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Ska de lämnas åt sitt öde? - Att vårda patienter med demens utan samtycke - En komparativ medicinrättslig studie

Andersson, Anna LU (2022) JURM02 20221
Department of Law
Faculty of Law
Abstract
Sweden has an ageing population. A problem which it shares with most other developed countries. As a person age, the risk of developing dementia increase. The ageing population constitutes a major challenge for the health care and social welfare systems.

Health care in Sweden and Norway can, generally, only be provided on voluntary basis. The Instrument of Government in Sweden explicitly prohibits the use of forced bodily interventions by public authorities. Despite this, people suffering with dementia are subject to intrusive coercive measures almost daily. There is no explicit legal support for these measures in Sweden, except for in emergency situations. The supreme court of Sweden has also accepted force as permittable through... (More)
Sweden has an ageing population. A problem which it shares with most other developed countries. As a person age, the risk of developing dementia increase. The ageing population constitutes a major challenge for the health care and social welfare systems.

Health care in Sweden and Norway can, generally, only be provided on voluntary basis. The Instrument of Government in Sweden explicitly prohibits the use of forced bodily interventions by public authorities. Despite this, people suffering with dementia are subject to intrusive coercive measures almost daily. There is no explicit legal support for these measures in Sweden, except for in emergency situations. The supreme court of Sweden has also accepted force as permittable through unwritten rules of social adequacy. In some circumstances dementia patients can be subjected to compulsory psychiatric care through the Compulsory Psychiatric Care Act. This is very much an exception, however.

Norway, on the other hand, has chosen to regulate and permit the use of coercive measures in some situations. The legislation clarifies in which circumstances and how these measures should be taken. It is also possible for patients and their relatives to have the decision to use coercive measures to be reviewed to stop the care.

According to article 2 ECHR member states are obliged to protect the lives of people within its jurisdiction. States have a duty to provide a regulatory framework which functions effectively. States are also obliged to take preventative operational measures to safeguard the right to life. It is unlikely that Norway will receive criticism for its regulatory framework. The Swedish system does not necessarily provoke criticism. However, it is possible to question how effectively the regulatory framework works.
Regarding article 3 and article 8 of the ECHR it is possible to critique the Swedish legislation. Especially regarding article 8. There is a lack of clear and foreseeable legislation which allows coercive measures in this context. As these measures take place without legal support, it should be regarded as a violation of article 8. In Norway there is legislation which permits these measures. As the states are granted a wide margin of appreciation, Norway should be able to avoid criticism if they can argue that there is a pressing social need for the interference.

The thesis ends with a discussion about whether the Swedish system should be reformed. There are grounds to critique the Swedish legislation in several regards, especially in terms of the rule of law and in relation to ECHR. Reformation should therefore be seen as a necessity. The legislation should clarify how people with impaired decision-making abilities should be treated. Similar legislation to the Norwegian, alternatively further investments into education in combination with clearer legislation regarding who should make decisions when a person lacks the ability to make decisions could possibly solve the existing problems. (Less)
Abstract (Swedish)
Sverige och omvärlden står inför en framtid med en åldrande befolkning. Med åldern ökar risken för att drabbas av demenssjukdom. I kombination gör dessa faktorer att antalet personer med demenssjukdomar ökar. Det ställs allt större krav på hälso- och sjukvård och socialtjänst på att de ska möta de utmaningar som denna patientgrupp ställer upp.

Vård ska som huvudregel i så väl Sverige som Norge ges med samtycke.
Påtvingande kroppsliga ingrepp är förbjudna enligt regeringsformen. Trots det utsätts personer med demenssjukdomar dagligen för mer eller mindre ingripande tvångsåtgärder. I Sverige finns det inget uttryckligt stöd för dessa åtgärder i lag. Endast i nödsituationer samt genom oskrivna regler om social adekvans är det i... (More)
Sverige och omvärlden står inför en framtid med en åldrande befolkning. Med åldern ökar risken för att drabbas av demenssjukdom. I kombination gör dessa faktorer att antalet personer med demenssjukdomar ökar. Det ställs allt större krav på hälso- och sjukvård och socialtjänst på att de ska möta de utmaningar som denna patientgrupp ställer upp.

Vård ska som huvudregel i så väl Sverige som Norge ges med samtycke.
Påtvingande kroppsliga ingrepp är förbjudna enligt regeringsformen. Trots det utsätts personer med demenssjukdomar dagligen för mer eller mindre ingripande tvångsåtgärder. I Sverige finns det inget uttryckligt stöd för dessa åtgärder i lag. Endast i nödsituationer samt genom oskrivna regler om social adekvans är det i undantagssituationer tillåtet att använda sig av tvångsåtgärder vid vård av demenspatienter. I situationer där patienten visar upp allvarliga psykiatriska symtom på grund av sin demens kan det vara möjligt att vårda dem enligt LPT, även om det är ett undantag.

Norge har valt att reglera användningen av tvång i situationer där personer som saknar förmåga att samtycka till vård vägrar ta emot vård. Lagen tydliggör i vilka situationer samt hur beslut om sådana åtgärder ska tas. Det finns också en möjlighet för patienter eller närstående till patienten att klaga i flera instanser för att vården ska upphöra.

EKMR artikel 2 ställer upp krav för att skydda liv inom dess jurisdiktion. Det ställs upp krav på att ett effektivt regelverk ska finnas på plats och att preventiva operativa åtgärder ska tas. Norge lär behöva motta någon större kritik för sin lagstiftning. Det svenska systemet lär inte nödvändigtvis väcka kritik. Dock kan man till viss del ifrågasätta hur effektivt systemet faktiskt fungerar.

I förhållande till artikel 3 och artikel 8 i synnerhet är det möjligt att kritisera det svenska regelverket. Det saknas ett tydligt lagstöd för användningen av tvång, något som borde ses som en överträdelse av artikel 8. I Norge å andra sidan finns det lagligt stöd. Tack vare staternas breda tolkningsmarginal lär Norge kunna undgå kritik Norge kan argumentera för att det finns ett trängande socialt behov av insatserna.

Examensarbetet avslutas med en diskussion kring om det svenska systemet borde och kommer reformeras. Det är tydligt att det svenska systemet går att kritisera på flera punkter och att en reform hade varit nödvändig. På något sätt borde lagstiftningen förtydliga hur vuxna personer med nedsatt beslutsförmåga bör hanteras. En lösning som liknar den norska, alternativt bredare satsningar på utbildning och tydligare lagstiftning och ställföreträdare skulle kunna lösa den problematik som finns. (Less)
Please use this url to cite or link to this publication:
author
Andersson, Anna LU
supervisor
organization
alternative title
Should we just leave them be? - Caring for patients with dementia who refuse care - A comparative study in health law
course
JURM02 20221
year
type
H3 - Professional qualifications (4 Years - )
subject
keywords
Komparativ rätt, Medicinsk rätt, Offentlig rätt
language
Swedish
id
9080578
date added to LUP
2022-06-12 15:35:03
date last changed
2022-06-12 15:35:03
@misc{9080578,
  abstract     = {{Sweden has an ageing population. A problem which it shares with most other developed countries. As a person age, the risk of developing dementia increase. The ageing population constitutes a major challenge for the health care and social welfare systems. 

Health care in Sweden and Norway can, generally, only be provided on voluntary basis. The Instrument of Government in Sweden explicitly prohibits the use of forced bodily interventions by public authorities. Despite this, people suffering with dementia are subject to intrusive coercive measures almost daily. There is no explicit legal support for these measures in Sweden, except for in emergency situations. The supreme court of Sweden has also accepted force as permittable through unwritten rules of social adequacy. In some circumstances dementia patients can be subjected to compulsory psychiatric care through the Compulsory Psychiatric Care Act. This is very much an exception, however. 

Norway, on the other hand, has chosen to regulate and permit the use of coercive measures in some situations. The legislation clarifies in which circumstances and how these measures should be taken. It is also possible for patients and their relatives to have the decision to use coercive measures to be reviewed to stop the care. 

According to article 2 ECHR member states are obliged to protect the lives of people within its jurisdiction. States have a duty to provide a regulatory framework which functions effectively. States are also obliged to take preventative operational measures to safeguard the right to life. It is unlikely that Norway will receive criticism for its regulatory framework. The Swedish system does not necessarily provoke criticism. However, it is possible to question how effectively the regulatory framework works. 
Regarding article 3 and article 8 of the ECHR it is possible to critique the Swedish legislation. Especially regarding article 8. There is a lack of clear and foreseeable legislation which allows coercive measures in this context. As these measures take place without legal support, it should be regarded as a violation of article 8. In Norway there is legislation which permits these measures. As the states are granted a wide margin of appreciation, Norway should be able to avoid criticism if they can argue that there is a pressing social need for the interference. 

The thesis ends with a discussion about whether the Swedish system should be reformed. There are grounds to critique the Swedish legislation in several regards, especially in terms of the rule of law and in relation to ECHR. Reformation should therefore be seen as a necessity. The legislation should clarify how people with impaired decision-making abilities should be treated. Similar legislation to the Norwegian, alternatively further investments into education in combination with clearer legislation regarding who should make decisions when a person lacks the ability to make decisions could possibly solve the existing problems.}},
  author       = {{Andersson, Anna}},
  language     = {{swe}},
  note         = {{Student Paper}},
  title        = {{Ska de lämnas åt sitt öde? - Att vårda patienter med demens utan samtycke - En komparativ medicinrättslig studie}},
  year         = {{2022}},
}