RESEARCH PAPER
Should a doctor stop rendering medical services? Principles of conduct towards patients attempting to commit suicide. Part 1 – The Polish perspective
 
More details
Hide details
1
Department of Medical Law, Inter-Department of Human Sciences, Medical University, Lodz, Poland
2
College of Medical Informatics and Statistics, Faculty of Health Sciences, Medical University, Lodz, Poland
3
Division of Toxicology, J. Nofer Institute of Occupational Medicine, Lodz, Poland
 
Ann Agric Environ Med. 2013;20(1):155–160
KEYWORDS
ABSTRACT
Introduction: According to the general idea a doctor can start the medical management process in an adult and not legally incapacitated patient after the patient has given consent to initiate such a process. The patient’s refusal makes rendering medical services impossible, irrespective of their scope and kind. It should be emphasized that such a refusal is respected if it is expressed fully, clearly and consciously. Cases in which such a refusal is expressed by an intoxicated suicidal patient, remaining under the influence of narcotics, drugs or medicaments which characterize with a similar activity should be particularly analysed. Although such a person is able to verbally declare his objection, his ability to process the information given by the doctor before initiating medical procedures is limited, or even non-existant. The refusal therefore cannot be regarded as reliable, which results in rendering medical services to the patient. Materials and methods: An analysis was made of Acts of Law and the opinions of the judiciar by comparing and excluding contradictory and incoherent elements. Results: Despite the lack of clear regulations of a patient rejecting procedures aimed at saving the patient’s life, or the prevention of serious health impairment or sustaining injury, it should be assumed that the objection expressed by the patient who does not demonstrate the ability to process the information provided by the doctor is not reliable, and the doctor is therefore still obliged to render medical services. External factors, such as consumption of alcohol, narcotics and drugs, which characterize with a similar activity impair perception and make the taking of a conscious decision impossible. Not providing medical help and introducing direct compulsion would mean neglecting provision of due diligence in the process of treatment and, as a consequence, placing the patient’s health at risk, and suffering from negative implications for the patient’s life and/or health in the future. Conclusions: Current provisions should directly regulate the negligence of respecting a refusal expressed ‘unconsciously’ by a patient who remains under the influence of alcohol, narcotics, drugs or medicaments which characterize with a similar activity. Moreover, apart from legal provisions, the law providers should consider introducing a direct compulsion in patients who are unable to make a conscious decision in the treatment process.
 
REFERENCES (19)
1.
The Act on Medical Activity, date of issue 15.04.2011, OL 2011 r., nr 112, item 654.
 
2.
The Act on Patient’s Right and Patient’s Right Spokesman, date of issue 6.11.2008; DzU 2009, No. 52, item 417; No. 76, item 641 with futher changes.
 
3.
The Civil Code, date of issue 23.04.1964, OL DzU 1964, No. 6, item 93 with further changes.
 
4.
The Medical and Dental Practitioners Act, date of issue 5.12.1996, uniform text OL 2011, No. 277, item 1694 with further changes.
 
5.
Decision of the Supreme Court, date of issue 27.10.2005, III CK 155/05, OSN Izba Cywilna (Civil Chamber) 2006, Nos. 7-8, item 137.
 
6.
Kapka-Skrzypczak L, Kulpa P, Sawicki K, Cyranka M, Wojtyła A, Kruszewski M. Legal highs – legal aspects and legislative solutions. Ann Agric Environ Med. 2011; 18(2): 304-309.
 
7.
Żukiewicz-Sobczak W, Zwoliński J, Chmielewska-Badora J, Krasowska E, Piątek J, Sobczak P, Wojtyła A, Fornal E, Kuczumow A, Biliński P: Analysis of psychoactive and intoxicating substances in legal highs. Ann Agric Environ Med. 2012; 19(2): 309-314.
 
8.
Decision of the Supreme Court, date of issue 30.04.1976, III CRN 25/76, OSPiKA 1977 r., No. 4, item 78.
 
9.
Decision of the Supreme Court, date of issue 23.11.2007, IV CSK 240/07, OSNC 2009, No. 1, item 16.
 
10.
Zielińska E. Doctor’s duties in case of disagreement on the treatment and in terminal condition patients. Law Med. 2000; 1(5): 82-96 (in Polish).
 
11.
Filar M. Medical treatment in patient incapable to express consent. Law Med. 2003; 11(13): 41-52 (in Polish).
 
12.
Mueller PS. The Terri Schiavo Saga: ethical and legal aspects and implications for clinicians. Pol Arch Med Wewn. 2009; 119(9): 574-81.
 
13.
Cameron S, Carmelle P, Draper B, A test for mental capacity to request assisted suicide. J Med Ethics. 2011; 37: 34-39.
 
14.
The Act on Protection of Psychic Health, date of issue 19.08.1994, OL 1994, No. 111, item 535 with further changes.
 
15.
The Penal Code, date of issue 6.06.1997, OL 1997, No. 88, item 553 with further changes.
 
16.
The Road Traffic Act, date of issue 20.06.1997, uniform text OL 2005, No. 108, item 908 with further changes.
 
17.
Decision of the District Court in Radom, date of issue 15.07.2003, I C 955/98. In: Law and Medicine 2007;2 (27) (in Polish).
 
18.
Decision of the Court of Appeal in Lublin, date of issue 29.09.2005, I ACa 510/05, Law and Medicine 2006; 3(24) (in Polish).
 
19.
Dworkin G. Paternalism [in]: ed, Gorovitz S, Jameton LA, Macklin R, et al. Moral Problems In Medicine, Englewood Cliffs, NJ, Prentice-Hall, 1983: 196-199.
 
eISSN:1898-2263
ISSN:1232-1966