Правовые нормы vs. представления врачей и пациентов о содержании и значении информированного согласия на медицинское вмешательство

Sergei A. Belov; Ekaterina A. Revazova; Ekaterina A. Rudneva

doi:10.21638/spbu14.2021.403

Authors

Sergei A. Belov St. Petersburg State University, 7–9, Universitetskaya nab., St. Petersburg, 199034, Russian Federation https://orcid.org/0000-0003-4935-9658
Ekaterina A. Revazova St. Petersburg State University, 7–9, Universitetskaya nab., St. Petersburg, 199034, Russian Federation; Central Healthcare Directorate, Russian Railways, 27, Mechnikova pr., St. Petersburg, 195271, Russian Federation https://orcid.org/0000-0001-7178-1615
Ekaterina A. Rudneva St. Petersburg State University, 7–9, Universitetskaya nab., St. Petersburg, 199034, Russian Federation; Institute for Linguistic Studies, 9, Tuchkov per., St. Petersburg, 199053, Russian Federation https://orcid.org/0000-0002-3502-4390

DOI:

https://doi.org/10.21638/spbu14.2021.403

Abstract

Informed consent to medical intervention represents the principle of individual autonomy, recognized in Russian law and medical practice nearly 30 years ago, but it is still viewed as controversial and even rejected. The purpose of informed consent is to provide obligatory prior notification about the consequences and risks of a medical procedure to be performed, as well as other possible options of treatment. Based on the results of anthropological and legal studies, the article focuses on issues concerning obtaining informed consent and its interpretations, comparing the meanings attributed to the document by lawyers, government agencies, courts, as well as doctors and patients. The legal nature of the consent consists in expressing a person’s will for medical intervention and his decision which cannot be made by anyone else. The meaning that patients and doctors attribute to informed consent, as shown by results of a survey and interviews, is shifting risks and responsibility for negative consequences from the medical organization to the patient. Stylistic features of the document influence its perception by ordinary citizens, resulting in fear and doubts about the doctor’s qualifications. Russian courts usually follow a formal approach when judging whether the signature reflects the patient’s real expressed will. Failure to understand the meaning of the document being signed, a circumstance that is sometimes cited when justifying an error in a transaction, is usually not recognized as sufficient. Although the document is formulated on behalf of the patient, he receives a ready-made text, containing information of a professional nature. This causes difficulties in the patient’s understanding of the document that has been drawn up on his behalf. However, when a person argues that he signed an informed consent without understanding its content, courts often do not consider his words sufficient, thus failing to stimulate medical organizations to provide a document that is catered to ordinary people’s medical and linguistic competences.

Keywords:

informed consent, medical intervention, court practice, interviews, doctors and patients, language of legal documents, understandability of legal language, difficulties in understanding documents

Downloads

Download data is not yet available.

References

Библиография

Карапетов, Артем Г., ред. 2018. Сделки, представительство, исковая давность: постатейный комментарий к ст. 153–208 Гражданского кодекса РФ. М.: Логос. Дата обращения 10 августа, 2021. https://m-lawbooks.ru/index.php/product/sdelki-predstavitelstvo-iskovaya-davnost-postateynyiykommentariy-k-st-153-208-gk-rf-pod-red-a-g-karapetova.

Кратенко, Максим В. 2008. «Действия по “распоряжению” личными нематериальными благами: понятие, виды и пределы осуществления». Законы России: опыт, анализ, практика 1: 60–65.

Останина, Елена А. 2019. «Право на свое тело: распоряжения в отношении органов, тканей, клеток и эмбрионов с позиций гражданского права». Вестник экономического правосудия Российской Федерации 8: 156–195.

Ревазова, Екатерина А. 2021. «Информированное добровольное согласие на медицинское вмешательство». Мониторинг правоприменения. Санкт-Петербургский государственный университет. Дата обращения 10 августа, 2021. https://pravoprim.spbu.ru/yurisprudentsiya/zashchitaprav-grazhdan/item/504-informirovannoe-dobrovolnoe-soglasie-na-meditsinskoe-vmeshatelstvo.html.

Рудых, Светлана Н., Василий А. Демченко. 2016. «Информированное добровольное согласие пациента на медицинское вмешательство». Деятельность правоохранительных органов в современных условиях: сборник материалов XXI международной научно-практической конференции. В 2 т. Т. 2, 113–118. Иркутск: Восточно-Сибирский институт МВД России.

Русина, Наталья С. 2009. «Правовые проблемы ненадлежащего оформления добровольного информированного согласия пациента на медицинское вмешательство». Актуальные проблемы российского права 3 (12): 146–150.

Старчиков, Михаил Ю. 2019. «Информированное добровольное согласие пациента на медицинское вмешательство: нормативные положения и судебная практика». Гражданин и право 7: 80–87.

Юдин, Егор В. 2021. «Принцип автономии пациента и право на информированное добровольное согласие при оказании медицинской помощи: некоторые правовые и биоэтические аспекты». Вопросы российского и международного права 1А (11): 239–252.

Austin, John L. 1962. How to do things with words: The William James lectures delivered at Harvard University in 1955. Oxford: Clarendon Press.

Brenneis, Donald L. 2006. “Reforming promise”. Documents: Artifacts of modern knowledge, ed. by Annelise Riles, 41–70. Ann Arbor: University of Michigan Press.

Faden, Ruth R., Tom L. Beauchamp, Nancy M. P. King. 1986. A history and theory of informed consent. New York: Oxford University Press.

Harper, Richard. 1998. Inside the IMF: An ethnography of documents, technology and organizational action. New York: Academic.

Hull, Mathew S. 2012a. “Documents and bureaucracy”. The annual review of anthropology 41: 251–267.

Hull, Mathew S. 2012b. Government of paper: The materiality of bureaucracy in urban Pakistan. Los Angeles: University of California Press.

References

Austin, John L. 1962. How to do things with words: The William James lectures delivered at Harvard University in 1955. Oxford: Clarendon Press.

Brenneis, Donald L. 2006. “Reforming promise”. Documents: Artifacts of modern knowledge, ed. by Annelise Riles, 41–70. Ann Arbor: University of Michigan Press.

Faden, Ruth R., Tom L. Beauchamp, Nancy M. P. King. 1986. A history and theory of informed consent. New York: Oxford University Press.

Harper, Richard. 1998. Inside the IMF: An ethnography of documents, technology and organizational action. New York: Academic.

Hull, Mathew S. 2012a. “Documents and bureaucracy”. The annual review of anthropology 41: 251–267.

Hull, Mathew S. 2012b. Government of paper: The materiality of bureaucracy in urban Pakistan. Los Angeles: University of California Press.

Iudin, Egor V. 2021 “The principle of patient autonomy and the right to informed voluntary consent in the provision of medical care: some legal and bioethical aspects”. Voprosy rossiiskogo i mezhdunarodnogo prava 1A (11): 239–252. (In Russian)

Karapetov, Artem G., ed. 2018. Transactions, representation, limitation of actions: article-by-article commentary on Articles 153–208 of the Civil Code of the Russian Federation. Moscow, Logos Publ. Accessed August 10, 2021. https://m-lawbooks.ru/index.php/product/sdelki-predstavitelstvo-iskovaya-davnostpostateynyiy-kommentariy-k-st-153-208-gk-rf-pod-red-a-g-karapetova. (In Russian)

Kratenko, Maksim V. 2008. “Actions ‘disposing’ personal intangible goods: concept, types and limits”. Zakony Rossii: opyt, analiz, praktika 1: 60–65. (In Russian)

Ostanina, Elena A. 2019. “The right to your body: orders regarding organs, tissues, cells, and embryos from the civila law perspective”. Vestnik ekonomicheskogo pravosudiia Rossiiskoi Federatsii 8: 156–195. (In Russian)

Revazova, Ekaterina A. 2021. “Informed voluntary consent to medical intervention”. Monitoring pravoprimeneniia. Sankt-Peterburgskii gosudarstvennyi universitet. Accessed August 10, 2021. https://pravoprim.spbu.ru/yurisprudentsiya/zashchita-prav-grazhdan/item/504-informirovannoe-dobrovolnoe-soglasie-na-meditsinskoe-vmeshatelstvo.html. (In Russian)

Rudykh, Svetlana N., Vasilii A. Demchenko. 2016. “Patient’s informed voluntary consent to medical intervention”. Deiatel’nost’ pravookhranitel’nykh organov v sovremennykh usloviiakh: sbornik materialov XXI mezhdunarodnoi nauchno-prakticheskoi konferentsii. In 2 vols. Vol. 2, 113–118. Irkutsk, Vostochno-Sibirskii institut MVD Rossii Publ. (In Russian)

Rusina, Natalia S. 2009. “Legal issues of improper issuing a patient’s voluntary informed consent to medical intervention”. Aktual’nye problemy rossiiskogo prava 3 (12): 146–150. (In Russian)

Starchikov, Mikhail Iu. 2019. “Patient’s informed voluntary consent to medical intervention: regulations and court practice”. Grazhdanin i pravo 7: 80–87. (In Russian)