Source: http://alzheimer-europe.org/Policy-in-Practice2/Country-comparisons/2009-Healthcare-and-decision-making-in-dementia/Hungary
Timestamp: 2017-02-23 04:52:38
Document Index: 621539147

Matched Legal Cases: ['§15', '§16', '§16', '§17', '§20', '§21', '§21', '§15', '§20']

Hungary - 2009: Healthcare and decision-making in dementia - Country comparisons - Policy in Practice - Alzheimer Europe
2009: Healthcare and decision-making in dementia Hungary
2009: Healthcare and decision-making in dementia ConsentIn the following sections on consent and information, the information is taken from CLIV Act of 1997 on the Health Care Act.Consent to medical treatmentExcept in special cases defined by law, a medical intervention can only be carried out if the patient has given his/her consent based on receipt of the relevant information and without having been misled, threatened or coerced (§15 (3)). This can be given orally, in writing or in another form unless stated otherwise in the Health Care Act. The information shall be individualized. If a person with incapacity does not have an appointed representative (please see below for details), the right to give or refuse consent and to be informed is given to the patient’s legal representative. If he/she does not have one, the right is given to one of the person’s relatives in order of importance, as mentioned in §16 (2) of the same law. In decisions relating to the treatment of a person who is incapable or has limited capacity, his/her opinions must be considered even if he/she does not have the right to give or refuse consent (§16 (5)).Appointment of a healthcare proxyA person with active legal capacity can appoint another person with active legal capacity to give or refuse consent on his/her behalf. The appointed person must receive the same information as the person would have received. It is also possible for a person with active legal capacity to specify which people should not be granted the right to give or refuse consent or recieve information on his/her behalf (e.g. in case of future incapacity). Consent in case of emergency The consent of a patient with incapacity can be substituted by an expert assessment if obtaining consent from the appointed representative would cause delay. In the case of invasive interventions, the same principle applies with the further condition that any delay would cause serious or permanent harm to the patient’s health (§17).The right to refuse treatmentFor people with capacityEveryone has the right to refuse treatment unless doing so would endanger the lives or physical safety of other people. However, if the refusal of treatment is likely to result in serious or permanent harm to the patient’s health condition, it must be made in an official or private document “with full authenticity”. These documents are regulated in the third Act of 1952 on Civil Procedure.The right to refuse life saving or life sustaining treatment is restricted to patients suffering from a severe disease which in the opinion of medical science is likely to cause death in the not too distant future and which even with the appropriate medical treatment is not curable (§20). The refusal is only valid if a medical committee examines the patient and reports unanimously in written form that the patient made his/her decision in full awareness of the consequences and that the conditions governing the exercise of this right have been met. The committee is made up of the patient’s attending physician, another doctor from the same field not involved in the treatment and a psychiatrist.Attempts must be made to identify in private conversation the reasons behind the patient’s refusal of treatment mentioned in the two previous paragraphs and to try to change it. During this conversation and in addition to the standard requirements for the provision of information, patients must be informed of the consequences of such refusal. They can withdraw their refusal at any time without any formal obligations.For people with incapacityA person with incapacity does not have the right to refuse treatment which is likely to result in serious or permanent harm to his/her health (§21.1).If the patient with diminished or precluded legal capacity refuses life-saving or life-sustaining treatment, the health care institution must file an action for consent from the court (i.e. to override the refusal). Until a court judgement has been made, the doctor must continue the treatment. In a direct life threatening situation, consent from the court for the necessary intervention is not required (§21(2)). The right to withdraw consent Consent can be withdrawn at any time. If the patient has no substantial reason for withdrawing consent, he/she may be obliged to cover any justifiable resulting expenses (§15(6)).Consent to non-conventional treatmentNo special rules are applicable. Consent to the donation of organs and/or human tissueWritten consent is required for the removal, during an intervention, of any living cell, plasma, tissue or organs for use other than that related to the person’s treatment. Patients have the right to make arrangements for the use of their body after their death. They can also refuse the post morten removal of organs and body tissue for use in transplantation or other treatment, as well as for studying and teaching purposes (§20). If no statement is made concerning the post-mortem removal of organs, it is presumed that the person consented.Consent to research and clinical trialsInformed consent is required for participation in research activities (European Commission, 2006). Advance directiveThe legal status of advance directives Article 22 covers the right for a person with active legal capacity to make an advance statement of refusal of life-saving and life-sustaining interventions if he or she suffers from an incurable illness and due to this illness is unable to physically take care of him/herself or if the suffering of the patient cannot be alleviated with drugs. The patient can also appoint another person with active legal capacity to refuse life-saving and life-sustaining treatment subject to the same conditions. Conditions surrounding the writing, validity and registering of an advance directiveTo write an advance directive, a person must have “full disposing capacity”. The advance directive must be in the form of notarial document. In order to be considered valid, a board-certified psychiatrist must have confirmed in a medical opinion, given not more than a month earlier, that the person had made the decision in full awareness of its consequences. If a person is unable to write, the advance directive must be made in the presence of two witnesses who should also sign the document.What an advance directive can coverAn advance directive can cover: the refusal of specific forms of treatment. life-supporting or life-saving interventions may be refused if the patient suffers from a serious illness which, according to the current state of medical science, will lead to death within a short period of time even with adequate health care, and is incurable. certain life-supporting or life-saving interventions may be refused if a person has an incurable disease and as a consequence of the disease is unable to care for him/herself physically or suffers pain that cannot be eased with appropriate therapy.