne postihnutých osôb a podobne.

MEDIUS: Za ten čas čo sa venujete medicínskemu právu zaznamenali ste posun či už v oblasti zdravotníckej legislatívy alebo zdravotníckej praxe?

Určite áno, i keď v niektorých oblastiach stále existujú veľké nedostatky. Základný balík zákonov týkajúci sa zdravotnej starostlivosti na Slovensku máme od roku 2004 a podľa môjho názoru nie je zle nakoncipovaný. V koncovke však aj tu nájdeme nedotiahnuté veci alebo rozpory. To sa však dá riešiť za pomoci odborníkov, ktorí však musia mať podporu rezortných orgánov, vlády a parlamentu.  Máme však aj biele miesta na mape legislatívy, spomeňme len absenciu právnej úpravy asistovanej reprodukcie či ústavnoprávne nedostatky v oblasti povinnej vakcinácie.  

MEDIUS: Ako je to s vymožiteľnosťou práv na náhradu škody? Čo všetko je potrebné pre úspech v spore?
 
Náhrada škody na zdraví pacienta je veľmi ťažká téma, ktorá so sebou prináša silné emócie. V prvom rade je dôležité prijať a pochopiť, že zodpovednosť „za niečo“ a „k niekomu“ je prirodzenou súčasťou života spoločnosti, a to bez ohľadu na oblasť vzťahov. Akonáhle vykonávam nejakú činnosť, v nejakej forme a podobe zodpovedám za spôsob jej vykonania alebo aj za jej výsledok. Taktiež si musíme uvedomiť, že nie vždy sa všetko podarí. Akokoľvek sa snažíme urobiť veci na jednotku, sú situácie, kedy nám to proste nevyjde. Medicína a starostlivosť o človeka nie je v tomto kontexte žiadna výnimka. Tieto skutočnosti si musia uvedomiť rovnako zdravotníci a rovnako aj pacienti, a keď sa im to podarí, nemusíme sa báť žiadnej inkvizície, difamácie a križiackych ťažení proti poskytovateľom zdravotnej starostlivosti. Riešenie zodpovednostných následkov je vzťahovým problémom medzi pacientom a poskytovateľom. Z mojich skúseností vyplýva, že eskalácia napätia nastáva, ak jeden z nich popiera akúkoľvek zodpovednosť a druhý formuluje likvidačné nároky. Taktiež sme si počas našej praxe uvedomili, že pacientovi mnohokrát stačí obyčajné „prepáčte, je nám to ľúto“... Riešenie nárokov na náhradu škody na zdraví je náročnou multidisciplinárnou činnosťou, ktorá si vyžaduje vklad právnika orientujúceho sa v problematike a súčasne rovnaký input odborného konzultanta na danú oblasť medicíny. Preukázanie zodpovednosti záleží od špecifík každého prípadu, ťažko by sme hľadali „rovnaké kauzy“, každá z nich je jedinečná ako človek, ktorého sa týka. Pokiaľ v niektorých oblastiach má aj laik šancu na súde uspieť, v týchto prípadoch je to skôr vzácne a intervencia odborne zdatného tímu je naozaj nevyhnutná.


MEDIUS: Kedy má zmysel riešiť „vec“ súdnou cestou? Aké iné možnosti má pacient v dispozícii?

Rád by som povedal, že nikdy, no musím byť realista, niektoré kauzy na súde skončia, akokoľvek sa snažíte tejto fáze vyhnúť.  Slovácko sa jednoducho chce súdiť , čo možno vyznie ako paradox, z môjho pohľadu je to škoda, a to pre obe strany sporu bez ohľadu na jeho výsledok. Spory pri náhrade škody na zdraví majú potenciál pôsobiť stresujúco na obe zainteresované strany. Negatívnym následkom takýchto konaní je strach lekára liečiť, silnejúca úloha defenzivnej medicíny namiesto medicíny zameranej na vyliečenie pacienta. V mnohých prípadoch je spor výsledkom neschopnosti strán hľadať konštruktívne a kompromisné riešenie. Som však optimista a verím, že tento trend je možné postupne meniť.

MEDIUS: Vedeli by ste opísať „ideálne“ právne nastavenie  vzťahu lekár pacient?

Opät spomeniem, že právny vzťah lekár – pacient je a vždy ostane v základe medziľudským vzťahom.  Akonáhle si uvedomíme, čo to znamená, akonáhle vytvoríme podmienky na to, aby lekár viac liečil v osobnom kontakte s pacientom a menej vystupoval v pozícii vypĺňača rôznych "lajstrov", umožníme rozvoj tohto vzťahu správnym smerom. Každý, lekár/zdr. pracovník aj pacient, si musí uvedomovať svoje práva a povinnosti, zdôrazňujem, nielen práva, ale aj povinnosti. Čo by do veľkej miery pomohlo? Vyrovnávanie informačnej asymetrie, vysvetľovanie pacientovi jemu zrozumiteľným jazykom, čo sa s ním deje, čo lekár navrhuje, aké sú s týmto výkonom spojené riziká. Teda vytváranie možnosti pre pacienta prijať slobodné rozhodnutie o tom, čo podstúpi a čo nie. Týmto je možné vnášať do ich vzťahu princíp partnerstva.


MEDIUS: Čo si myslíte, aké nástroje by dokázali posunúť poskytovanie zdravotnej starostlivosti všeobecne a aj po právnej stránke vpred?

Tým, že pôsobím aj na univerzite vidím, v akom stave je vzdelávanie mladých ľudí. Musíme začať naozaj (najneskôr) od univerzít, od lekárskych fakúlt. Chýba mi väčší priestor pre výučbu bioetiky, chýba mi väčší priestor pre výučbu medicínskeho práva pre medikov. Ako môžeme čakať od zdravotníkov, aby rešpektovali práva pacienta a chovali sa k nemu eticky, keď ich málo (či vôbec?) k tomuto vedieme? Ako to môžeme očakávať od zdravotníkov v praxi, keď im zamestnávateľ nevytvára odborné prostredie v podobe možnosti konzultácie etických a právnych otázok? Informácie a vzdelávanie by mohla súčasný stav pomaly zlepšovať. Je potrebné ale pracovať nielen so zdravotníckymi pracovníkmi, ale aj s nami všetkými, ktorí sme pacientmi.

MEDIUS:  V čom, konkrétne, môže podľa Vášho názoru, právne vzdelávanie zlepšiť, tak povediac, život slovenského lekára, sestry, farmaceuta?

Posledné otázky už ani nie sú tak právne a neviem, či sa cítim úplne kompetentný na ne odpovedať. Situáciu môže zlepšiť kultivovaná a neobviňujúca komunikácia medzi všetkými zainteresovanými. Situáciu môže zlepšovať napríklad vzdelávanie, ktoré bude rešpektovať špecifiká zdravotníckeho sektoru a ktoré bude vnášať ľudskoprávny aspekt do výkonu zdravotníckeho povolania. Situáciu určite zlepší, ak prijmeme zodpovednosť a začneme ju vnímať ako štandardnú súčasť výkonu našej profesie. Sú to výzvy pre zdravotníkov, pacientov, tvorcov právnych predpisov ako aj pre tých, ktorí právne predpisy aplikujú v praxi. Takže je to domáca úloha pre nás všetkých...

Ďakujem za rozhovor.

Spracovala: Zuzana Zoláková




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