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Cilvēktiesībās balstīta pieeja pacientu ar garīga rakstura traucējumiem un ierobežotu lemtspēju ārstēšanā: tiesiskā, ētiskā un klīniskā perspektīva


Projekta nosaukums latviski: Cilvēktiesībās balstīta pieeja pacientu ar garīga rakstura traucējumiem un ierobežotu lemtspēju ārstēšanā: tiesiskā, ētiskā un klīniskā perspektīva

Projekta nosaukums angliski: Towards a human rights approach for mental health patients with a limited capacity: a legal, ethical and clinical perspective

Projekta numurs:  lzp-2020/1-0397

Projekta īstenotājs: Latvijas Universitāte (LU)

Projekta vadītājs: Solvita Olsena (LU)

Projekta īstenošanas vadošā struktūrvienība LU ir Medicīnas fakultāte

Projekta īstenošanas periods: 01.01.2021. – 31.12.2024.

Projekta kopējais finansējums: 296 844 EUR

Informācija par projektu

Projekta mērķis ir pētīt cilvēktiesībās balstītas pieejas lemtspējā ierobežotu pacientu ar garīga rakstura traucējumiem tiesību aizsardzības tiesiskās, bioētiskās un klīniskās iespējas un izaicinājumus. Projektā tiek piedāvāts: 1) pētīt gan esošo lemtspējā ierobežotu pacientu ar garīga rakstura traucējumiem tiesību aizsardzības regulējumu, gan tiesību piemērošanas praksi iestādēs un tiesās; 2) pētīt ne tikai lemtspējā ierobežotu pacientu daudzumu psihiatriska profila ārstniecības iestādēs, bet arī šo pacientu lemtspēju raksturojošos rādītājus un vajadzības; 3) pētīt veselības aprūpes un tiesību aizsardzības speciālistu viedokļus pētāmajā jomā. Pētnieki piedāvā apkopot jaunākās tiesību, bioētikas un klīniskās medicīnas zinātņu atziņas attiecībā uz lemtspējā ierobežotu pacientu aizsardzības iespējām, kā arī vērtēt to piemērošanas iespējas gan nacionālā, gan pārrobežu kontekstā.

Pētījumā iegūtie empīriskie un teorētiskie dati ļaus izstrādāt tiesiski, ētiski un klīniski integrētu inovatīvu risinājumu, proti, cilvēktiesībās balstītu pieeju lemtspējā ierobežotu pacientu ar garīga rakstura traucējumiem aizsardzībai un ārstēšanai. Projekta pētnieki izstrādās 1 doktora disertāciju, publicēs 4 zinātniskus rakstu un vairākus populārzinātniskus rakstus. Projekta ietvaros notiks pasākumi, kas veicinās gan sabiedrības, gan medicīnas un tiesību speciālistu kompetenci lemtspējā ierobežotu pacientu cilvēktiesību aizsardzības jomā.

 

Projektā paveiktais:

  1. Kadile L. Health Care Decisions in Social Care Settings: General Regulation and Interpretation in CPT’s Jurisprudence, Medicine, Law & Society, Vol 16, No. 1, pp. 1- 24, April, 2023. https://doi.org/10.18690/mls.16.1.1-24.2023 (WoS, OA).

  2. Iesniegta: Olsena S., Fausch I., Amos M. (2025) “A comparative analysis of the decision-making rights of patients with limited capabilities in healthcare and mental healthcare in Estonia, Latvia and Lithuania”. European Journal of Health Law (WoS, Scopus, OA).

  3. Iesniegta: Olsena S., Amos M., Ratniks A. “Legal barriers to ensuring the rights of cross-border acute mental health patients in the European Union. Implementation challenges in Estonia and Latvia” the European Journal of Health Law (WoS, Scopus, OA).

  4. Publikācijas projekts tuvākajā laikā tiks pabeigts un iesniegts: Stars I., Konstantinova K., Rozenberga E., Olsena S. (2025) ‘Patients', relatives' and clinicians' perceptions of decision-making in Latvian psychiatric hospitals and outpatient clinics: a triadic perspective’. Journal Healthcare, the Special Issue on "Evaluation and Potential of Effective Decision-Making in Healthcare", (WoS, Scopus, OA).

  1. Loseviča, M., & Kadile, L. (2023) “Healthcare Quality Indicators as a Tool for Safeguarding Patients with Limited Capacity and Physician Rights. Medical Sciences Forum, 19(1), 11. https://doi.org/10.3390/msf2023019011 (EBSCO, OA)

  2. Olsena S., Kadile L. (2022) “From Legal Capacity to Act to Decision Making Capacity in Latvian Patients’ Rights Law”. New Legal Reality: Challenges and Perspectives. I. Collection of research papers in conjunction with the 8th International Scientific Conference of the Faculty of Law of the University of Latvia, 21–22 October 2021, Riga: University of Latvia Press, 2022 P.114 -122. https://doi.org/10.22364/iscflul.8.1.09

  3. Olsena S. (2022) Rights of adults with limited decision-making capacity in administrative procedure. The Constitution of the Republic of Latvia – 100. Collection of research papers of the 80th International Scientific Conference of the University of Latvia. Rīga: LU Akadēmiskais apgāds, 2022, p. 400-408, https://doi.org/10.22364/juzk.80.43

  4. Losevich, M., & Konstantinova, K. (2024). The Exercise of Public Health Powers in Mental Healthcare – the Impact on Public Safety. Society. Integration. Education. Proceedings of the International Scientific Conference, p. 649-667. https://doi.org/10.17770/sie2024vol2.7851

  5. Kadile L. Improvement of the Process of Assessing the Patient’s Decision-Making Capacity in Latvia: Legal, Ethical and Clinical Perspective: doctoral thesis (Ph.D.). Riga, 2023. Available: dspace.lu.lv/dspace/bitstream/handle/7/63047/298-95369-Kadile_Laura_lk14053.pdf

Zinātnisku rakstu krājuma “Cilvēktiesības balstīta pieeja garīgās veselības aprūpei Latvijā”. Olsenas S., Šābertes L. Potaičuka A. zin.red. Manuskripts ir sagatavots un iesniegts Latvijas Universitātes Apgādam. Tiks publicēts 2025.gadā. 

  1. Olsena S. (2021)“ConstitutionalLawFrameworkfor Building a HumanRightsBasedApproach to Mental Health Carein Latvia”.The International Scientific Conference on Medicineatthe 79th InternationalScientificConferenceoftheUniversityof Latvia, Riga, Latvia. Medicina,  Volume 57(1), 2021, p. 6.

  2. Kadile L.(2021). “Ability to understandorcontrolactionsas a preconditionforcapacityassessmentinhealthcare”. International Scientific Conference on Medicineatthe 79th InternationalScientificConferenceoftheUniversityof Latvia, Riga, Latvia. Medicina,  Volume 57(1), 2021, p. 65.

  3. Kadile L. (2021) “The meaning of the expression of intent in legal transactions”. 79th Annual International Conference of the University of Latvia, Riga (Latvia), session “Civil law in times of changing circumstances”, February 2021.

  4. Olsena S., Loseviča M. (2022)“Application of Informed Consent Waiver for Involvement of Persons with Limited Capacity in Clinical Research”.International Scientific Conference on Medicinewithinthe 80th InternationalScientificConferenceoftheUniversityof Latvia.Medicina, Volume 58 (1), 2022, p. 87

  5.  Kadile L. (2022) “Legal Nature of Agreements in Health Care, International Scientific Conference on Medicinewithinthe 80th InternationalScientificConferenceoftheUniversityof Latvia”. Medicina, Volume 58 (1), 2022, p. 86.

  6. Konstantinova K. (2022) “Indications for Medical Treatment Without Consent – Opinions of Medical Practitioners”.International Scientific Conference on Medicinewithinthe 80th InternationalScientificConferenceoftheUniversityof Latvia.Medicina, Volume 58 (1), 2022, p. 118

  7. Kadile L.  (2022) “Assessment of decision-making capacity of patients with capacity disorders during the Covid-19 Pandemic in Latvia”.8th European Conference of the European Association of Health Law, Ghent (Belgium), April 2022. Book of Abstracts, Volume: ISSN: 2708-2784, 2022, pp.25-26, https://eahl.eu/sites/default/files/2022-01/01_Issue%202022.pdf

  8.  Olsena S. (2022) “Legal framework requiring assessment of patients' decision-making capacity in psychiatry as a step towards the quality of care”.8th European Conference of the European Association of Health Law, Ghent (Belgium), April 2022.

  9. Kadile L., (2022) “Assessment of decision-making capacity as a precondition for protection of patients` rights in Latvia”. FORTHEM Annual Student Conference “Europe Today and Tomorrow”, University of Burgundy, Dijon, May 2022.

  10. Kadile L. (2022) “The protection of patients with limited capacity in Latvia”, The 80th Annual International Conference of the University of Latvia, Riga (Latvia), Law section, February 2022.

  11. Olsena S., Kadile L. (2022) “CPT’s Jurisprudence on Capacity and Incapacity of People in Detention (psychiatry and social care homes)”. 7th World Congress on Adult Capacity, Edinburgh, UK, June/2022.

  12. Kadile L., Losevica M.  (2022) “Healthcare quality indicators as a tool for safeguarding patient with limited capacity and physician rights”, International Conference “One Health: A systematic approach to managing urban and natural resources”. Catania, Italia, September, 2022.

  13. Baidina K., Konstantinova K. (2022) “Barriers and facilitators for Assertive community treatment (ACT) implementation in Latvia”. 12th European Congress on Violence in Clinical Psychiatry, October, 2022.

  14. Olsena S. (2023) “Legal framework for the protection of EU cross-border patients with limited decision-making capacity in Latvian hospitals, 81th Annual International Conference of the University of Latvia, Riga, Latvia.Medicina, Volume 59 (1), 2023, p. 62.

  15. Amos M., Fausch I., Olsena S. (2023)“Towards implementation of article 12 (2) of the CRPD in Estonian, Lithuanian and Latvian patients’ rights laws”,81th Annual International Conference of the University of Latvia, Riga, Latvia, March, 2023, Medicina, Volume 59 (1), 2023, p. 63.

  16. Loseviča M., Konstantinova K., Olsena S. (2023) “The standard of disclosure in emergency psychiatry when applying the MacArthur competence assessment tool-treatment (MacCAT-T) methodology”, 81th Annual International Conference of the University of Latvia, Riga, Latvia, March, 2023, Medicina, Volume 59 (1), 2023, p.124.

  17. Olsena S. (2023) “Legally Questionable Application Of Psychiatric Treatment Without Consent To Persons Who Are Limited In Self-care Ability”. RSU Research Week 2023, March 2023.

  18. Kadile L. (2023) ‘Obtaining patient`s consent in Latvian healthcare: past, present, and future’, International Scientific Conference “Ius Commune in the Making: Innovation in the History of Law”, Maastricht, The Netherlands, May 2023.

  19. Konstantinova K, Olsena S. (2023)“Addressing Decision-Making Capacity in Application of Involuntary Treatment in Latvia: Case Law Analysis”. 31st European Congress of Psychiatry, 2023, Paris, France.European Psychiatry.2023;66(S1):S541-S541. doi:10.1192/j.eurpsy.2023.1143.

  20. Loseviča M.,Losevičs A.,RaivičaE. (2024)“Physical safety in psychiatry – a call for action”. 13th European Congress on Violence in Clinical Psychiatry (ECVCP): 7-8 November, 2024, Krakow, Poland.

  21. Olsena S. (2024) “Latvian legislation needs to be amended to improve the protection of the rights of patients with reduced decision-making capacity”.82th International Scientific Conference of the University of Latvia, Riga, March, 2024. Medicina, Vol 60 Suppl 1, 2024, p. 61.

  22. Losevich M., Olsena S., Konstantinova K. (2024) “Electroconvulsive therapy in patients with questioned decision-making capacity – clinical and ethical challenges”.82th International Scientific Conference of the University of Latvia, Riga, March, 2024. Medicina, Vol 60 Suppl 1, 2024, p. 170.

  23. Konstantinova K., Losevich M., Olsena S. (2024) “Involuntary admissions due to inability to care of oneself – the case law of Latvia, conclusions de lege lata and postulates de lege ferenda”.82th International Scientific Conference of the University of Latvia, Riga, March 2024. Medicina, Vol 60 Suppl 1, 2024, p.171.

  24. Olsena S. (2023) Human rights-based psychiatric care in Latvia - possible legal, ethical and clinical solutions in Latvia.5th World Congress of Latvian Scientists "Research Latvia", 28 June, 2023.

  25. Konstantinova K. (2023) Challenges of Providing End-of-Life Care for People with Dementia in Latvia.5th World Congress of Latvian Scientists "Research Latvia", 28 June, 2023.

  26. Fausch I. (2023) ‘Who Shall Decide? Raising Awareness of Limitations to Take Healthcare Decisions by Patients with Limited Capacity’.27th World Congress for Medical Law. Vilnius, August, 2023.

  27. Olsena S., Amos M., Fausch I. (2023) “Ensuring Application of the Informed Consent Principle in Psychiatry for Patients with Mental Disability - Comparative Lithuanian, Latvian and Estonian Study”.27th World Congress for Medical Law. Vilnius, August 2023.

  28. Olsena S. (2024) “The Paradigm Shift Away from Coercion in Mental Health Care: the Role of National and International Courts”.9th European Conference of the European Association of Health Law, Warsaw (Poland), September 2024.

  29. Konstantinova K. (2023)“Development of interview protocols for users and providers of mental health services as a research tool for decision-making practices in Latvia”. 9th Qualitative Research in Mental Health Conference (QRMH9)”, August 2023, Budapest, Hungary.

  30. Konstantinova K., Olsena S., Stars I.(2023) “The ethical and legal issues in conducting qualitative studies on patients with mental disorders and limited decision-making capacity”. World Psychiatry Congress, Vienna, Austria,September 2023.

  31. Konstantinova K., Loseviča M., Olsena S. (2023) ‘Necessity and justification of restricting the liberty of persons with mental disorders who are characterised by violent behaviour’.9th International Law Conference, Riga, November 2023.

  1. Konstantinova K. (2023) ‘Coercion and mental health services: a Latvian perspective’. EU COST Action FOSTREN workshop in Manchester, UK, May 2023.

  2. Amos M. ‘Observations Regarding Autonomy in Mental Health Institutions’. International Symposium on autonomy in mental healthcare, Riga, 13 November 2023. see presentation from 2:59:00.

  3. Olsena S., Kadile L. (2023)‘Experience of Latvia: Case Law of Latvian Courts concerning the treatment of mental difficulties’, International Symposium on autonomy in mental healthcare, Riga, 13 November 2023, see presentation in video from 5:03:16.

  4. Olsena S., Rajamaki A., Konstantinova K. (2023)‘How a human rights-based approach to patients’ rights is taught, learned and researched during medical studies at the University of Latvia’, CoE conference ‘Promoting autonomy in health care’, Riga, 14 November 2023, see presentation from 6:16:16.

  5. Olsena S. (2024) ‘Towards reduction of coercion in mental healthcare services in Latvia’.EU COST Action FOSTREN workshop in Ljubliana, February, 2024.

  6. Konstantinova K. (2024) ‘The Role of Psychiatrists in Implementing the HRBA in Latvia: Present and Future’. EU COST Action FOSTREN workshop, 15 May, 2024, Riga.

  7. Losevich M. (2024) ‘Implementation of the mental capacity institute - barriers and facilitators’. EU COST Action FOSTREN workshop, 15 May, 2024, Riga.

  8. Olsena S. ‘The role of legal professionals in reducing coercion in psychiatry: national and international perspectives’. EU COST Action FOSTREN workshop, 15 May, 2024, Riga.

The project developed a proposal to organise a high-level pan-European conference to raise awareness of the human rights of people with mental health problems and psychosocial disabilities in healthcare. The proposal has been included in the programme of the Latvian Presidency of the Council of Europe in 2023. All relevant stakeholders in the Council of Europe and in Latvia have been approached. The Office of the Ombudsman and the Steering Committee on Bioethics of the Council of Europe agreed to join the initiative and became co-organisers of the conference. All the organisational work was done in 2023, the University of Latvia and the project hosted the conference "Promoting autonomy in mental health care" on 14 November 2023 in Riga. The project team presented the research results at this event. See the programme and video recording of the conference here.

The project team in cooperation with the Ombudsman of Latvia, organised an International Symposium for Legal Practitioners on "Autonomy and Mental Health Care: A Legal Analysis" on 13 November 2002. See the programme and video of the Symposiumhere. The project team presented the research results in this event. 

The project team organized an international workshop on human rights in psychiatry “Identifying and Reducing Coercion Through a HumanRights-Based Approach in Psychiatry“ in cooperation with the EU Cost Action Fostren on 15 May, 2024, in Riga. 

Kopsavilkums. Pētniecības projekts: “Cilvēktiesībās balstīta pieeja pacientu ar garīga rakstura traucējumiem un ierobežotu lemtspēju ārstēšanā: tiesiskā, ētiskā un klīniskā perspektīva”, Lzp-2020/1-0397, ietvaros ir detalizēti izpētīti cilvēku ar garīga rakstura traucējumiem cilvēktiesību aizsardzībai veselības aprūpē nozīmīgi tiesiskie, ētiskie un klīniskie aspekti. Pētījumā apkopotie dati parāda gan pastāvošos trūkumus, gan nepieciešamos tiesiskos un praktiskos risinājumus, kas jāizmanto, lai Latvija varētu veidot cilvēktiesībās balstītu garīgas veselības aprūpi. Neraugoties uz pētniecības izaicinājumiem, pētnieku komanda veica kvalitatīvu pētījumu par piespiešanas fenomena izpausmēm psihiatrijā Latvijā. Projekts deva iespēju Latvijas Universitātei un tās pētniekiem veidot gan nacionālus, gan starptautiskus dialogus ar dažādām institūcijām un personām, tā sekmējot cilvēktiesībās balstītas garīgās veselības aizsardzību Latvijā un Eiropā. 

Summary. The legal, ethical, and clinical aspects related to the protection of the human rights of individuals with mental disorders in healthcare were examined in depth in the research project 'Towards A Human Rights Approach for Mental Health Patients with Limited Capacity: Legal, Ethical and Clinical Perspective, (Lzp-2020/1-0397). The study highlighted both existing gaps within the healthcare system and the essential legal and practical solutions needed to develop human rights-based mental healthcare in Latvia. Despite the challenges encountered during the research, the team conducted a qualitative investigation into the use of coercion in Latvian psychiatry. The project also facilitated the University of Latvia and its researchers in establishing both national and international dialogues with various institutions and individuals, thereby promoting human rights-based mental healthcare in Latvia and across Europe.

 

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