Polish Model of Psychiatric Hospitalisation without a Patient’s Consent

Consent - Lacking Consent

In the beginning, when analysing the psychiatry, it is said that it should be described as one element in the broader medical reality. Standpoints suggesting that psychiatry is “another medical department” exist, what can be found many times. It is certainly a division of special character, requiring close insight and rationality in legal actions. In the Polish legal order, the principle of respecting the patient’s autonomy covers all people treated in all types of hospital wards. Thus, when talking about people who may be treated in the psychiatric hospitals, we should say that the patient’s consent for such a treatment is area of concern [6]. In the Mental Health Protection Act, what is particularly important, the “patient’s consent” term was defined. It is understood as “a freely given consent of a person with mental disorders, who, irrespectively to the mental condition, is actually capable of understanding the information delivered in an accessible manner that concerns the purpose of admitting to the psychiatric hospital, the person’s health state, proposed diagnostic and treatment activities, as well as foreseeable effects for such activities or ways for changing them” [7]. Thus, according to the Stanisław Dąbrowski’s point of view, the sole existence of mental disorders in a patient is not sufficient for the conclusion that such a person is lacking of competences for giving consent. Whereas, the referred author reasonably stipulates, following many years of clinical expertise, that a group of patients exist who do not have critical attitude to own health state. Following similar cases, such people may undertake initiatives dangerous to themselves or other people. When such situation may result from the symptoms of mental disease, opportunity for forced activities towards such a patient exists [8]. When closer insight into such activities is being put aside, it should be emphasised that the Polish “Psychiatric Act” refers to the mixed model of forced activities. It is all about the combination of important legal and medical elements. On the one hand, the legislator has referenced to the fundamental standpoint, namely the principle of respecting human dignity that makes the key law. Such a principle can be observed in the introduction to the Act (in its Preamble), where it is stipulated that the mental health of human being is of special personal interest [9]. The Polish Civil Code enforces automatic protection for such rights [10]. On the other hand, a medical element is also demonstrated here. One factor is crucial, namely the forced treatment is only possible for people in particular clinical states [9]. The Polish Mental Health Protection Act allows for a treatment without consent explicitly in the case of mentally retarded or mentally sick people. The “disease” term demonstrated here is of special interest. In the Bioethics Committee of the European Council document, referred above, it was stipulated that the “mental disease” term is interpreted diversely in various countries [1]. When analysing such a concern, Stanisław Pużyński found that it does not exist in the international classification of diseases. About 20 years ago, the concern stipulated above was elaborated by Stanisław Dąbrowski. He added that the Polish Psychiatric Act, when enabling the forced medical activities, purposefully focuses on the people suffering from psychosis. He stated that only similar conditions may be dangerous for a patient with disabled: conscience, capability of critical thinking, capabilities of making rational decisions and satisfying basic life’s requirements. In such a case, it all comes to doubtful patient’s competences in the area of consent for a treatment [5].

Forced Activities

The Mental Health Protection Act foresees three treatment courses for patients without the granted consent. Each such mode foresees three types of supervision:

• Administrative: made by the head of ward or hospital director,
• Medical: made by a medical examiner or an admitting doctor, as well as a medical expert designated by the court.

• Legal-juridical: made by the guardian court and the Ombudsman for Psychiatric Hospital Patients [11]. The first course can be described as “immediate”. It is stipulated in art. 23 of Act hereto. It is expected that a mentally sick person can be admitted to the psychiatric hospital without a consent (clinical aspect), who is simultaneously dangerous to oneself, or to life and health of other people (behavioural element). Such a person can be examined without consent, even before admitting to the hospital (art. 21 of the Act). In order to facilitate the admission stipulated above, a psychiatrist must examine such a person at territory of hospital: when conditions allow for this, such a decision should be consulted with other psychiatrist. Then hospital authorities are notified, whereas the information about the forced treatment is delivered to the Court generally within 48 hours. What is particularly important, a judge must come to the patient within three days for verification purposes, whether such a patient was admitted to the hospital according to law. Then an independent psychiatrist is designated, who must assess the situation from the medical point of view. After two weeks, a judge decides on future treatment, according to such grounds. In such a period, a patient can be diagnosed or treated [12]. Another requiring description course is psychiatric observation. It was constructed identically to the “immediate” course from the procedural point of view, with exception to the fact, that it can last only 10 days. In such a period, patient cannot take any medicines (art. 33, item 3 of the Act). The purpose of such course is explanation, whether the aggressive or self-endangering behaviour in a patient originates from the existence of mental disease (hallucination or delusions), or it comes from a mental disorder (neurosis, disorder of psychical development or personality disorders) [13]. The last course is described as a “conclusive”. It pertains to the case, when a mentally sick person cannot basically satisfy own life’s requirements. Simultaneously, the deteriorating health state can be observed. It is also assumed, that only hospitalisation can provide help for a patient. In this detailed case, a motion is filed to the court by relatives, what is required. A psychiatrist’s report must be attached to the motion above, who sees the treatment in the psychiatric hospital as mandatory, in relation to the developing disease. When such a motion is received, the court designates an independent psychiatrist, who must assess the patient’s condition. On such grounds, the court decides on future treatment [14].