Should a doctor stop rendering medical services? Principles of conduct towards patients attempting to commit suicide. Part 1 – The Polish perspective
Justyna Zajdel 1, Radoslaw Zajdel 2, Anna Krakowiak 3 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): ICID: 1041691 Article type: Original article
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.
PMID 23540231 - click here to show this article in PubMed