AMENDMENT TO THE HEALTH SERVICES ACT OR APPLICATION ISSUES OF EXISTING LEGISLATION (Part Two)
As announced in the previous article, which focused mainly on the excessive administrative burden for health care providers, in this article we will discuss other aspects of the amendment affecting, for example, previously expressed wishes or the use of restraints.
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Use of restraints
The amendment also responds to a still highly debated issue, namely the procedure for notifying the use of restraints in a patient who has been hospitalised on the basis of a consent under section 40(2) of the Health Care Act.
The current legislation stipulates that a health service provider is obliged to notify the competent court of the use of restraints on a patient within 24 hours, regardless of the duration of the restraint. In practice, this causes significant problems when providers themselves either interpret this provision to mean that the court should only be notified if such restraint lasts longer than 24 hours, or that indeed any restraint of a patient for any length of time should be notified to the court. While the second option is in line with the legislation, if all health service providers did so, the competent courts would then do nothing else.
The amendment therefore responds to this situation by providing that health service providers should only notify the court of the use of restraints if such restraints are to last for more than 24 hours. At the same time, however, the right of the patient's legal representative, guardian, persons close to the patient or persons designated by the patient to petition the court to review the admissibility of such restraint, even if the restraint lasts for less than 24 hours, is provided for.
Previously expressed wishes (Section 36 of the Health Care Act)
In previous articles, we have informed you about the form that a previously expressed wish must take, the instructions that must be given by the physician in connection with a previously expressed wish, or in what cases the physician need not or cannot respect a previously expressed wish.
The amendment specifies that, in order for a previously expressed wish to be respected, the patient must be instructed in writing by the attending physician with specialist competence. The current legislation defines quite narrowly that the instruction must be given only by the general practitioner with whom the patient is registered or by another treating physician in the field of health care to which the previously expressed wish relates. The amendment responds, inter alia, to the practice whereby the making of advance directives is very often mediated, in particular by doctors with specialised competence in palliative medicine.
At the same time, the amendment narrows down the cases in which a doctor may not respect a previously expressed wish. According to the amendment, a previously expressed wish may not be respected if its fulfilment could endanger other persons or if it encourages an act that could result in death.
Victims of domestic or sexual violence
At the same time, the amendment takes new account of the special rights of victims of domestic or sexual violence.
According to Section 28(4) of the Health Care Act, in addition to the basic rights of patients under the Health Care Act, these persons should also have the right to request a change of attending health care professional when providing health care services, provided that the current staffing capacity of the provider allows for such a change, the change does not endanger the health or life of the patient and the change does not interfere with the provision of health care services, and they should also have the right to information on available social, psychological and legal assistance.
On the other hand, there is an obligation on the provider to ensure that patients who show signs of domestic or sexual violence are informed about the available social, psychological and legal assistance.
The amendment also introduces comprehensive care centres for children. This health care facility is intended to provide comprehensive support to families with children with severe somatic disabilities or severe somatic chronic illness. The amendment also provides new definitions of hospices, emergency admissions, etc.
The amendment also redefines the conditions for the provision of spiritual care in the health care system, and adds definitions for certain health services such as emergency services, aesthetic medicine procedures and follow-up inpatient care. The amendment does not forget about the evaluation of the quality and safety of health services, patient organisations and others.