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Samtycke satt ur spel? En rättslig analys av samtycke och nöd i hälso- och sjukvården

Engström, Ella LU (2024) LAGF03 20242
Department of Law
Faculty of Law
Abstract (Swedish)
I Sverige är den kroppsliga integriteten skyddad både genom regeringsformen
och den europeiska konventionen om skydd för de mänskliga rättigheterna
och de grundläggande friheterna. Inom hälso- och sjukvården konkretiseras
denna rättighet via 4 kap. 2 § patientlagen (2014:821) (PL) som stadgar att
vård enbart får ges med patientens samtycke, om inte annat följer av särskild
lagstiftning. Ett undantag från samtyckeskravet återfinns i 4 kap. 4 § PL, som
föreskriver att patienten ska få den vård som krävs för att avvärja en akut och
allvarlig fara för liv eller hälsa, även om patientens vilja inte kan fastställas
på grund av medvetslöshet eller andra orsaker. 24 kap. 4 § brottsbalken (BrB)
tillämpas subsidiärt i de fall 4... (More)
I Sverige är den kroppsliga integriteten skyddad både genom regeringsformen
och den europeiska konventionen om skydd för de mänskliga rättigheterna
och de grundläggande friheterna. Inom hälso- och sjukvården konkretiseras
denna rättighet via 4 kap. 2 § patientlagen (2014:821) (PL) som stadgar att
vård enbart får ges med patientens samtycke, om inte annat följer av särskild
lagstiftning. Ett undantag från samtyckeskravet återfinns i 4 kap. 4 § PL, som
föreskriver att patienten ska få den vård som krävs för att avvärja en akut och
allvarlig fara för liv eller hälsa, även om patientens vilja inte kan fastställas
på grund av medvetslöshet eller andra orsaker. 24 kap. 4 § brottsbalken (BrB)
tillämpas subsidiärt i de fall 4 kap. 4 § PL inte är tillämplig, exempelvis för
att bereda vård vid mer varaktiga situationer av beslutsoförmåga. Bestämmelsen är en straffrättslig ansvarsfrihetsgrund som kan användas såväl inom som
utom hälso- och sjukvården.

Uppsatsen har till syfte att med hjälp av en rättsdogmatisk metod undersöka
förhållandet mellan patientens negativa självbestämmanderätt i hälso- och
sjukvården och de möjligheter som hälso- och sjukvårdspersonal har att in
gripa i nödsituationer enligt 4 kap. 4 § PL och 24 kap. 4 § BrB. Utöver detta
syftar arbetet till att jämföra bestämmelserna samt utreda potentiella rättssä
kerhetsproblem som kan uppstå vid gränsdragningen dem emellan.

Mina undersökningar visar att både 4 kap. 4 § PL och 24 kap. 4 § BrB är
avsedda att möjliggöra ingripande i akuta sammanhang. 4 kap. 4 § PL är dock
en specialbestämmelse och därmed utformad med hälso- och sjukvården i
åtanke. Bestämmelsen syftar till att skydda patienters liv och hälsa, medan 24
kap. 4 § har ett bredare syfte att skydda både samhället och individer från
skada. I enlighet med principen om lex specialis tillämpas 4 kap. 4 § PL före
24 kap. 4 § BrB när en situation omfattas av båda lagrum.

Jag finner betydande brister i hur hälso- och sjukvårdspersonal tillämpar pa
tientlagen i praktiken, särskilt gällande reglerna om vård i nödsituationer. Ex
empel från forskning och rättsfall belyser problem med informationsplikten
och otydligheter i gränsdragningen mellan bestämmelserna i 4 kap. 2 § och 4
kap. 4 § PL samt mellan 4 kap. 4 § PL och 24 kap. 4 § BrB. Jag reflekterar
kring en revidering som tydliggör innebörden och omfattningen av 4 kap. 2 §
och 4 § i samma lag. Vidare konstaterar jag att 24 kap. 4 § BrB bör behålla
sin generella utformning, då dess flexibla natur är avgörande för att hantera
olika typer av nödsituationer både inom och utom hälso- och sjukvården. (Less)
Abstract
In Sweden, bodily integrity is protected by both the Instrument of Government and the European Convention for the Protection of Human Rights and Fundamental Freedoms. In the context of healthcare, this right is concretized through Chapter 4, Section 2 of the Patient Act (2014:821), which stipulates that care may only be provided with the patient's consent, unless otherwise prescribed by specific legislation. An exception to the consent requirement is found in Chapter 4, Section 4 of the Patient Act, which mandates that necessary care must be provided to avert danger that urgently and seriously threatens a patient's life or health, even if the patient's will cannot be determined due to unconsciousness or other reasons. Chapter 24, Section 4... (More)
In Sweden, bodily integrity is protected by both the Instrument of Government and the European Convention for the Protection of Human Rights and Fundamental Freedoms. In the context of healthcare, this right is concretized through Chapter 4, Section 2 of the Patient Act (2014:821), which stipulates that care may only be provided with the patient's consent, unless otherwise prescribed by specific legislation. An exception to the consent requirement is found in Chapter 4, Section 4 of the Patient Act, which mandates that necessary care must be provided to avert danger that urgently and seriously threatens a patient's life or health, even if the patient's will cannot be determined due to unconsciousness or other reasons. Chapter 24, Section 4 of the Penal Code applies subsidiarily when Chapter 4, Section 4 of the PL is not applicable. This may occur in order to provide care in more pro-longed situations of decision-making incapacity. This provision constitutes a criminal law basis for exemption from liability and can be applied both with-in and outside the healthcare sector.

The purpose of this essay is to examine, using a legal dogmatic method, the relationship between the patient’s negative right to self-determination in healthcare and the opportunities available to healthcare professionals to act in emergencies under Chapter 4, Section 4 of the Patient Act and Chapter 24, Section 4 of the Penal Code. In addition, this work aims to compare the regulations and to investigate potential legal certainty issues that may emerge in defining the boundaries between them.

My findings show that both Chapter 4, Section 4 of the Patient Act and Chapter 24, Section 4 of the Penal Code are intended to enable interventions in emergency situations. However, the former is a special provision specifically adapted to healthcare. Chapter 4, Section 4 of the Patient Act aims to protect patients' lives and health, while Chapter 24, Section 4 of the Penal Code has a broader purpose of protecting both society and individuals from harm. In accordance with the principle of lex specialis, Chapter 4, Section 4 of the Patient Act takes precedence over Chapter 24, Section 4 of the Penal Code when a situation is encompassed by both provisions.

Furthermore, I find significant shortcomings in how healthcare professionals apply the Patient Act in practice, particularly regarding emergency care pro-visions. Examples from research and case law highlight issues with the duty to provide information and ambiguities in the boundaries between Chapter 4, Sections 2 and 4 of the Patient Act, as well as between Chapter 4, Section 4 of the Patient Act and Chapter 24, Section 4 of the Penal Code. I deliberate on a revision that clarifies the meaning and scope of Chapter 4, Section 2 and Section 4 of the Patient Act. Furthermore, I conclude that Chapter 24, Section 4 of the Penal Code should retain its general formulation, as its flexible nature is essential for managing various types of emergencies both with-in and beyond the healthcare context. (Less)
Please use this url to cite or link to this publication:
author
Engström, Ella LU
supervisor
organization
course
LAGF03 20242
year
type
M2 - Bachelor Degree
subject
keywords
Socialrätt, straffrätt, medicinsk rätt
language
Swedish
id
9179813
date added to LUP
2025-03-20 13:57:17
date last changed
2025-03-20 13:57:17
@misc{9179813,
  abstract     = {{In Sweden, bodily integrity is protected by both the Instrument of Government and the European Convention for the Protection of Human Rights and Fundamental Freedoms. In the context of healthcare, this right is concretized through Chapter 4, Section 2 of the Patient Act (2014:821), which stipulates that care may only be provided with the patient's consent, unless otherwise prescribed by specific legislation. An exception to the consent requirement is found in Chapter 4, Section 4 of the Patient Act, which mandates that necessary care must be provided to avert danger that urgently and seriously threatens a patient's life or health, even if the patient's will cannot be determined due to unconsciousness or other reasons. Chapter 24, Section 4 of the Penal Code applies subsidiarily when Chapter 4, Section 4 of the PL is not applicable. This may occur in order to provide care in more pro-longed situations of decision-making incapacity. This provision constitutes a criminal law basis for exemption from liability and can be applied both with-in and outside the healthcare sector.

The purpose of this essay is to examine, using a legal dogmatic method, the relationship between the patient’s negative right to self-determination in healthcare and the opportunities available to healthcare professionals to act in emergencies under Chapter 4, Section 4 of the Patient Act and Chapter 24, Section 4 of the Penal Code. In addition, this work aims to compare the regulations and to investigate potential legal certainty issues that may emerge in defining the boundaries between them.

My findings show that both Chapter 4, Section 4 of the Patient Act and Chapter 24, Section 4 of the Penal Code are intended to enable interventions in emergency situations. However, the former is a special provision specifically adapted to healthcare. Chapter 4, Section 4 of the Patient Act aims to protect patients' lives and health, while Chapter 24, Section 4 of the Penal Code has a broader purpose of protecting both society and individuals from harm. In accordance with the principle of lex specialis, Chapter 4, Section 4 of the Patient Act takes precedence over Chapter 24, Section 4 of the Penal Code when a situation is encompassed by both provisions.

Furthermore, I find significant shortcomings in how healthcare professionals apply the Patient Act in practice, particularly regarding emergency care pro-visions. Examples from research and case law highlight issues with the duty to provide information and ambiguities in the boundaries between Chapter 4, Sections 2 and 4 of the Patient Act, as well as between Chapter 4, Section 4 of the Patient Act and Chapter 24, Section 4 of the Penal Code. I deliberate on a revision that clarifies the meaning and scope of Chapter 4, Section 2 and Section 4 of the Patient Act. Furthermore, I conclude that Chapter 24, Section 4 of the Penal Code should retain its general formulation, as its flexible nature is essential for managing various types of emergencies both with-in and beyond the healthcare context.}},
  author       = {{Engström, Ella}},
  language     = {{swe}},
  note         = {{Student Paper}},
  title        = {{Samtycke satt ur spel? En rättslig analys av samtycke och nöd i hälso- och sjukvården}},
  year         = {{2024}},
}