In the relationship between patients and the medical institution, a variety of relationships arise. In some situations, patients refuse medical intervention. What rights each citizen has, how to correctly refuse medical intervention, in which cases it is impossible to do it - all this is spelled out in detail in Federal Law No. 323 "On the Basics of Protecting the Health of Citizens." The article will examine in more detail who can sign the refusal, in which cases doctors can act without the consent of the patient, and other issues.
Voluntary refusal of medical intervention
Federal law in article 20 describes in detail the categories and groups of people who have the right to refuse medical assistance. The right to refuse is announced by Section 33 of the Law. So, they can sign a waiver:
- Potential patients themselves.
- Legitimate representatives of potential patients.
In the above law, those groups of people are considered in full detail for whom their legal representatives have the right to refuse medical intervention. These categories include:
- Minors up to 15 years of age, drug addicts up to 16 years of age.
- Minors under 18 years of age who need transplantation of tissues and human organs.
- Incapable citizens of the Russian Federation who are not able to independently express their will.
- Juvenile drug-dependent adolescents at the time of the examination or the provision of necessary drug treatment.
Patient Health Protection
In medical practice, there have been cases when legal guardians, signing the refusal of medical intervention, exposed the patient's life to risks that threatened his life, leading to death. To avoid such situations, the Federal Law on the Protection of Citizens' Health clearly defines the criteria that give permission for legal representatives to sign a refusal to intervene by doctors.
If there is a need to sign a refusal of an intervention that may save the patient’s life, legal representatives of the legally incapacitated patient are required to notify the guardianship authorities. As soon as the refusal is executed and signed, immediately the next day the information should reach the appropriate authorities.
Despite the decision made by legal guardians, the treating doctor, in order to save the patient’s life, has the right, in some exceptional cases, to go to court to challenge the refusal.
What can you refuse
Before any medical intervention, the doctor must obtain informed voluntary consent from the patient for any manipulations. This document is signed immediately upon first contact with a medical institution. Despite this, at any stage of treatment, the patient has the right to write a refusal of medical intervention. Paragraphs 9 and 10 of Ministerial Order No. 1177n (on the signing of informed consent) specify that a refusal can be issued in two forms:
- The patient completely refuses any medical services.
- The patient partially refuses any specific medical services.
It should not be forgotten that these provisions apply not only to free medical institutions where all the conditions of the State Guarantees Program are observed, but also to all medical institutions that carry out legal medical practice.
Refusal of medical intervention: sample
Every citizen (patient of a medical institution) has the right to independently decide on the complete or partial refusal of medical intervention in their health.
You have the right to write a refusal from the operation, from a blood transfusion. Choosing a complete refusal to intervene, the citizen actually stops any kind of cooperation with this medical institution. From this moment on, medical staff will not take responsibility for the health and even life of the patient.
Before the patient signs a refusal, the attending physician must inform him in detail about all the possible results and consequences of the decision. On a special form in an accessible form for everyday understanding, all complications, the probability of death, other options for the outcome of the refusal are outlined.
To fill out the refusal, the Ministry developed a special form, where all important provisions are detailed (see the photo for a sample).
By signing this document, patients or their legal representatives should be clearly aware of the likely consequences, complications and possible death.
Failure Registration
Registration of refusal of medical intervention is carried out by compiling a document, the form of which must be provided by employees of the clinic, medical institution. A written refusal is attached to the patient’s medical records.
The right to this refusal is confirmed by Article 33 of the Federal Law "On the Basics of Protecting the Health of Citizens".
Detailed Provisions for giving Informed Voluntary Consent, as well as for refusing to intervene, are specified in Order No. 1177n of the Ministry of Health of the Russian Federation.
The established rules, as well as sample forms, apply specifically to those medical institutions that support the State Guarantee Program. Paid organizations are not participants in this program, they have the right to use their own developed forms. However, they are simply obliged to take into account the provisions of Law No. 323. Any practicing medical organization must comply with Art. 33 "Refusal of medical intervention" and fill out all the necessary documentation.
Impossibility of failure
Good health is the most important indicator of a comfortable life for any person. That is why you need to treat him with special responsibility. Unfortunately, one often has to resort to medical intervention. The best option is when the patient can independently choose a clinic, a doctor who completely trusts his health and even life. But there are times when patients are not able to make independent voluntary decisions.
Law No. 323 sets out in detail situations where refusing medical intervention is simply unacceptable; options and provisions are considered when medical services should and can be provided without signing a consent.
Intervention without patient consent
Article 34 spells out provisions where medical intervention is without the consent of the patient. Hospitalization, isolation, observation or medical examination is allowed in relation to those who suffer from diseases that are dangerous to others, mental disorders that have committed acts dangerous to society.
Also, the patient’s consent is not required in such cases:
- When the patient’s life is at risk, he is in an emergency condition and cannot express his wishes, emergency assistance is needed.
- Emergency assistance is required, but there are no legal representatives nearby.
- In the presence of diseases that endanger the health and life of others. This includes various viral fevers, HIV, hepatitis B, C, diphtheria, leprosy, pediculosis, malaria, genital infections, melioidosis and glanders, tuberculosis, anthrax, plague, cholera.
- Severe, severe mental illness.
- During forensic medical examinations, as well as forensic psychiatric.
- When a person commits a crime.
The decision on any medical intervention without the patient’s open consent is made by the attending doctor or a consultation of doctors. The legislation of the Russian Federation gives it the right. If it is impossible to conduct a consultation, and the treating doctor does not want to take responsibility, the court can decide on the need for intervention.
Paid services provided by medical institutions
In 2012, paid services provided by doctors were legalized. That is why modern clinics offer patients a range of services for a fee. A patient who has concluded a contract for the provision of paid medical services, on the basis of the law, has the right to terminate it at any time. But in this case, the patient must pay the costs incurred by the medical organization at the time of execution of the contract.
If the patient is completely satisfied with the services provided, the contract remains valid, then after a full treatment the medical organization hands out all the documents: a copy of the contract, the doctors’s conclusion, extracts from the provided services.
In any paid clinic, the doctor is obliged to inform patients that under the current Program of state guarantees, services can be provided in the clinic free of charge. Patients should be aware of alternative treatments.
Patients' right to health information - article 31
The Law on the Protection of Citizens' Health gives each patient the right to receive complete information about their own health status. This is prescribed in Section 31 of the Law. Information means information about the presence of the disease, the results of the examination, diagnosis, prognosis, risks associated with treatment, all kinds of intervention options, consequences, as well as treatment results.
Information can be obtained by the patient himself. If the patient is under 15 years old or the citizen is legally incompetent, then the legal representatives have the right to collect information from the attending physician, department head, and other specialists involved in the examination.
Each patient, having familiarized himself with the documents reflecting his state of health, can get advice from other specialists on them. Upon request, a citizen can receive copies of all his medical documents.
All information for health reasons is recorded in medical documentation, is a medical secret and cannot be provided to third parties without the impressive grounds that are prescribed in article 61.
Consent to Intervention - Article 32
The Law on the Protection of Citizens' Health in Article 32 describes the need to collect informed voluntary consent from a patient before any medical intervention.
In cases where the patient is in a state where it is impossible to express his own will, and the intervention is absolutely necessary, the issue is decided at the consultation or directly by the attending physician, after which the officials of the medical institution are notified.
For minors under 15 years of age, as well as incapable citizens, informed consent is signed by their legal representatives. In their absence, the decision is also made by the council or the attending physician.
Important to consider
Having examined the main legislative acts on the refusal of medical intervention, we can draw the main conclusions that the patient has the right to:
- Getting medical care that will be provided to him in any emergency.
- Independent choice of a medical medical institution, as well as the refusal, due to any circumstances, of medical intervention.
- To receive free medical services under the State Guarantee Program and alternative paid services.
Russian citizens, regardless of location, have the right to receive medical care throughout the Russian Federation under the compulsory medical insurance policy.