SCIE,I\TIFIC LE.TTERS OF ACADEMIC SOCIE,TY OF MICHAL BALUDAI{SKY rssr{1338-9432 2014
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SCIE,I\TIFIC LE.TTERSOF ACADEMIC SOCIE,TY OF MICHAL BALUDAI{SKY
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Scientific Lettes ofAcademic Society ofMichal Baludmsta ' Volame 2' No' 6/2014
2. Providing Psychiatric Care on a Voluntary Basis to
the consent of her guardianIn view of the above, it is worth providing some remarks
in order to show the lawfulness of such mechanism of
Drocedure.l. As resards to lesal incapabilitv ofperso4s' -
erti"te :q of tne Civil Code of Ukraine (hereinafter - CC
of Ukraine) provides that an individual may be declared
incompeteni by a court decision if such person due to chronic,
stable mental iisorder is not able to realize the importance of
his or her actions, and (or) control them. Incapable individual
has no right to perform any transaction, that is any action
aimed at acquisition, modification or termination of civil
rights and obligations. The guardian carries out transactions
oi b.hulf and in the interest of an incapable individual(Article 4l of the CC of Ukaine)'
Part I of Article l3 Law of Ukraine "On Psychiatric Care"
realizes this right instead of such person.
2. As reqards to criteria of lawfulness of osvchiatric care
Drovlsl0n.--
f 1
-futt 6 of Article 284 of CC of Ukraine states that
proviiion of psychiatric care to an individual shall be
conducted in accordance with the law.2) According to Article 43 of the Law of Ukraine
"Principles of Ukainian Health Care Legislation" (hereinafter- Princ-iples), informed consent of the patient, in accordance
with erticle 39 of the Principles, is necessary when applying
methods of diagnostics, prophylactics and treatment' For
patients under thi age of 14 years (a minor patient) and the
patient recognized in accordance with the law incapable,
meOicat inteivention is carried out with the consent of their
legal representatives."
3) According to Article 42 of the Principles, medical
intervention - iJttre application of methods of diagnostics,
prevention or treatrnent connected with the influence on the
human body.4) Criteria of lawfulness for consent or refusal to medical
intervention are three necessary components: a) awareness; b)voluntariness; c) competence $, p 2311.
62
5) Projecting the "informed consent" concept to the
sphere ofpsychiatric care, it follows, in particular:' a) Coniemine awareness: according to Article 26
"Information on the mental health of individuals and the
orovision of mental health care" of the Law of Ukaine "On
isychiatric Cate", a psychiatrist is required to explain to the
person who is provided with psychiatric care, taking into
account mental state of this person, in a comprehensive
manner information about this person's state of mental
health, possible prognosis ofthe disease, the use ofdiagnostic
methods and treatmen! alternative methods of heatment'
risks and side effects, conditions, procedures and duration of
psychiatric care, the rights ofthe person under this Law and
ihe possible limitation of these rights in the course of
psycliatric care provision. The right to receive this
information about a minor under 15 and those recognized in
accordance with the law incapable belongs to their legal
representatives. An individual in the course of psychiatric
d" ptotoisiott or hisftrer legal representative has the right to
get acquainted with the history of the disease and other
documents and to receive in writing any decision concerning
psychiatric care that is being provided.Therefore, the right to medical information about the
person recognized incapable, will belong to his or h-er legal
ieoresentative. Similar rules are contained inPart2 of Article
Zg-S of CC of Ukraine and Part 2 of Article 39 of the
Principles, which provides that parents (adoptive parents),
guardians have a right to information about the state ofhealth
ofthe child or person under guardianship.Part 4 of Atti"le 6 of the Convention on Human Rights
and Biomedicine foresees that the representative, the
authority, the person or the body mentioned in paragraphs 2
and 3 above shall be given, under the same conditions, the
information referred to in Article 5. Therefore, the guardian,
since it is mentioned in part 3 of Article 6 of the analysed
Convention shall be entitled to receive in advance adequate
information about the purpose and nature ofthe intervention
as well as about its consequences and risks.
be elucidated separately in this paper.c) Concerning competence: incompetent to consent to
medical care as well as to refuse from it is considered to be a
person recognized incapable according to the law.
In the Civil Code of Ukraine it is stipulated that provision
of health care to an individual who has attained the age of
fourteen, is conducted upon his or her consent (Part 3 of
Article 285 of CC of Ukraine). Competent adult individual,
who understands the significance ofhis or her actions and can
control them, has the right to refuse treatment (Part 4 of
Article 285 of CC of Ukraine). Similar is the rule foreseen in
Part I of Article 43 of the Principles' which foresees that
conceming the patient recognized incapable in accordance
with the law, medical intervention is carried out with the
consent ofhis or her legal representative. A patient who has
acquired full civil capacity and understands the significance
of his or her actions and can control them, has the right to
refuse treatrnent (Part 4 ofArticle 43ofthe Principles)'
Under Part I of Article 13 of the Law of Ukaine "On
Psychiatric Care" person recognized incapable in accordance
with the law, is hospitalized to a psychiatric institution at the
request or with the Consent ofhis ofher guardian' In Part I of
ariicle tg of the Law of Ukraine "On Psychiatric Care" is
stipulated that the discharge of the person voluntarily
hoipitalized to a psychianic institution is made upon a
written request of this person or his/ her legal representative
or according to the decision of a psychiatrist.
Scientific Lettes ofAcademic Society ofMichal Baludmsta ' Volame 2' No' 6/2014
2. Providing Psychiatric Care on a Voluntary Basis to
the consent of her guardianIn view of the above, it is worth providing some remarks
in order to show the lawfulness of such mechanism of
Drocedure.l. As resards to lesal incapabilitv ofperso4s' -
erti"te :q of tne Civil Code of Ukraine (hereinafter - CC
of Ukraine) provides that an individual may be declared
incompeteni by a court decision if such person due to chronic,
stable mental iisorder is not able to realize the importance of
his or her actions, and (or) control them. Incapable individual
has no right to perform any transaction, that is any action
aimed at acquisition, modification or termination of civil
rights and obligations. The guardian carries out transactions
oi b.hulf and in the interest of an incapable individual(Article 4l of the CC of Ukaine)'
Part I of Article l3 Law of Ukraine "On Psychiatric Care"
realizes this right instead of such person.
2. As reqards to criteria of lawfulness of osvchiatric care
Drovlsl0n.-- f 1
-futt 6 of Article 284 of CC of Ukraine states that
proviiion of psychiatric care to an individual shall be
conducted in accordance with the law.2) According to Article 43 of the Law of Ukraine
"Principles of Ukainian Health Care Legislation" (hereinafter- Princ-iples), informed consent of the patient, in accordance
with erticle 39 of the Principles, is necessary when applying
methods of diagnostics, prophylactics and treatment' For
patients under thi age of 14 years (a minor patient) and the
patient recognized in accordance with the law incapable,
meOicat inteivention is carried out with the consent of their
legal representatives." 3) According to Article 42 of the Principles, medical
intervention - iJttre application of methods of diagnostics,
prevention or treatrnent connected with the influence on the
human body.4) Criteria of lawfulness for consent or refusal to medical
intervention are three necessary components: a) awareness; b)
voluntariness; c) competence $, p 2311.
62
5) Projecting the "informed consent" concept to the
sphere ofpsychiatric care, it follows, in particular:' a) Coniemine awareness: according to Article 26
"Information on the mental health of individuals and the
orovision of mental health care" of the Law of Ukaine "On
isychiatric Cate", a psychiatrist is required to explain to the
person who is provided with psychiatric care, taking into
account mental state of this person, in a comprehensive
manner information about this person's state of mental
health, possible prognosis ofthe disease, the use ofdiagnostic
methods and treatmen! alternative methods of heatment'
risks and side effects, conditions, procedures and duration of
psychiatric care, the rights ofthe person under this Law and
ihe possible limitation of these rights in the course of
psycliatric care provision. The right to receive this
information about a minor under 15 and those recognized in
accordance with the law incapable belongs to their legal
representatives. An individual in the course of psychiatric
d" ptotoisiott or hisftrer legal representative has the right to
get acquainted with the history of the disease and other
documents and to receive in writing any decision concerning
psychiatric care that is being provided.Therefore, the right to medical information about the
person recognized incapable, will belong to his or h-er legal
ieoresentative. Similar rules are contained inPart2 of Article
Zg-S of CC of Ukraine and Part 2 of Article 39 of the
Principles, which provides that parents (adoptive parents),
guardians have a right to information about the state ofhealth
ofthe child or person under guardianship.Part 4 of Atti"le 6 of the Convention on Human Rights
and Biomedicine foresees that the representative, the
authority, the person or the body mentioned in paragraphs 2
and 3 above shall be given, under the same conditions, the
information referred to in Article 5. Therefore, the guardian,
since it is mentioned in part 3 of Article 6 of the analysed
Convention shall be entitled to receive in advance adequate
information about the purpose and nature ofthe intervention
as well as about its consequences and risks.
be elucidated separately in this paper.c) Concerning competence: incompetent to consent to
medical care as well as to refuse from it is considered to be a
person recognized incapable according to the law.
In the Civil Code of Ukraine it is stipulated that provision
of health care to an individual who has attained the age of
fourteen, is conducted upon his or her consent (Part 3 of
Article 285 of CC of Ukraine). Competent adult individual,
who understands the significance ofhis or her actions and can
control them, has the right to refuse treatment (Part 4 of
Article 285 of CC of Ukraine). Similar is the rule foreseen in
Part I of Article 43 of the Principles' which foresees that
conceming the patient recognized incapable in accordance
with the law, medical intervention is carried out with the
consent ofhis or her legal representative. A patient who has
acquired full civil capacity and understands the significance
of his or her actions and can control them, has the right to
refuse treatrnent (Part 4 ofArticle 43ofthe Principles)'
Under Part I of Article 13 of the Law of Ukaine "On
Psychiatric Care" person recognized incapable in accordance
with the law, is hospitalized to a psychiatric institution at the
request or with the Consent ofhis ofher guardian' In Part I of
ariicle tg of the Law of Ukraine "On Psychiatric Care" is
stipulated that the discharge of the person voluntarily
hoipitalized to a psychianic institution is made upon a
written request of this person or his/ her legal representative
or according to the decision of a psychiatrist.
Scientific Letters ofAcadernic Society ofMichal Baludansky Volume 2, No. 6/2014
criminal offense (Article 151 of the Criminal Code ofUkraine). This is a tool that serves as a safeguard againstarbitrariness of psychiatrists towards incapable person;
6) during further stay in a psychiatric hospital incapableperson shall be examined by a panel of psychiatrists at leastonce a month in order to decide the necessity for continuationor termination of inpatient psychiatric care provision to suchpersons (Part 2 of Article 15 of Law of Ukraine "OnPsychiatric Care") It appears that the control over thecondition of a person's state is conducted in clearly stipulatedperiods, which prevents maintenance of a person in a facilitywithout good reasons;
7) in case a panel of psychiatrists finds out abusescommitted by the legal representative of the personrecognized as a legally incapable, the owner of a psychiatricinstitution or its authorized body shall notify the guardianshipand custody at the residence ofa person who was hospitalized(Part 3 of Article 15 of the Law of Ukraine "On PsychiatricCare"). The lawmaker provided another mechanism ofcontrol, to which guardianship authority, who is responsiblefor supervision ofguardians is involved (paragraph 1.7 oftheRules of Guardianship and Care, approved by order of theState Committee of Ukraine for Family and Youth, MinistryEducation of Ukraine, Ministry of Health Care of Ukraine,Ministry of Social Policy of Ukraine dated 26May 1999 No.34tr661131188);
8) discharge of a person, who was voluntarilyhospitalized to a psychiatric institution is made upon writtenrequest of the person or a legal representative or on thedecision of a psychiatrist (Part I of Article 18 of the Law ofUkraine "On Psychiatric Care"). Hence, the right to refusefurther treatment, which is realized by a guardian, who iscompetent to conduct this ability, is guaranteed;
9) legal representative may be denied in discharge from apsychiatric institution of a person, who was hospitalized to apsychiatric institution voluntarily,
if the panel of psychiatrists
establishes normative grounds for involuntary hospitalization(Part 2 of Article 18 of the Law of Ukaine "On Psychiatric Care"). In this case, the question concerning involuntaryhospitalization of a person, prolongation of hospitalization anddischarge shall be resolved in accordance with the law regulating the procedure for compulsory psychiatric care provision, and at this stage judicial procedures will be involved.
Taking into account national safeguards we should drawattention to the position of the ECTHR in this respect. In the Decision of "M. v. Ukraine "(2012) [6] ECTHR noted thefollowing "if in-patient psychiatric treatment is voluntary thispresupposes that the patient has the guaranteed right to stop any further ti"eatment and to lecrve the hospital whenever he orshe wishes to do so This
freedom of action is subject to mental health practitioners' authority to refuse to discharge the patient, provided that the relevant compulsory admissionprocedures are immediately applied, following which the person shall be treated as an involuntary patient." (Patagraph7r)
t0) the list of opportunities, belonging to persons whostay in a psychiatric facility is normatively fixed:
I 0.1 . persons, who are provided with psychiatric care havethe right to: a) refuse from psychiatric care, unless itsprovision in a forced manner is provided by law; b)maintenance of a person in a psychiatric hospital shall beconducted only for the time period, which is necessary forexamination and treatment.
10.2 person during their stay in a psychiatric hospitalhave the right to appeal directly to the manager or departmenthead of a psychiatric institution concerning issues connectedwith psychiatric care provision, discharge from a psychiatric institution and observance of the rights under the Law of Ukraine "On Psychiatric Care".
Summing the above mentioned safeguards, it should be
indicated that the lawmaker provided for many guarantees of
64
the rights of incapable persons in the course of provision ofpsychiatric care on a r-olunta4 basis.
3. International and Regional Guarantees of Psychiatr icCare Provision: To the Issue of National LawsHarmonization
l. Declaration of Han'aii II. approved by the GeneralAssembly of the World Psl chiatric Association in Vienn4Austria, on 10th Jull 1993) foresees that no procedure shallbe performed nor treatment gi'r'en against or independent of apatient's ou'n will. unless because of mental illness, thepatient cannot form a judgement as to what is in his or herown best interest and n-ithout which treatment seriousimpairment is likely to occur to the patient or others.(paragraph 5) [1 p. 236 - 237].
2. In the Annex to Principles for the Protection ofPersons with Mental lllness and for the Improvement ofMental Health Care. adopted by the tIN General Assembly(1992), - Principles for the Protection of Persons with MentalIllness and for the Improvement of Mental Health Care -
principle 1l "Consent to Treatment" is foreseen: ll, p.237 -
2stl.2.l.No treatment shall be given to a patient without his
or her informed consent, except as provided for in paragraphs6,7 , 8, 13 and I 5 ofthe present principle. (paragraph 1)
2.2.Treatment may be given to such a patient withouthis or her informed consent if the personal representativeconsents on the patient's behalf.
2.3.All treatment shall be immediately recorded in thepatient's medical records, with an indication of whetherinvoluntary or voluntary.
3. World Psychiatric Association Statement andViewpoints on the Rights and Legal Safeguards of theMentally Ill, adopted by the General Assembly of the WPA atthe VIII World Congress of Psychiatry (1989) U, p. 233 -
2351 provide a number of safeguards among which is 1) thenecessity for the deprivation of liberry shall be reviewed at regular and fixed intervals as prescribed by national law; 2) patients who are deprived oftheir liberfy, shall have the right to a qualified guardian or counsel to protect their interests.
4. In the EctHR iudgement in case of "Stanev v.Bulgaria" (2012) l5l the ECTHR elucidated a comparative-legal analysis of the laws of twenty States Parties to theConvention, which showed that there is no uniform approach in Europe to the question of placement of legallyincapacitated persons in specialised institutions, particularlyas regards the authority competent to order the placement andthe guarantees afforded to the person concerned. (paragraphs9r - 94)
5. In the EctHR judgement in case of "Stanev v.Bulgaria" (2012) t5l three minimum conditions, when beingobserved, a mentally disordered person can be deprived of liberty: firstly, it must be reliably shown that a person is of unsound mind; secondly, the mental disorder must be of a kind or degree warranting compulsory confinement; thirdly,the validity of continued confinement depends upon the persistence of such a disorder.
6. Recommendations No. R(99)4 of the Committee of Ministers of the Council of Europe On Principles Concerningthe Legal Protection of Incapable Adults (1999) [8] fix principles which should be aimed at strengthening nationallaws and practice of the member-states. Among such principles the "Informed Consent" principle is figured out. This principle foresees that in cases where an adult is not in fact capable of giving free and informed consent to a given intervention, the intervention, may nonetheless be carried outprovided that it is for his or her direct benefit, authorizationhas been given by his or her representative or by an authorifyor a person or body provide for by law.
7. Article 26 of the Recommendation
Rec (2004)10 ofthe Committee of Ministers to member states concerning
theprotection of the human rights and dignity of persons with
99
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