Lawlessness in the law

A three-hobby continues to introduce its readers to the problems of modern psychiatry in the future of the situation with all Russian healthcare. In his new article, a psychiatrist, cand. honey. Sciences Emmanuel Lvovich Gushansky talks about what a complex ball of issues is associated with a significant restriction of the rights and capabilities of incompetent people.

Overly , a respected reader sometimes reads the phrase “the court recognized NN as incompetent in the newspapers,” he is unlikely to realize what specifically is talking about and what a wide range of problems is associated with this. Let me remind you that such a decision is made by the court based on the conclusion of a forensic psychiatric examination, which notes that due to a chronic mental disorder (schizophrenia with pronounced personality changes, the consequences of organic defeat of the central nervous system with deep and irreversible violations of the psyche, etc.) or dementia NN cannot understand the significance of its actions and manage them.

The mentally ill people recognized by the court incompetent, they are losing all civil rights, cannot realize their desires, use their property, dispose of their pensions, deposits in a savings bank, enter into any contractual relationship, work to hire temporary or permanent work. They only have access to their physiological departures, since they are implemented within the framework of not civil, but biological laws.

The recognition of a person is incompetent entails the institution of guardianship over him, since incapacity extends to all his civil rights and eliminates their upholding by this person in the manner prescribed by law. Guardians (legal representatives) must fulfill the civil functions lost by them.

At the same time, it very often turns out that guardians do not have sufficient medical knowledge, or an understanding of how to help the sick person fill the opportunities that he has taken away from him. While incompetent people who are deprived of any rights and the ability to defend their interests are completely dependent on their guardians.

In our country, guardians mainly carry out guardianship councils in neuropsychiatric dispensers, which require only reports on the expenditure of the patient’s funds for his needs and are not interested in how the patients lost and compensated by the patient are compensated for, what are the possibilities for their interests are the patients, what are the reserves for their social and household adaptation.

The incompetent do not have the right to appeal to the court to declare them capable, and those who have such a right of guardians and medical institutions do not show any interest in this; The decisions of the courts on the recognition of the patient with incompetent are not revised with the established periodicity.

The story of K., which occurred in 2009, shows what abuse this can lead to.

After a quarrel with his ex -wife (they were divorced, but lived in one apartment), K. was forcibly placed in a psychiatric hospital, where he diagnosed a delusional state due to schizophrenia. The ex -wife appealed to the court with a request to recognize K. as incompetent. In the hospital, before the end of treatment, he was conducted by a forensic psychiatric examination, on the basis of which the court recognized him as incompetent. At the hearing, K. was not present, since experts sent a certificate to the court that K., by mental state, could not be present in court and defend their interests. His son, who was disliked of his father, was appointed guardian K..

Meanwhile, during the treatment, K.'s condition improved, a mental disorder, which was regarded as a delusional, lost its relevance, was questioned by the diagnosis of schizophrenia. Nevertheless, after discharge from the hospital, K. was deprived of the right to work, withdraw money from a savings book, drive his car, make transactions, enter into contractual relations, etc.

He settled with his brother and communicates with his son-Opekun only because of necessity. The guardian and psychiatrists of the PND, “hypnotized” by a psychiatric diagnosis, do not want to go to court to recognize K. by the capable, although they know that he continues to work, drive a car and maintain close relations with another woman.

They may object to me that the case of K. is unique in some way that mistakes are in any business and that most of the legally incompetent persons are in boarding houses or in psychiatric hospitals for a long time, where the main doctors of these institutions perform the duties of guardians under the law. But this all the more excludes the individual approach and the practical replenishment of those lost rights and opportunities that are incompetent persons by law.

Despite the fact that the stay in the team voluntarily or involuntarily encourages these unhappy interaction and participation in elementary joint activities, Russian boarding houses do not have any organs (tips of relatives, elementary forms of self-government of patients, organization of psychologically justified and motivated employment of patients, etc.) that could intensify the social interests of patients. The situation of legally incompetent patients in such institutions is comparable to staying in concentration camps, where the bulk is persons who are deprived of the opportunity to defend their human dignity.

With such legalized lawlessness, in my opinion, the situation stated in clause 7 of Art. 43 of the Federal Law “On the Condition of Medicines”, approved by the President of the Russian Federation on April 12, 2010, according to which, with the consent of their legal representatives (guardians) , “clinical trials of drugs intended for the treatment of mental illnesses recognized as legally incompetent are allowed.”

Such a general situation has a clear corruption component and conflicts with the Helsinki Declaration of the World Medical Association (World Medical Association) with the changes made in 2008 of the General Assembly of this organization. This declaration postulates the exceptional nature of such tests, the possibility of obtaining consent to a test not only from a legal representative, but also from a person recognized as incompetent, the need for objective professional and ethical control.

The very possibility of such an uncontrolled test of psychotropic drugs in persons who are not able to acquire and carry out civilian duties, fulfill them and protect their interests is, in my opinion, gross mockery of defenseless people. This is due to the following circumstances:

1. The guardians (legal representatives) are not entitled to make decisions on testing medicines, since they do not have appropriate knowledge, rights and powers for this.

2. Most people with mental disorders recognized as legally incompetent are in psychiatric hospitals or boarding houses for mentally ill, where the main doctors of these institutions perform the functions of guardians. Under these conditions, pharmacological companies acquire unlimited opportunities for influence (including corruption) on the administration of boarding houses in order to introduce their products and extract profit due to defenseless and disenfranchised patients. The famous Dr. Joseph Mengel from Aushwitz would dream of such opportunities!

3. The results of such testing of drugs should not be used to decide the issue of their widespread use, since the vast majority are incompetent in the vast majority - these are persons with severe and irreversible signs of brain damage, as a result of which their reaction to taking a drug is perverted and should not be taken into account when using such a drug in practice.

In my opinion, the entire system of servicing incompetent in Russia, protecting their interests, creating prospects for restoring legal capacity needs fundamental restructuring. The institution of guardianship should also be changed - perhaps this function should be entrusted to specially trained social and medical workers, and the incapacity for each should be specified by the list of those functions that are not available to this patient.

In this perestroika, it is worth taking into account the experience of Germany, where since 1992, according to the legislation on guardianship, recognition of the legally incompetent has been canceled, guardianship and guardianship have been replaced by the Betruung Institute. The curator appointed with the consent of the serviced must correspond to his fundamental wishes and be in personal contact with the patient. If necessary, the activities of the curator can be supplemented by the services of a person who cares [1].

I am sure that not only the construction of an innovative economy, but also the concern for the weak, the respect of their rights can be the key to the creation of a civilized society in Russia.

1. See the manual “Psychiatry. Psychosomatics. Psychotherapy ”(translation from German. I. Sapozhnikova, E.L. Gushansky, Aletaia, Moscow, 1999, pp. 430-431).