Patients Rights in Czech Legislation
Information on patients’ rights pursuant to Czech legal regulations
RIGHTS OF THE PATIENT IN RELATION TO TREATMENT:
In relation to treatment, it applies that patients are entitled to being provided medical services on the appropriate professional level pursuant to Section 28, Act No. 372/2011 Coll., on Medical Services. When being provided medical services, the patient is further entitled to:
- be treated with respect, dignity, courtesy and respect of the patient’s privacy when being provided medical services in accordance with the nature of the provided medical services,
- choose a provider authorized to provide medical services that meet the health needs of the patient, and the medical facility, unless this Act or other legal regulations state otherwise - the possibility to choose a provider and medical facility does not relate to things such as medical emergency services, and to the providers to which the provider of the ambulance transports the patient, mandatory isolation, quarantine or protective treatment, etc.,
- request consulting services from a different provider or medical professional than the person who provides the medical services to the insured party; this does not apply during the provision of urgent care, or for persons in custody, imprisoned persons or persons in preventive detention,
- be informed of the internal regulations of the inpatient or single-day care medical care facility
- and further,
- If the persons is a minor, to the continuous presence of a legal representative or person designated by the legal representative, guardian or other person in whose care the patient was entrusted by the decision of a court or other authority.
- To the continuous presence of a legal representative or person designated by the legal representative, if the person is deprived of legal capacity, or is a person with limited legal capacity in such a way that the person is not capable of assessing the provision of health services, or the consequences of their provision,
- The presence of relatives or persons designated by the patient, in accordance with other legal regulations and internal rules, and if the presence of these persons does not disrupt the providing of medical services; this shall not apply for persons in custody, imprisoned or in preventive detention,
- be informed in advance about the price of the provided medical services not covered, or only partially covered by public health insurance, and the manner in which they are to be paid, if the insured party’s health condition allows for it ,
- know the name or names and surnames of medical care workers and other professionals directly involved in the provision of medical services, and persons preparing with the provider to perform medical services who are present when the medical services are provided, or who engage in activities that are part of instruction,
- refuse the presence of persons who are not directly involved in providing of medical services, and persons preparing to perform the occupation of a medical care worker,
- receive visitors in an inpatient or single-day care medical facility with regard to their health condition, and in accordance with internal regulations and in a manner that does not infringe on the rights of other patients, unless this Act or another law states otherwise,
- receive spiritual care and spiritual support at an inpatient or single-day care medical facility from clergy of churches and religious groups registered in Czech Republic, or from persons authorized to perform spiritual activities in accordance with internal regulations in a manner that does not infringe on the rights of other patients, and in view of the of the insured party’s health condition, unless stated otherwise by another legal regulation; a spiritual visit cannot be denied to the patient in cases where the patient’s life is in jeopardy, or in cases of serious injury, unless stated otherwise by another legal regulation,
- to the providing of medical services in an environment that is minimally restrictive while ensuring quality and safety of providing medical services.
RIGHTS OF PATIENTS TO INFORMATION ON HEALTH CONDITION:
The patient is entitled to be informed by the provider in an understandable manner, and to a sufficient extent, about his/her health condition, and about the proposed individual treatment procedure, and of all changes to it. This means providing information on
- the cause and origin of the sickness (if known), its stage and anticipated development,
- the purpose, nature, expected benefits, risks and possible consequences of the proposed health services, including individual medical procedures,
- other options to provide medical services, their relevance, benefits and risks for the patient,
- other necessary treatment,
- lifestyle restrictions and recommendations with regard to health, and
- to waive receiving the health information (Section 32, Act on Health Services), and
- identify persons to whom information should be provided about patient’s health, or who may be informed about the patient’s state of health (Section 32 and Section 33, Act on Health Services) or, conversely, express prohibition on submitting health information to any person (Section 33, Act on Health Services)
Health information is communicated to the patient upon admission to care, and always if it is appropriate when taking into account the provision of health services or health condition of the patient.
The patient, or a person designated by the patient, must be allowed to ask additional questions related to the patient’s medical condition and proposed medical services, and such questions must be answered clearly.
The patient may waive receiving the information about his/her health, or may determine the person to whom it is to be communicated. The record of waiver of receiving the information on health status and determining the persons to whom the health information is to be communicated is part of the medical records of the patient.
FREE AND INFORMED CONSENT OF THE PATIENT WITH TREATMENT:
Medical services may only be provided to a patient with the patient’s free and informed consent, or if such consent can be assumed. The patient must thus have sufficient information in order to be able to make a decision regarding whether he/she will agree with the proposed treatment.
Consent with providing medical services is considered
a) free, if it is given without any pressure,
b) informed, if the patient is provided with information, prior to granting consent about the medical condition of the patient, and about the proposed medical services pursuant to Section 31, Act on Medical Services; consent shall also be considered informed in cases where the patient waived receiving the information pursuant to Section 32, paragraph1.
Despite adequate explanation, the patient may, however, refuse the necessary treatment – in such a case, the attending physician shall request a written statement (so called “revers” – the requirements thereof are set out in the Decree of the Ministry of Health No. 98/2012 Coll., on Healthcare Documentation).
Although no legal regulation stipulates how long the patient should be given to make up his/her mind, the basic rule should be applied that the more complex the treatment is, the longer such time should be. In some cases, the patient’s consent or the consent of his/her legal representative with the performance of treatment must be in writing (i.e. if the requirement of written form of the consent is set out in the Act on Medical Services or if the healthcare facility requested the consent in written form with regard to the nature of the treatment). The requirements regarding the content of the consent with the treatment in writing are stipulated in the Decree on Healthcare Documentation.
A patient may also withdraw his/her consent with the providing of medical services. Withdrawal of consent is not effective if a medical procedure has already begun whose interruption can cause serious injury or threaten the life of the patient.
A patient may in the future be in such a state of health in which he/she will not be able to agree or disagree with the providing of health services, and the manner in which they are provided – the patient may therefore provide such approval or disapproval in advance. This is the so-called institute of "previously-voiced request" pursuant to Section 36, Act on Medical Services. Only such a previously-voiced request will be respected which was made on the basis of a written instruction of the patient about the consequences of his/her decision by a general medical practice physician which whom the patient is registered, or by another attending physician in the field of medical care to which the previously-voiced request relates. The previously-voiced request must be in writing and must be accompanied by an officially certified signature of the patient, and it is valid for 5 years.
Previously-voiced requests that encourage such practices which can result in an active cause of death, or if its fulfilment could endanger others, cannot be respected.
A patient may only be provided emergency care without the patient’s consent, and this applies in cases where the patient is unable to express such consent (which shall not affect the patient’s previously-voiced request), or in the case of treatment of a serious mental disorder, which, if left untreated, could in all likelihood seriously harm the patient. Urgent care without the consent of a legal representative to a minor can be provided for the same reasons, or to a patient deprived of legal capacity, and also in the case of medical services that are necessary to save a life or prevent serious harm to health, or if there is suspected torture, abuse or neglect with regard to the patient.
RIGHT OF A PATIENT TO MEDICAL DOCUMENTATION:
Pursuant to Section 65, Act No. 372/2011 Coll., on Medical Services, in relation to medical documentation, patients are also entitled to:
• be provided with all of the information gathered in the medical documentation kept about the patient, or in other records relating to the state of the patient’s health.
• view the medical documentation in the presence of an employee authorized by the provider
• receive an abstract or copy of the medical documentation. If a patient does not acquire an abstract or copy by his/her own means on location, the provider shall make a copy of the medical documentation. The provider shall make an abstract or copy of the medical documentation within 30 days of being requested to do so. Such a request shall be submitted to the medical facility that keeps the documentation, preferably in writing. The provider may request payment for making an abstract or copy of the medical documentation for an amount that may not exceed the costs relating to the work. The price list for making an abstract or copy of the medical documentation must be located at a place that is publically-accessible to patients.
• determine a person who may view the medical documentation and acquire abstracts or copies of it. The legal representative of the patient may also determine such a person.
The patient or the patient’s legal representative shall be advised on the above rights by the attending physician.
RIGHT TO INFORMATION ON THE MEDICAL CONDITION OF A DECEASED PATIENT:
Persons closely related to the deceased patient, unless the patient determined otherwise when living, or other persons, if any, the patient may have indicated as persons who may be informed of his/her state of health have the right to be informed of the state of health of a patient who died, on the causes of death and results of autopsy, if any, the right to inspect in the presence of healthcare personnel the healthcare documentation or any other records related to the patient’s state of health, and to make extracts or copies of such documents. If during his/her lifetime a deceased patient prohibited the sharing of information on his/her health condition to certain people close to the patient, such information may only be given to such persons if it is in the interest of protecting their health, or the health of other persons, and only in the necessary scope.
CODE OF ETHICS FOR THE RIGHTS OF PATIENTS:
Last but not least, the Central Ethics Committee of the Ministry of Health of the Czech Republic prepared and adopted the patient rights codex, so called Ethic Codex of Patient Rights, declared valid as of 25 February 1992:
• The patient has a right to considerate professional healthcare provided with understanding by qualified personnel.
• The patient has a right to know the name of the physician and other healthcare personnel providing care. He/she has a right to request privacy and reasonable services available within the institution as well as the possibility to be in contact with the family members or friends on a daily basis. These visiting options (i.e. continuous) may only be limited due to serious reasons.
• The patient has a right to receive from his/her physician any data necessary to make an informed decision on consent prior to the commencement of each further new diagnostic or therapeutic procedure. Except in cases of emergency, the patient should be adequately informed of any possible risks connected to the mentioned procedure. If there are multiple alternative procedures or if the patient requires information on treatment options, he/she is entitled to be advised of them. The patient also has a right to know the names of the persons involved.
• The patient has, in the extent permissible by law, a right to refuse treatment and at the same time he/she should be informed of the consequences of such a decision for his/her health.
• During both outpatient and inpatient examination, assistance and treatment, the patient has a right to maximum consideration being given to his/her privacy and decency in relation to the scheduled treatment. Case analyses, consultations and treatment are private and must be conducted in a discrete manner. The presence of persons not directly involved in the treatment must be approved by the patient, even in faculty facilities, unless the patient has chosen such persons him/herself.
• The patient has a right to expect that all reports and records related to his/her treatment are treated as confidential. The protection of information on the patient must also be ensured in cases of computer processing.
• The patient has a right to expect that the hospital must, as possible, reasonably comply with the patient’s requests for the provision of care in an extent corresponding to the nature of his/her illness. If necessary, the patient may be handed over or transferred to another healthcare institution after being provided with a complete justification and information on the necessity of such transfer and other existing options. The institution receiving the patient in its care must approve the transfer in advance.
• The patient has a right to expect that his/her treatment will be conducted with reasonable continuity. He/she is entitled to know in advance what physicians are available to him/her, at what attendance hours and where. Following the release, the patient has a right to expect that the hospital determines the procedure for his/her attending physician to continue providing information on further care.
• The patient has a right to detailed explanation comprehensible to him/her in case the physician decided to apply a non-standard procedure or an experiment. The patient’s conscious consent in writing is a prerequisite to the commencement of both non-therapeutic and therapeutic research. The patient may, at any time and without stating the reason, withdraw from any experiment after having been advised of any possible consequences of such a decision for his/her health.
• The patient at the end of his/her life has a right to sensitive care of all healthcare personnel who must respect his/her wishes unless these are in conflict with applicable law.
• The patient has a right and an obligation to know and comply with the valid regulations of the healthcare facility providing treatment to him/her (so called hospital regulations). The patient has a right to check his/her bill and request an explanation of the items on the bill, regardless of who pays the bill.