CYIL vol. 8 (2017)

CYIL 8 ȍ2017Ȏ RESTRICTIONS OF PERSONAL FREEDOM IN THE CONTEXT OF PSYCHIATRIC CARE … Regarding protective treatment, the Government stated that the Ministry of Justice established a Working Group on Protective Treatment in 2014 and that appropriate legislative and systemic changes will be prepared. The Group also addressed the problem of expert opinion in the process of extension of protective treatment. 51 However, no change in this respect has been enacted to this day. The Government stressed that the lodging of complaints about a procedure or activity relating to health services is already regulated by the Act on health services. The Ministry of Health will distribute information packs containing information on patient rights and responsibilities to all hospitals where it has not yet been provided. 52 Means of restraint A specific and particularly controversial case of invasion of bodily integrity and restriction on patients’ freedom consists in the use of means of restraint. As the term suggests, the purpose of the means of restraint is limitation of the patient’s free movement in case it would endanger the patient or other persons. Most often, this is used in inpatient psychiatric facilities 53 and sobering-up stations, 54 while other typical usage represents restraining disoriented persons in nursing homes and various social service facilities. 55 The need for the limitation of a patient’s movement may, however, arise in nearly any health care context: for example it may be necessary to immobilize a disturbed patient in the intensive care unit who could otherwise unintentionally rip away the infusion. The use of means of restraint must be understood as a measure of last resort which can only be applied in situations when more moderate measures (such as a verbal reassurance of the patient) do not suffice, while the least restraining means corresponding its intended use must be applied. 56 In the Czech Republic, means of restraint are defined and regulated by the Act on health services. Before the Act on health services came into force on 1 April 2012, there was no 53 For a review of literature concerning the use of means of restraint in psychiatric inpatients in several European, Asian and North American countries see STEWART, Duncan, BOWERS, Len, SIMPSON, Alan, RYAN, Carl, TZIGGILI, Maria, Mechanical restraint of adult psychiatric inpatients: a literature review. Report from the Conflict and Containment Reduction Research Programme City University London. accessed 12 April 2017. 54 As sobering-up stations are very widespread and well-functioning in the Czech Republic, the frequent use of means of restraint can be considered a darker side of their activity. See Public Defender of Rights. Sobering- up stations 2013. accessed 12 April 2017. 55 See GASTMANS, Chris, MILISEN, Koen, Use of physical restraint in nursing homes: clinical-ethical considerations. Journal of Medical Ethics. (2006, Vol. 32, No. 3), p. 148-152. accessed 12 April 2017. For a review of documents with recommendations on physical restraint reduction in nursing homes in several countries see MÖHLER, Ralph, MEYER, Gabriele, Development methods of guidelines and documents with recommendations on physical restraint reduction in nursing homes: a systematic review. BMC Geriatrics. (2015, Vol. 15). accessed 12 April 2017. See also the research on the use of means of restraint in nursing homes in two cantons in Switzerland in HOFMANN, Hedi, SCHORRO, Ewald, HAASTERT, Burkhard, MEYER, Gabriele, Use of physical restraints in nursing homes: a multicentre cross-sectional study. BMC Geriatrics. (2015, Vol. 15). accessed 12 April 2017. 56 Section 39 (2 c) of the Act on health services. 4. 51 Ibid ., p. 27. 52 Ibid ., p. 27.

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