Lisnecska Natalia

Chairman of the Board

26.10.2021

Today we will discuss the issue of medical information.

What forms of information can a doctor use?

Depending on the characteristics of the patient, the disease and his or her health condition different forms of information shall be used. Four models are widespread abroad:

1. Information (scientific, consumer) model, using which the doctor acts as a competent expert, impartially provides the patient with complete information about the disease, prognosis, treatment methods and explains all the unclear provisions.

The patient makes his own decisions and takes responsibility. The doctor’s task is to skillfully bring him to the right choice. This model preserves the patient’s complete autonomy with a minimal role of the doctor.

2. Interpretive (scientific, consumer) model is close to the previous one, but the doctor is in closer contact with the patient, acts as a counselor, consultant: providing information, he or she patiently with explanations convinces the patient of the correctness of a personal decision. In this case, simultaneously with the observance of the patient’s autonomy, the doctor’s role increases.
3. Advisory model provides for the achievement of mutual agreement during the joint discussion of the patient’s condition, features of diagnostic and therapeutic methods. Thus the doctor acts as the senior friend, the teacher. This model brings the relationship between doctor and patient closer to those sought by the doctor, in compliance with the requirements of medical ethics and deontology, common in domestic medicine. The patient’s autonomy, his independence and at the same time the leading role of the doctor lead to the harmonization of relations.
4. Paternalistic (parental) model is quite common in our practical health care. It contradicts human rights and the patient’s rights, according to which the doctor is obliged to inform the patient, to put his interests above his own, and not to act as a guardian, sometimes a dictator, making decisions or imposing them on the patient. Such a model is justified only in the case of emergency help.

Therefore, the model choice depends on the specific situation and characteristics of the patient, taking into account his competence and character, as well as the possibilities of the medical institution.

What are the legal bases of citizens’ rights to information about their health?

This right, declared in many documents, is most fully set out in the text of the Fundamentals of the legislation of Ukraine on public health. This document states that every citizen has the right to receive information about his or her health in a form accessible to him, if it does not contradict his or her wishes. This information summarizes the examination result, diagnosis, prognosis, treatment methods, risks, consequences, and other information associated with their use.

If a citizen is incapacitated or has not reached the age of 15, this information may be provided to his/her legal representatives. Everyone can get acquainted with the medical documentation and obtain a copy of it, obtain expert advice on their health. It should be noted that information that is a medical secret, in some cases may be provided without the patient’s consent.

Disease information and prognosis in the case of adverse outcome is provided in a delicate form in accordance with the requirements of medical ethics. The choice of information model, as mentioned above, depends on the patient’s competence and other factors. If unwilling, the patient may refuse the information altogether: then it should be recorded in the medical history or medical record and a document of refusal should be signed. However, an attempt to communicate must take place, because the patient as a citizen can perceive important messages for him and make decisions that were previously postponed. Signing a waiver document does not deprive a person of the opportunity to obtain such information in the future.

If the doctor, feeling sorry for the patient’s psyche, decided to inform about the diagnosis relatives or other legal representatives, he should do so only with the patient’s consent, and if it is impossible to obtain it (emergency, severe mental disorder, etc.) – know the patient’s relationship with relatives and be careful .

Unlawful refusal of an official to provide information, if it harmed the legitimate interests of citizens, entails administrative and criminal penalties.

From a legal point of view, the issue of informing citizens about the factors that threaten health is considered completely differently. This includes (in addition to directly medical) information about the environment, technogenic and even economic risks.

How should health information be treated from a legal point of view?

The fundamentals of the legislation of Ukraine on public health provide that every citizen has the right to receive in a form accessible to him/her information about his/her health, examination results, the presence of the disease, his/her diagnosis, prognosis, treatment methods and associated risks, options for medical intervention, their consequences and treatment results. The attending physician, the head of the department or other persons directly involved in the examination and treatment are obliged to inform. In the case of incapacity of a citizen, as well as if the person has not reached 15 years of age, their legal representatives (parents, guardians, etc.) are informed. This right should be considered more widely when adverse industrial or environmental conditions may endanger human health. Officials are obliged to inform the citizen about the facts and circumstances that pose this threat, in accordance with the Fundamentals of the legislation of Ukraine on public health. This document states that it is mandatory to regularly inform the public about the prevalence of socially significant or dangerous environmental diseases and the right to information about factors that affect health. Citizens also have the right to information about the state of the environment and the state of infectious and technogenic safety.

It is important that information about the health of a citizen cannot be provided against his/her will, and in the case of an unfavorable result – provided only in a delicate form. This shows the close connection between the legal relationship and the need to adhere to medical ethics. Family members are provided with information if the citizen does not object or has not appointed a specific person to whom he/she trusts this information.

Physicians and hospital officials should be aware that a citizen has the right to read medical records directly that reflect his or her health. At his/her request, he/she shall be provided with copies of medical documents relating to his/her health, provided that they do not affect the interests of a third party.

The patient’s rights also extend to the right to secrecy of the fact of seeking medical care, as well as to prior notification of his/her voluntary consent to medical intervention or refusal of medical care.

To be continued…