Search

Cel pracy Celem niniejszej pracy oryginalnej jest zaprezentowanie rozbieżności w stosowaniu przepisów prawa na tle obowiązku uzyskania zgody na podjęcie leczenia przez osobę, wobec której wydano postanowienie sądu zawierające zobowiązanie w tym zakresie. Metoda W oparciu o dane za lata 2010-2020, pozyskane ze specjalistycznego podmiotu leczniczego w rodzaju opieka psychiatryczna i leczenie uzależnień, dokonano analizy przypadków zastosowanego wobec pacjentów tego szpitala trybów leczenia odwykowego. Ocenie poddano informacje na temat liczby pacjentów leczących się odwykowo w tym okresie w tym podmiocie leczniczym, porównując liczbę leczonych w oparciu o ich własną zgodę oraz skierowanych do leczenia na mocy postanowienia sądu. Wyniki We wszystkich przypadkach, które oznaczono jako "zrealizowane" poprzez przymusowe doprowadzenie do szpitala, a których liczba wynosi w poszczególnych latach, odpowiednio: 2016 - 407, 2017 - 416, 2018 - 379, 2019 - 412 a w 2020 - 364, zwolnienie pacjenta ze szpitala po zakończonym leczeniu następowało dopiero w oparciu o postanowienie sądu a nie na podstawie jego zgody własnej - wypisu na żądanie. Powyższa analiza wskazuje zatem, że na przestrzeni 5 lat pacjenci w liczbie 1978 nie mogli opuścić szpitala do momentu wydania przez sąd w tej materii stosownego postanowienia. Wnioski Mając na względzie rezultaty wykładni literalnej oraz systemowej przepisów, które regulują zasady wyrażania zgody na czynności medyczne, należy przyjąć, że prawna możliwość egzekwowania nałożonego przez sąd obowiązku leczenia odwykowego po stwierdzeniu w prawem przepisanym trybie, iż zachodzą medyczne oraz społeczne przesłanki jego orzeczenia, może prawnie oraz faktycznie dotyczyć jedynie etapu przyjęcia do stacjonarnego lub niestacjonarnego zakładu leczenia odwykowego.

Zawód psychoonkologa w Polsce nie jest dostatecznie uregulowany prawnie. Aktualnie, według rozporządzenia Ministra Zdrowia w sprawie świadczeń gwarantowanych z zakresu leczenia szpitalnego, psychoonkolog to osoba z wyższym wykształceniem medycznym, tj. absolwent uczelni medycznej, np. lekarz czy pielęgniarka, którzy spełnili dodatkowy warunek ukończenia studiów podyplomowych z psychoonkologii. Jest zatem widoczne, że pozostająca w mocy definicja legalna zawodu psychoonkologa jest niespójna z regulacją tego zawodu obowiązującą od 2018 r., a wynikającą z obwieszczeniu tego samego ministra w systemie Polskiej Ramy Kwalifikacji (PRK). PRK zawęża bowiem grono osób mogących uzyskać kwalifikację z zakresu diagnostyki i pomocy psychoonkologicznej wyłącznie do psychologów i lekarzy psychiatrów, ograniczając tym samym grupę osób uprawnionych do wykonywania zawodu psychoonkologa. Dodatkowy problem prawny wynika z istotnych różnic w charakterze zawodów lekarza i psychologa, z uwagi na nieobowiązywanie w praktyce, mimo formalnego pozostawania w mocy, ustawy o zawodzie psychologa. Nie można wreszcie pomijać okoliczności, że oprócz dwóch wzajemnie sprzecznych regulacji zawodu psychoonkologa na gruncie wskazanych wyżej przepisów (Rozporządzenie MZ i PRK), istnieje jeszcze w Polsce trzecia droga uzyskiwania tzw. certyfikatu psychoonkologa nadawanego przez Polskie Towarzystwo Psychoonkologiczne (PTPO). Obecnie osoby certyfikowane w ramach tej procedury, a poza psychologami i lekarzami certyfikat uzyskiwali też przedstawiciele innych profesji, np. pielęgniarki czy zatrudnieni w hospicjach duchowni, w większości nie będą mogli formalnie wykonywać tego zawodu, ponieważ ustawodawca nie przewidział uznania certyfikatów nadawanych przez PTPO za równoważne z uzyskaniem kwalifikacji psychoonkologicznej w kontekście wskazanych wyżej przepisów.

As the outcome of COVID-19 is associated with oxidative stress, it is highly probable that polymorphisms of genes related to oxidative stress were associated with susceptibility and severity of COVID-19. The aim of the study was to assess the association of glutathione S-transferases (GSTs) gene polymorphisms with COVID-19 severity in previously vaccinated and unvaccinated Polish patients with confirmed SARS-CoV-2 infection. A total of 92 not vaccinated and 84 vaccinated patients hospitalized due to COVID-19 were included. The WHO COVID-19 Clinical Progression Scale was used to assess COVID-19 severity. GSTs genetic polymorphisms were assessed by appropriate PCR methods. Univariable and multivariable analyses were performed, including logistic regression analysis. GSTP1 Ile/Val genotype was found to be associated with a higher risk of developing a severe form of the disease in the population of vaccinated patients with COVID-19 (OR: 2.75; p = 0.0398). No significant association was observed for any of the assessed GST genotypes with COVID-19 disease severity in unvaccinated patients with COVID-19. In this group of patients, BMI > 25 and serum glucose level > 99 mg% statistically significantly increased the odds towards more severe COVID-19. Our results may contribute to further understanding of risk factors of severe COVID-19 and selecting patients in need of strategies focusing on oxidative stress.

Persistent therapy is the continuation of treatment despite having assessed the patient’s clinical condition as showing no prospect of improvement, having exhausted all available treatment options and having found that continued therapy would extend the patient’s suffering with no chance of improvement. Persistent therapy is an exception from the physician’s obligation to provide medical assistance in each case when delay could result in the threat of loss of life, serious bodily injury or serious health disorder. Provisions of Polish law do not provide for any special procedure for consent by an authorized body (e.g. court) for discontinuation of treatment as the result of a finding of no medical indications for its continuation. Accordingly, it rests upon the medical staff to make and implement the decision in this regard. This includes first and foremost making a collective decision, reflecting all circumstances relating to the patient’s clinical condition in the medical records, and giving effect in practice to the patient’s rights — including the right to be informed about the condition of one’s health, to give informed consent to the provision of a medical service, and to die peacefully and with dignity — as appropriate given the patient’s state of consciousness.

Despite the development of medicine, acts of violence against health care professionals, are a current, frequent and widespread phenomenon. In Poland, many health care staff are entitled by law to legal protection provided for public officials. Therefore, criminal offenses against them are more severely punished. In the years 2018-2019, research was carried out on acts of aggression that had been experienced by a group of 249 health care staff in health care facilities in the Świętokrzyskie Voivodeship. Just slightly more than 7.5% of the respondents indicated that they had not experienced aggression, which only confirms the scale of the problem. Therefore, managers of health care facilities should use all possible means to limit the extent of attacks and prevent their possible consequences..

In polish civil litigation procedure the cases concerning medical errors always require an expert opinion in order for the court to assess doctors due diligence. The court does not have specialist knowledge, thus his decision, if not taken on the basis of a specialist opinion, is procedurally incorrect. Expert's opinion can be effectively questioned by each of the parties of the dispute, what may lead to either complementary or further opinion. Every specialist opinion of an expert in civil law disputes concerning medical errors has to meet the requirements of integrity, logic and be comprehensive enough.

In the age of pandemic, health services face even more often tragic and irreconcilable dilemmas. A physician is obliged to provide medical procedure whenever a delay in providing it could cause a risk of loss of life, serious injury or health disorder, and in every other urgent case. However, each medical intervention, although necessary and urgent, may be risky for a patient in the age of pandemic, as a doctor may be potentially infected by SARS-CoV-2 (severe acute respiratory syndrome corona virus 2). While it is widely known medical staff is more likely to be exposed to become a source of infection, the risk related to each medical procedure becomes inevitable. The physicians face a serious dilemma as they are aware they might be infected, not having any symptoms or pending the test results while at the same time the necessity to perform medical procedure might occur live-saving. It seems a physician cannot prematurely resign from medical assistance with reference to a potential infection risk. However, the risk has to be reasonably estimated and responsibly reduced. If the risk of SARS-CoV-2 infection is high enough to exceed potential advantages of the medical intervention, this intervention might occur unjustified. It might not apply to super urgent lifesaving situations in which failure to provide treatment may lead to patient’s death. It is necessary to minimize the risk to achievable level in order to avoid infection.

A doctor may refrain from treatment, unless there is a direct threat to life or sudden health risk. In the event of withdrawal from treatment, the doctor is obliged to inform a patient or his legal representative or actual guardian in advance, and indicate other possibilities to obtain medical procedures from another physician or medical entity. If a physician performs his profession on a contract of employment, he may refrain from treatment only if there are serious reasons, after obtaining a consent of his supervisor. In the event of withdrawal from treatment, a doctor is obliged to justify his decision and record this fact in medical documentation. The provision of the Patients’ Rights Act states that, a patient, his statutory representative or actual guardian have a right to early enough information about the intention to withdraw from treatment as well as a possibility to obtain medical procedures from another physician or medical entity. Similarly, these issues are regulated by the Code of Medical Ethics, which stipulates that in particularly justified cases, a doctor may refrain from treatment, except in urgent cases, however he is obliged to indicate a different possibility to obtain medical help.

The medical secret is one of the most important duties related to the profession. It guarantees confidentiality of patient’s most sensitive data, allows him to build with the doctor a real relationship, based on trust, allows unhampered contacts, excludes third persons from the circle of the interested parties. Medical confidentiality is a significant right of patients, which is protected by law, for breach of which the court can grant a compensation. The disclosure of medical confidentiality may result in a civil liability for a physician who violates protected rights of a patient. Due to the obvious violation of deontological or criminal obligations, the legislator provides ethical liability in the event of an unlawful violation of the obligation of medical confidentiality. All the exceptions to this principle are of high importance as well as the circumstances of the release from medical confidentiality.

In December 2021, the Minister of Health in Poland announced via Twitter that vaccination was not compulsory. Such a message from a public authority, who was to a significant extent responsible for organising the process of preventing and combating the infections caused by the SARS-CoV-2 pandemic, appeared to have a negative impact on the public perception of the role of vaccination in combating this disease. The impossibility of directly enforcing vaccination, in the sense that there is no legal basis for its compulsory administration, should not weaken the sense of obligation towards a socially necessary attitude of vaccination as a means of protecting the population against the disease; this should be promoted by public authorities. An auxiliary role in shaping this type of message should be played by the law of appropriate quality, regulating the rules related to vaccination in a way that encourages citizens’ trust in the state and the law.

The aim of the article is to assess the access to health services in light of European Union regulatory changes, with particular emphasis on cataract procedures implemented in Poland during the years 2015–2017. Statistical data from the National Health Fund for the years 2015–2017 was analyzed by means of statistical description, graphical and table presentation. For parametric queues, a Student's t-test (α = 0.05) was used. For the number of submitted and paid applications under the directive, the linear trend model and the significance of the directional coefficient (α = 0.05) were used. The waiting queue for cataract surgery from the second quarter of 2015 to the fourth quarter of 2016 had an upward trend. In 2017, a drop in the number of waiting patients was observed, with a simultaneous increase in the number of applications submitted under the directive. At the same time, contract growth was observed, which translated into a decrease in the number of patients waiting for surgery in Poland. Nevertheless, no decreasing trend in the number of patients treated under the cross-border directive was observed.

Patients' rights refer to all stages of the process of providing healthcare services and its various aspects, both in terms of the standard of services and the circumstances related to their provision. A patient can enforce financial compensation from a doctor or a medical entity in the event that his or her rights are violated as, regardless of whether or not in connection with this type of violation there has been a mistake understood as a mistake in the medical art.

As errors in medicine occur, it is important to obey all the requirements necessary to avoid the liability for medical damages. Physician’s liability depends on a type of legal relationship within which he acts.

The deficiency of doctors in Poland has recently become a huge problem for our healthcare system. However, this negative phenomenon is a result of a number of factors which have been arising for many years and currently constitute obstacles as well. This deficiency means further complications for the healthcare system, causing a serious threat for the safety of patients and the continuity of the process of health services. Undoubtedly the sources of current crisis can be identifiable, however a remedy is dubious.