Is the patient's consent always needed, or are there situations where the patient's right to decide about his or her he alth is suspended? "The welfare of the sick is the highest law" - in the modern world this maxim has gained a broader meaning, because nowadays the doctor must respect the patient's right to decide about their he alth.

The patient's consent to the procedure or operationis, under Polish law, necessary for the doctor to take action. In our Constitution (art. 41, section 1) you can read that "everyone shall be guaranteed personal inviolability and freedom".

Performing a medical treatment without the consent of the patient or his legal guardian is a punishable offense, which may be prosecuted under Art. 192 of the Criminal Code.

The medical ethics code (art. 15) states that "diagnostic, treatment and preventive procedures require the consent of the patient. If the patient is not able to give informed consent, it should be expressed by his legal representative or the person actually caring for the patient" . Another important document is the Convention for the Protection of Human Rights and Dignity of the Human Being in Relation to the Applications of Biology and Medicine, in which (Article 5, general provisions) we read: "A medical intervention cannot be carried out without the free and informed consent of the subject. the person concerned will receive appropriate information about the purpose and nature of the intervention, as well as its consequences and risks. The person concerned may freely withdraw consent at any time. "

When is the patient's consent to the procedure valid?

Pursuant to the law in force in Poland, consent to treatment will be legally binding only if it is given before an operation is performed or another medical service is provided at a higher risk. Expressing consent after the procedure (the so-called subsequent consent) has no legal force. In order for consent to be respected and considered lawful, it must be expressed by a person authorized to grant it. Giving consent must be the result of the free decision of the person concerned, who knows and understands what he is deciding on and what the consequences of the procedure may be. In addition, consent must be given in the form prescribed by law.

Patient consent: special cases

If patientis a minor (under 18 years of age) or is incapable of expressing consent (e.g. is unconscious), it can be expressed on his behalf by statutory representatives of the patient, i.e. parents, guardians, probation officer or guardianship court. When a person under the age of 16 refuses consent to treatment, but it has been expressed by the legal guardians, the doctor is obliged to provide help. If the patient is over 16 years of age, the so-called double consent - apart from the parent's consent, the person concerned must express it in person. In a situation where he refuses it and the minor's guardians agree to the treatment, a decision of the guardianship court is necessary. In the case of incapacitated, mentally ill or mentally handicapped persons, in addition to the consent of their legal guardians to perform medical activities, the consent of the court may also be required.

Important

Patient consent: oral or written?

In this respect, the law allows for several solutions. In most hospitals, patients sign special forms. But in critical situations, when it is not possible to sign such a document, the patient may consent to the treatment orally or through such behavior that does not raise doubts that he agrees to the proposed treatment. However, for the sake of their own safety, the doctor should obtain the patient's consent before performing surgery or diagnosing the patient with an invasive method. This means that the patient should sign a document that describes the type of surgery and the resulting risks or complications. If the patient is unable to sign, the document should contain the signatures of witnesses - people confirming his will - and a description of the situation that made it impossible to sign the document.

The patient's consent must be informed

Consent to undergo an operation or drug therapy with serious side effects must be fully informed. Moreover, the patient's non-objection cannot be legally understood as consenting, since consent must be related to a specific medical activity. In addition, the receipt of consent from the patient for treatment, which he signs during admission to the hospital, is not tantamount to consenting, for example, to an operation. Informed consent is considered to be the consent signed by the patient after reading what he / she is deciding on, which method of treatment will be used, what are the risks and consequences, and possible complications in carrying out a specific procedure. Information about the procedure should be presented in comprehensible language (it does not have to contain medical details), adjusted to the intellectual level of the patient. If it doesn't,the consent obtained by the doctor may in the future (if the patient suffers a he alth impairment) be considered unexplained consent. This means that, in the light of the law, the doctor performed the procedure without the patient's consent, for which he or she is liable to prosecution.

It is different when, during an operation or any other type of treatment, unforeseen circumstances arise which, if not taken into account, may threaten the patient's life or he alth. For the sake of his well-being, the doctor may - without the patient's formal consent - extend the scope of the operation or include additional diagnostic tests. But he should consult his decision with another specialist in the same field. Information about the change in the scope of the operation is to be recorded in the medical records. The physician must also inform the patient or their legal guardians about it, but if it was possible to foresee the necessity of its extension before the procedure, and the physician did not inform the patient about it, he may be held responsible for carrying out the procedure without the consent of the person concerned.

The patient's consent when life is at risk Without formal consent, the doctor may provide the patient with medical help, subject him to tests only when he or she requires immediate assistance due to his he alth condition, and due to e.g. loss of consciousness due to age whether the disagreement with legal guardians cannot obtain the appropriate consent. When the patient's life is in danger, the doctor can start treatment (e.g., perform an operation, diagnostic tests) without the risk of criminal liability.

Consent for surgery is not required also when waiting for it, i.e. delaying treatment, may endanger the patient's life. The circumstances of such events must be recorded in the medical records. After the procedure or surgery, the doctor must notify the patient's legal guardians or the guardianship court about the procedures or tests performed.

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