CYIL vol. 8 (2017)

PETR ŠUSTEK CYIL 8 ȍ2017Ȏ freedom and autonomy is often restricted, i.e. involuntary hospitalization and the use of means of restraint. These restrictions do not fit within the scope of torture according to its definition in the United Nations Convention against Torture, which has been partly endorsed by the European Court of Human Rights, since there is normally a lack of qualified intention required for an ill-treatment to be considered torture. However, restraining a patient’s freedom may constitute the inhuman or degrading treatment abolished in Article 16 (1) of the Convention against Torture and Article 3 of the European Convention on Human Rights. Neither the United Nations Committee against Torture (CAT) Report from 2012 nor the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) Report from 2015 consider Czech legal regulation of involuntary hospitalization particularly problematic. While the CPT expressed several partial concerns, it did not criticise the functioning of involuntary hospitalization, it did not criticise the system itself or the numbers of patients hospitalized without consent. More general criticism is contained in the CAT Report which denounces a widespread institutionalization of psychiatric patients and recommends a speedy process of deinstitutionalization of psychiatric, health, social and other services for persons with intellectual or psychosocial disabilities to more community-based services and/or affordable housing. The use of means of restraint is subjected to relatively detailed regulation in the Act No. 372/2011 Coll., on health services. In this respect, the CAT is concerned primarily about the use of net-beds and even the prohibited cage-beds and the absence of investigations into the ill-treatment and deaths of institutionalized persons confined to cage and net-beds. The practice of placing patients in net-beds is also strongly criticised in the CPT Report. While challenged by international organizations as well as campaigns of international NGOs, the use of net-beds is supported by a large number of Czech psychiatrists as a relatively moderate measure protecting patients from the need to use of psychotropic medication or other more restrictive means of restraint. The CPT further criticised the frequent lack of adequate supervision over restrained patients by members of the health care staff. Related to this problem was the European Court of Human Rights judgment of 18 October 2012, Bureš v. The Czech Republic , in which the Court found that use of protective straps and leaving Mr. Bureš for several hours without supervision violated Article 3 of the European Convention on Human Rights. The Czech Republic is taking certain measures to comply with the international requirements regarding the protection of human rights of psychiatric patients. Most recently, the amendment of the Act on health services was enacted, strengthening the protection of patients’ freedom in the context of the use of means of restraint. However, this process is very slow and uncertain. Apart from the diversity of expert opinions, the reason behind this reluctance to change the old ways of Czech psychiatry is its poor financing, resulting in an unsatisfactory material state of the field as well as the lack of qualified health care staff. The questions of legal, ethical and financial problems of psychiatry in the Czech Republic need to be addressed together in order to find a suitable and sustainable solution.

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