Informed consent for medical. Informed voluntary consent to medical intervention

Informed voluntary consent to medical intervention is a documentary confirmation of the patient or legal representative of the rights and interests to receive timely assistance through surgical or conservative intervention. This formality is necessary, as in the case of prescribing antibiotic treatment to a child, when parental consent is required for this type of assistance. According to the Federal Law No. 323, as amended in 2018, “On the Basics of Protecting the Health of Citizens of the Russian Federation,” the patient must, in some cases, give written permission for operations.

Informed voluntary consent to types of medical interventions allows you to shield the doctor from the consequences when the operation can have a disastrous outcome. By allowing a medical facility to carry out some of the steps required by the doctor's job description, the patient is dooming himself to success and recovery, either to urgent action that may save his life, or it is an attempt to do something that is required for salvation. In other cases, when an emergency situation requires it, the doctor has the right, bypassing the opinion of relatives and the patient himself, to operate on a citizen, referring to the moral and ethical code of the doctor.

On the other hand, without informational permission from the patient or relative, many believe that medical personnel act at their own peril and risk. Is it worth talking about a moral code when sometimes a life can be saved, but the patient or his relatives do not agree to the right of a citizen to compete for a chance of salvation? There are a number of regulated relations between the two sides of a possible conflict, and it is reflected in the law “On the Fundamentals of Protecting the Health of Citizens of the Russian Federation”.

The main provisions are as follows:

A person who has not reached the age of majority is obliged to inform the medical staff of his age. If a doctor's intervention is required, an operation is required, the written consent of a parent or guardian is required on the basis of Part 5 of Art. 47 and part 2 of Art. 54 of this Law of the Russian Federation. In other words, in relation to the child, the parents are responsible for his life and its salvation. If parents do not want the operation to be carried out, they must also inform the medical authority by writing a refusal. This is their right, however, in exceptional cases, doctors can contact the police to clarify the circumstances. It is worth noting that the unlawful denial of assistance is a criminally punishable act against the health of the child. Having received a refusal, the doctor, having no other way to help, does not accept the patient due to the impossibility of saving a life.
Written parental consent may also be required for drug treatment of a minor when required by law and the patient's social status. Suppose his behavior is considered socially dangerous to others, then the parents either sign consent to treatment or control the process on their own. However, unauthorized discharge cannot be allowed - the doctor is obliged to register the child and notify the educational institution that this citizen needs urgent emergency assistance in the field of drug rehabilitation. Toxic intoxication, which can affect life, the doctor must eliminate, and only then be taken for treatment. Emergency measures are carried out without parental consent on the basis of Article 9 of the Federal Law.
If a parent of a dependent or an adult citizen does not want to receive medical care, the possible consequences that may occur if medical intervention is refused are explained to him in a simple and clear manner, sometimes in writing. It also explains the complications that can lead to untimely provision of emergency medical care. All the consequences that may occur after the intervention are also indicated - this is necessary for a person to understand and be aware that even after manipulations by the doctor or at the time of their implementation, unforeseen events may occur. The doctor insures himself against uninsured situations.
If parents represent the interests of children who have not reached the age of 14, refuse urgent assistance, the medical staff may call the police or submit documents to the court to clarify the circumstances of the case. The legal representatives of the interests of the child will be required to provide explanations in an accessible form in court or during pre-trial proceedings to the guardianship authorities, if they consider the arguments valid, they will reserve the right to act at their own peril and risk, contacting, for example, a private organization. If this does not happen, the parents will be convicted for obstructing assistance to the child on the basis of the Criminal Code of the Russian Federation.

The list of types of manipulations is established and approved by the order of the Russian Federation of 2011 FZ-No. 48, article 6724. The new edition entered into force in June 2013, which says that after choosing a certain type of intervention, a citizen is provided with a sample application form with the right to sign, which means consent to the adoption of prescribed medical measures for his treatment. In some cases, he may partially agree to a number of measures taken, as well as indicate a typical list of changes - for example, the presence of an allergic reaction to drugs with an artificial element. It will need to be replaced so that, in combination with other medicines, there is no imbalance, and they harmoniously and harmoniously “work” with each other.

A citizen can give consent to the intervention of a doctor, without whose permission it is impossible to carry out an operation or other types of planned actions, with the exception of a number of cases. All types are indicated in the internal documents of medical personnel in the statutory form No. 1 (DOE).

This list is an open document, and can be obtained for review by any patient who is in a hospital and undergoing treatment in a particular institution. Failure to submit regulations and internal charters borders on administrative responsibility.

In exceptional circumstances, a representative interpreter may be needed, for example, for treatment abroad, to establish contact with the attending physician:

To begin with, you should choose a medical institution that conducts one or another type of intervention.
Further, for the implementation of this type of service, a specialist doctor in this field is selected.
He is obliged to explain to the patient how much time is required for the operation, rehabilitation, what are the possible consequences.
If the patient consents, he signs a voluntary agreement for medical interventions in the form No. 2.
To draw up a refusal, the patient fills out form No. 3, which is evidence in possible subsequent conflicts.

The doctor also has the right to refuse treatment to the patient if he does not have the appropriate equipment for diagnostics, knowledge and a set of drugs to start treatment. It is impossible to refuse due to the lack of a policy if a citizen applies to a state institution. A private clinic may operate a personal identification system, after which the measures that are possible at the time of registration of the patient will be carried out.

As a rule, the main types of interventions are:

Provision of sanitary and medical care for primary and emergency treatment in a medical institution. The regulation of the Federal Law No. 390 of 2012 is regulated.
Providing urgent treatment for human intoxication on the basis of Federal Law No. 323 of 2011.
Provision of urgent medical care in the form of hospitalization on the basis of Federal Law No. 48 of 2011.
Based on the Federal Law No. 54 of 2012 (new edition) - the provision of emergency surgical care for children under 16 years of age with the consent of the parents without their presence.

It is worth noting that the child has the right to receive assistance as a minor if the parents are at work or abroad. Thus, the right from other relatives is not required if there is a connection with the parents. Otherwise, it is necessary to confirm in writing the consent to the operation, for example, for a grandson, if it is possible to come and sign all the papers. This legal moment is considered a salvation for doctors when serious consequences arise, and parents consider medical personnel to be guilty of the death of loved ones.

In the event of disputes and conflict situations, an autopsy may be ordered in court to determine the cause of death. If the doctor is guilty, he will be severely punished for not providing appropriate assistance. The same goes for emergencies, when permission from citizens is not required, and doctors refuse to take responsibility for saving a person's life.

When is informed consent required?

There are a number of cases when urgent medical care is needed, but a person cannot be provided with it, not because of the lack of a health insurance policy.

Of course, it is best to know in advance about the existing symptoms of the disease, however, not always a person who is far from medicine can understand why he does not have surgery right away:

Consent must be given orally when collecting an anamnesis - the procedure for considering complaints, symptoms. If the disease is advanced, the patient should be interviewed to identify syndromes in dynamics.
Palpation of the patient - permissible in exceptional cases, but consent is required if percussion, auscultation, rhinoscopy, pharyngoscopy, indirect laryngoscopy, vaginal examination, rectal examination are needed. These procedures are optional, aimed only at compiling a complete picture of the examination. The more complete it is, as well as the tests given to the sick, the clearer it will become than the patient is sick.
Anthropometric studies - for example, the child needs to measure the circumference of the chest, weight, size of body parts. If the mother does not pass the examination at the local polyclinic, she must consent to the "approach" to the child. At the same time, the norms of etiquette are observed - according to the Charter, it is allowed to approach babies after the implementation of sanitary safety standards (shoe covers, hand washing, gloves, mask).
Thermometry is also included in the list of manipulations that require permission. If a person entered the department, having signed a permit for a number of actions, then measuring temperature, taking tests is already permissible within the framework of a medical institution.
Tonometry is a procedure for measuring the pressure inside the eye. It is permissible to perform manipulations with the permission of the patient, if he came for a consultation with an ophthalmologist. In the clinic, for such actions, permission is required from the parents, since usually mothers with children come to the doctor for a routine examination. Adults take referral to specialized clinics where permission is not required due to the perceived symptomatology of the referral.
Non-invasive examinations of the organs of hearing and vision. All actions must be performed strictly on the basis of this consent of the citizen.
Examination of the human nervous system - you can’t just do research in this area. Otherwise, when using some techniques, it is possible not to detect an existing disease, but to disrupt its consequences and the course of the disease.
Laboratory studies - clinical, biochemical, virological, bacteriological and immunological. If the mother came for routine vaccination, she is obliged to give consent or refusal to carry out such a manipulation.
Functional examination methods, which also include electrocardiography. While in the hospital, the patient is obliged to give an additional agreement to conduct arterial / daily monitoring of the electrocardiogram, spinography, cardiotocography for pregnant women.
The implementation of radiography and fluorography for people over 15 years of age, as well as ultrasound, is carried out with voluntary oral consent. It can be an entry in the Patient Record Book. Doppler examination is possible with written consent.
The introduction of intramuscular, intravenous and subcutaneous drugs, even as prescribed by a doctor, takes place with the written consent of the patients. Even if it is necessary to administer the medicine in time, and the patient is sleeping, he should be awakened and asked permission to carry out such actions in relation to his health.
Massotherapy. This is not palpation, but a direct effect on the human body, and written consent is required to be convinced of his health, especially when it comes to massage therapy for babies.

If the child is healthy, the parents do not plan to vaccinate him at all, the doctor has the right to contact the guardianship authorities - the absence of a vaccine without a ban on the basis of medical indications is equated to an increased chance of contracting serious diseases.

If the doctor is going to vaccinate the child, and has consent from the mother, before it is carried out during the Mantoux test, he is obliged to notify the parent of the possible consequences and only after that conduct a trial vaccination to detect allergic reactions. The diaskin test is administered intradermally, so allergic reactions and manifestations of body temperature instability are inevitable. To save a child's life, a test should be performed twice to see the dynamics of the reaction.

Some institutions require informed voluntary consent for medical interventions. Informed voluntary consent for medical intervention sample is provided below:

On the basis of the List of National Health of the Russian Federation at the time of choosing a physician and a medical type institution for the provision of appropriate assistance:

I, _____________ (full name), ____________ (date of birth), registered at ____________, provide written consent to:

Implementation of necessary and emergency interventions, which are specified in this provision. I understand the possible consequences that can happen, but I do not refuse the prescribed treatment. I also grant the right to the attending physician to carry out lawful acts in relation to my health and life for the sake of preservation and salvation.

Physician ______ (physician's full name) explained the goals and methods of assistance, as well as their consequences, the likelihood of complications in the absence of assistance. I know that I can refuse them or demand their termination during treatment, with the exception of cases specified in Part 9 of Art. 20 FZ-No. 323 dated November 21, 2011.

Signatures of the parties and the date of preparation of the document __________.

This document is drawn up directly with the doctor who is authorized on duty or by the nature of his abilities and duties to carry out manipulations with respect to sick citizens who are registered in a hospital or for a course of treatment and rehabilitation in a medical institution.

If the services provided by the doctor do not fully reflect the possibilities for performing operations and treatment:

the patient may refuse services;
demand to change the doctor to another;
otherwise, if provided by the agreement.

As a rule, children admitted to intensive care units and children's hospitals do not need parental permission to receive medical care. However, in some cases, if the types of interventions can cause irreparable consequences, complications, then the parents are informed, brought up to date, and only then a decision is made on further treatment.

Patients can also refuse certain types of medical services if they are really not vital, but lead to severe complications, after which urgent hospitalization and rehabilitation are required.

Sometimes this applies to operations unplanned by the institution, and relatives or parents are afraid for the "urgency" of help, because it may not save, but lead to death:

Having given consent, it is unlikely that the autopsy will indicate the objective guilt of the doctor.
Many citizens refuse to “survive” to a critical point, and not leave because of an incurable disease ahead of time.

Refusal of all possible types of medical interventions specified by this Law of the Russian Federation when choosing a doctor and a medical institution for receiving emergency medical care. Agreed and read by me, written and compiled by my own hand, I understand and I am aware that the refusal can harm my health, but due to my personal subjective prejudices, not based on the data of the specifics of medicine, I take responsibility for the consequences of what is happening, I do not want to receive this institution ______________ manipulations regarding my psychological or physiological health. I ask by this application to recognize me as a discharged patient so that in the future all diseases will be on my responsibility.

I, _____________ (full name), ____________ (date of birth), registered at ____________, when providing ___________ (name of services) at ___________ (name of the clinic), refuse the following manipulations, on the basis of Federal Law No. 390, registered by the Ministry of Justice of the Russian Federation on 5.05 .2012 No. 24082 (strike out the unnecessary).

_________________ (name of the intervention).

____________________________________________ (explanations).

_______________________________ (doctor's opinion).

Physician _____________ explained in an accessible form the essence and methods of providing assistance, as well as their consequences, including the likelihood of complications if assistance is not provided, the possibility of complications and the expected results of inaction or actions. It is explained and clear to me that if risk factors arise, serious consequences for me can occur. Therefore, I waive the need to conduct ______________ (name of intervention), confirming the fact with this waiver in accordance with the Federal Law.

Signature of ___________ (parent).

Signature ___________ (full name of the doctor).

Registration date _______.

Even after such a refusal, a person can give a voluntary agreement to the intervention, a sample of which is presented above. They do not have the right to refuse him if a citizen applies again to a medical institution.

Every year, according to national statistics from the Ministry of Health, 76% of people refuse services. Out of 2677 people, only 3 will sign this agreement. Some of the remaining "arrange" with the doctor to get an extraordinary consultation. As a rule, a simple health check, palpation, examination or ultrasound is not a threat, so many doctors do not even ask patients for consent to carry out their direct duties.

There are only exceptional cases regarding ultrasound, and these include pregnant women:

the allowed maximum number of examinations is reduced to 10;
the minimum number cannot be lower than 3;
before taking the woman should notify the doctor about the passage of ultrasound.

For example, a typical situation is when a woman at 30 weeks of pregnancy gets to the Emergency Hospital with acute stabbing pain. Suspicion of pancreatitis due to the location of the fetus. An ultrasound is needed, but 3 days ago she was on a routine examination. Is it possible to conduct a second sound examination? No, without her consent, the doctor can only accept a refusal in writing, establishing the cause of pain by palpation and other means, since a second examination may adversely affect the condition of the fetus. The impact on the embryo is safe only at the customs control post and when checking in for a flight with airlines. Ultrasound devices are equipped with a powerful beam, which can provoke an increased exchange of the cellular form and give out the reaction of the mother's body, such as rejection of the fetus.

There are cases when consent from patients is not required, but this should also be learned from the laws:

Prior emergency examination indications that indicate a threat to the life of the patient. If the person's condition does not allow expressing the will of consent or refusal, the doctor has the right, on the basis of part 2 of this law, to apply a number of urgent measures.
If existing diseases are found that are dangerous to others.
Persons suffering from mental disorders.
Persons who have committed atrocities against the health and lives of other people.
At the time of the forensic medical examination, which affects the scope of psychiatric research in the PND (psycho-neurological dispensary).

Based on the data, the patient cannot accuse the doctor of illegal actions, since the cases relate to urgent measures to save human life.

For example, an ambulance brought victims of an explosion in a public place. A child of 5-7 years old turned out to be in need of urgent help, the identity was not established. Shrapnel severe wounds, requires a blood transfusion and an emergency operation to remove the fragments and suturing the ruptures. An operation to remove foreign parts that have entered the body is not ruled out. If time is spent looking for parents, guardians, the doctor will lose the time allotted for saving the child. In such situations, a council of doctors does not even gather, but an unscheduled surgical intervention is carried out, which will help the patient survive or lead to the same outcome that was expected in case of failure to provide medical care.

It is also not considered necessary to require consent from parents, or to accept a refusal if a preschooler or schoolchild passes a specialized medical commission to determine him to a kindergarten or summer camp. This is a natural verification procedure, which is aimed at finding out and establishing the level of health of the child for admission to a preschool educational institution or school. In our time, this is a mandatory procedure, since all children must undergo vaccination, annual examinations and routine examinations by family doctors.

Disagreements between parents

There is an unspoken rule - the doctor is obliged to notify both parents about the condition of the child. If one of them is “for”, the other is “against”, the medical intervention is carried out without contesting. If the second parent is not available, is divorced, lives separately with the patient, then the entire responsibility for the IDS falls on the shoulders of the first parent. In medical practice, there are no problems, since both the father and mother understand the importance of the services provided. If this is contrary to the law, ethical standards and principles of morality, the rights of the child are violated, then the one who gives consent takes full responsibility for the consequences. All values are displayed in the annexes to the DOW - documentation support for the management of medical services.

At the same time, a council of doctors may meet - the head physician is obliged to notify the heads of departments about possible legal aspects that occur after the intervention. In rare cases, an inspector from the guardianship authorities is invited to consider the issue regarding the rights of the child.

When complications arise in the cases described above, the second parent cannot participate in the process of choosing a punishment for the first parent, since he was not present at the time the child's illness was established, and could not know in advance the correct outcome of events. In the most deplorable cases, an autopsy is performed to determine the cause of death.

This moment includes several stages:

Submission of an application for revision of the medical report.
Drawing up a claim to determine the adverse outcome of treatment.
If the physician’s misconceptions are revealed, reflected in the medical history, a systematic and comprehensive examination continues to identify complications that could be caused by incorrect treatment, which provoked cardiac arrest.
A medical error can be taken into account in the medical and legal assessment of the actions of all personnel.
The absence of negligence does not mean the legality of actions - negligence and ignorance are allowed.
A diagnostic error can provoke further incorrect treatment.
Tactical violations - incorrect indications for surgery.
A technical error most often leads to the appointment of the wrong treatment, during which the disease progresses, and there is no conservatism at all.

There are also hidden atypical symptoms of the disease that cannot be diagnosed due to the patient's condition, or for independent reasons - the position of kidney stones, the concealment of pathologies, the location of the fetus in the womb, the effect of anesthesia at the time of examining the heartbeat and rhythm.

The most difficult diseases to diagnose are: pneumonia among children from 1 to 4 years old, granuloma of the skin and mucous membranes (from the field of dentistry), when it is impossible to determine the degree of spread of infection by x-ray, cardiac arrhythmia - the dynamics does not establish deviations from the norm and rarely, when the initial symptoms of the disease appear. It is worth saying that the least violations and medical errors were recorded in the field of unscheduled surgery.

Despite the large amount of mistrust and negative feedback from patients, emergency medicine "works" better than planned surgery. However, in both areas of work, it is impossible to say in advance what the outcome will be. During the operation, a failure may occur, and no one is immune from the “typical” failure to withstand the load on the body.

Appendix No. 2
to the order of the Ministry of Health of the Russian Federation
dated December 20, 2012 N 1177n
(as amended on August 10, 2015)

Form

Informed voluntary consent to types of medical interventions, included in the List of certain types of medical interventions, on which citizens give informed voluntary consent when choosing doctor and medical organization to receive primary health care I, ___________________________________________________________________________ (full name of the citizen) "__________" ______________________________________________ year of birth, registered at the address: __________________________________________ (address of the citizen's place of residence or legal representative) give informed voluntary consent to the types of medical interventions included in the List of Certain Types of Medical Interventions , to which citizens give informed voluntary consent when choosing a doctor and a medical organization for receiving primary health care, approved by order of the Ministry of Health and Social Development of the Russian Federation of April 23, 2012 N 390n (registered by the Ministry of Justice of the Russian Federation on May 5, 2012 N 24082) (hereinafter referred to as the List), to receive primary health care / receive primary health care by a person whose legal representative I am (strike out the unnecessary) in _____________________________________________________________________________. (full name of the medical organization) Medical worker _________________________________________________ (position, full name of the medical worker) in a form that is accessible to me, explained to me the goals, methods of providing medical care, the risk associated with them, possible options for medical interventions, their consequences, including including the likelihood of complications, as well as the expected results of medical care. It was explained to me that I have the right to refuse one or more types of medical interventions included in the List, or demand its (their) termination, except as provided for by Part 9 of Article 20 of the Federal Law of November 21, 2011 N 323-FZ " On the fundamentals of protecting the health of citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, N 48, item 6724; 2012, N 26, item 3442, 3446). Information about the persons I have chosen, to whom, in accordance with paragraph 5 of part 5 of article 19 of the Federal Law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation", information about the state of my health or the state of the person may be transferred, whose legal representative I am (strike out the unnecessary) ________________________________________________________________________ (full name of the citizen, contact phone number) __________ _____________________________________________________________ (signature) (F. AND ABOUT. citizen or legal representative of a citizen) __________ _____________________________________________________________ (signature) (full name of the medical worker) "__" ____________________________________________ (date of issue)

Today I want to tell you about the tricks of such a document as Consent to Medical Intervention.

So, probably, everyone has already managed to face the fact that in the clinic, before getting an appointment with a doctor, they give us a form that says that we give consent to all types of medical interventions indicated in the list of certain types unknown to the average person. medical interventions.

By signing such Consent, it turns out that a person seems to agree to ALL types of medical intervention from the List.

So what's the problem?

As you may have guessed, there is more than one problem here:

1. It is not clear what the person agreed to - the majority have never seen this List. What was the consent given for – examination, massage, vaccination or something else? Clearly, no one answers this question in the registry - “Womanaaaa, you don’t understand - everything is written in the listoooo.”

2. Signed a consent to all types of medical interventions specified in the List, which means that he agreed not only to an examination or measurement of pressure, but also to x-rays and the administration of drugs.

3. In practice, such consent is actually signed even before everything has been explained to the person - why this or that procedure is needed, what are the contraindications, side effects, risks, etc.

Some, quite rightly, began to be afraid - what if such consent would give doctors an organ transplant? Of course, a person who has been taught by bitter experience already knows - you need to delve into everything, you need to approach everything wisely.

Ordinary doctors are often far from the right, like a monkey from nuclear physics, so you should not take their word for it.

And now let's break it all down, dispel fears and learn how to act when we are slipped a strange piece of paper called "Informed voluntary consent for types of medical intervention."

First, let's define terms:

medical intervention- these are types of medical examinations and (or) medical manipulations in relation to the patient, as well as artificial termination of pregnancy, affecting the physical or mental state of a person and having a preventive, research, diagnostic, therapeutic, rehabilitation orientation, performed by a medical worker and other worker who has the right for the implementation of medical activities (follows from paragraph 5 of Article 2 of the Federal Law of November 21, 2011 N 323-FZ "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation").

Thus, medical intervention equally includes a simple medical examination, measurement of blood pressure, as well as taking blood for analysis, and even transplantation of donor organs.

Before performing medical intervention, it is necessary to obtain the consent of the person. For children under 15 years of age, consent is given by parents (legal representatives), guardians or trustees, and for organ transplantation - up to 18 years of age.

No consent, no intervention. But there are exceptions to this rule, established in Part 9 of Article 20 of the Federal Law of November 21, 2011 N 323-FZ "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation."

So, without the consent of a person, one of the parents or other legal representative, medical intervention is allowed:

1) if medical intervention is necessary for emergency indications to eliminate the threat to a person's life and if his condition does not allow him to express his will or there are no legal representatives (in relation to the persons specified in part 2 of this article);

2) in relation to persons suffering from diseases representing danger to others;

3) in relation to persons suffering severe mental disorders;

4) in relation to persons who have committed socially dangerous acts ( crimes);

5) when conducting forensic medical examination and (or) forensic psychiatric examination.

For example, when you came for a preventive examination to a therapist, an ophthalmologist, an ENT specialist, i.e. there is no threat to your life, as it seems to you, there is also no dangerous illness for others, you do not suffer from severe mental disorders, then it is quite legal to offer you to sign a consent to medical intervention.

It should not be consent in one fell swoop to all the types of examinations and manipulations indicated in the List.. Your application should contain only those for which you applied and in respect of which you were provided with all the information - why do you need it, what is the goal, expected result, etc. Those. Your consent must be INFORMED.

Informed Consent- this means that before signing the piece of paper, the health worker informed the person in a form AVAILABLE to him FULL information about the goals, methods of providing medical care, the risk associated with them, possible options for the types of medical interventions included in the List, about the consequences of these medical interventions, including about the likelihood of complications, as well as the expected results of medical care.

How about in practice?

Hello. I would like to see a therapist, I have a temperature of 39, a runny nose and a cough, I'm afraid I won't live to see tomorrow, the flu, probably

Sign the consent to medical intervention,

Otherwise we won't accept it.

Okay, let's sign the inspection consent.

No, it is necessary according to our form. Otherwise we won't accept...

Is the health worker doing the right thing in this situation?

Obviously not.

But such a dialogue, as it turned out, is quite common.

The only thing the health worker informs about is that “we won’t accept you without a piece of paper.”

But what about cases in which consent is not required? For example, according to emergency indications to eliminate the threat to human life. And if a person dies, if he is denied help and sent home?

But the main thing is different.

A person is not obliged to give consent to manipulations regarding which he has not received information.

What does it mean?

I came for an examination, which means I sign a consent to medical intervention in the form of an examination.

I came to do fluorography, which means I sign consent to medical intervention in the form of fluorography.

I came to Laura to wash my ears, which means I sign the consent to wash my ears.

I came to give injections to a child, which means I sign a consent to the intramuscular administration of medicines - and indicate which ones (name, quantity).

Thus, if a person does not want to sign a consent to a medical intervention on the letterhead of a medical organization, which contains a link to the List and indicates that the person consents to any intervention from this list, then this is his right.

What types of medical intervention are prescribed in the List approved by the Ministry of Health(Appendix to the order of April 23, 2012 N 390n):

1. Questioning, including the identification of complaints, the collection of anamnesis.

2. Inspection, including palpation, percussion, auscultation, rhinoscopy, pharyngoscopy, indirect laryngoscopy, vaginal examination (for women), rectal examination.

3. Anthropometric studies.

4. Thermometry.

5. Tonometry.

6. Non-invasive studies of the organ of vision and visual functions.

7. Non-invasive examination of the organ of hearing and auditory functions.

8. Study of the functions of the nervous system (sensory and motor areas).

9. Laboratory methods of examination, including clinical, biochemical, bacteriological, virological, immunological.

10. Functional examination methods, including electrocardiography, 24-hour blood pressure monitoring, 24-hour electrocardiogram monitoring, spirography, pneumotachometry, peak flowmetry, rheoencephalography, electroencephalography, cardiotocography (for pregnant women).

11. X-ray methods of examination, including fluorography (for persons over 15 years old) and radiography, ultrasound, Doppler studies.

12. The introduction of drugs as prescribed by a doctor, including intramuscularly, intravenously, subcutaneously, intradermally.

13. Medical massage.

14. Therapeutic exercise.

Those. listening to a patient about his health complaints is already a medical intervention.

As you can see, we are not talking about organ and tissue transplantation here.

Everyone has the right to sign consent even for ONE manipulation, for ONE TYPE of medical intervention.

Also, everyone has the right REJECT at any time from medical intervention.

This is directly stated in the Federal Law of November 21, 2011 N 323-FZ "On the fundamentals of protecting the health of citizens in the Russian Federation" (clause 8 of part 5 of article 19).

And not a single federal law contains an article OBLIGING citizens or their legal representatives (parents) to give consent to ALL types of medical intervention IN ADVANCE - i.e. until the onset of the disease or the moment when a person wants to receive medical care.

So, signing the consent on the letterhead of the medical organization in the form approved by the Ministry of Health is not at all necessary.

Yes, the Ministry of Health has approved a consent form for medical intervention and a form for refusing medical intervention.

But let's not forget that Ministry of Health orders must comply with federal laws. And in federal law, the obligation to sign such a form is not provided.

Therefore, if you do not want to give consent immediately to all the manipulations from the List, then you can write your individual consent.

But such consent must contain the necessary data about you - last name, first name, patronymic, year of birth, address of residence. You can also specify a list of relatives or legal representatives whom the patient allows to provide information about his diagnosis, severity and nature of the disease.

And, of course, insist that before signing the consent you are explained everything about:

The purpose of providing medical care;

Methods of providing medical care;

The risk associated with the provision of medical care;

Possible options for medical intervention;

The consequences of medical intervention;

Expected results of medical care.

And the last thing I want to talk about today.

Many people ask - what will happen if you do not sign any consent at all? Does a doctor have the right to refuse medical care?

Laws in Russia do not allow refusing medical care to a person!

This is written in the Federal Law of November 21, 2011 N 323-FZ "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation" (paragraph 7 of Article 4): "The main principles of health protection are: ... the inadmissibility of refusing to provide medical care." It also says about the priority of the interests of the patient in the provision of medical care.

This law even has a separate article 11, which is called "The inadmissibility of refusing to provide medical care":

1. Refusal to provide medical care in accordance with the program of state guarantees of free provision of medical care to citizens and collection of fees for its provision by a medical organization participating in the implementation of this program, and medical workers of such a medical organization are not allowed.

2. Medical assistance in an emergency form is provided by a medical organization and a medical worker to a citizen without delay and free of charge. Refusal to provide it is not allowed.

3. For violation of the requirements provided for in parts 1 and 2 of this article, medical organizations and medical workers are liable in accordance with the legislation of the Russian Federation.

As can be seen from the text of the article of the law, no conditions for signing a document on consent to medical intervention are specified.

Therefore, if you were sent to the registry to all four sides, then this is illegal.

What to do in this case?

You can write a complaint to the head doctor, or you can write to the prosecutor's office and the insurance company.

Just need to contact in writing– remember this always. Of course, there may be a reaction to your verbal complaint, but often there is zero reaction to words. You don't have nerves of steel, do you?

Therefore, calmly just write a complaint, register it, save your copy with a mark of acceptance. Usually, after a written complaint, the reaction is immediate - the person is accepted.

Remember - you have the right to give consent to medical intervention in a FREE form. But in order to be able to establish that this consent is from you, you must specify your full name, date of birth and address.

You can prepare such a document in advance at home, print it out on a printer or write it by hand.

And now let's sum it up:

If you become ill or your child becomes ill, then when you contact a doctor, you consent in writing to a SPECIFIC MEDICAL INTERVENTION, which is NEEDED in this SPECIFIC CASE;

There are no rules in the laws of Russia OBLIGING citizens or their legal representatives to give IN ADVANCE (before the onset of the disease) informed voluntary CONSENT to ALL types of medical intervention;

Even during illness, a person or his legal representative (parent, guardian, caregiver) HAS THE RIGHT TO REFUSE medical intervention or demand its termination.

What else is important to pay attention to:

If your child is in the hospital without you, undergoing examination or treatment there, then check what you signed the consent for. It happens that parents do not even know what kind of injections they give their children and what kind of examination they conduct.

Therefore, FIRST GET from the attending physician all the information about the child’s health, about the planned methods of treatment, and only then sign the papers about your consent to them, - just write more precisely what exactly you agree to, so that later it doesn’t suddenly turn out that the child was injected is not clear that in the blood, did not make any puncture or cut off something.

Good luck in protecting your rights and the rights of the child!

1. A necessary precondition for medical intervention is the giving of informed voluntary consent of a citizen or his legal representative to medical intervention on the basis of complete information provided by a medical worker in an accessible form about the goals, methods of providing medical care, the risk associated with them, possible options for medical intervention, about his consequences, as well as the expected results of medical care.

2. Informed voluntary consent to medical intervention is given by one of the parents or other legal representative in relation to:

1) a person who has not reached the age established by Part 5 of Article 47 and Part 2 of Article 54 of this Federal Law, or a person who has been recognized incapacitated in accordance with the procedure established by law, if such a person, due to his condition, is not able to give consent to medical intervention;

2) a minor drug addict when providing him with drug treatment or during a medical examination of a minor in order to establish the state of narcotic or other toxic intoxication (with the exception of cases established by the legislation of the Russian Federation when minors acquire full legal capacity before they reach the age of eighteen).

3. A citizen, one of the parents or other legal representative of the person specified in part 2 of this article shall have the right to refuse medical intervention or demand its termination, except for the cases provided for by part 9 of this article. The legal representative of a person who has been recognized legally incompetent in accordance with the procedure established by law shall exercise this right if such a person, due to his condition, is not able to refuse medical intervention.

4. In case of refusal of medical intervention to a citizen, one of the parents or other legal representative of the person specified in part 2 of this article, the possible consequences of such a refusal must be explained in an accessible form for him.

5. If one of the parents or other legal representative of the person specified in part 2 of this article, or the legal representative of the person recognized as incapacitated in the manner prescribed by law, refuses from the medical intervention necessary to save his life, the medical organization has the right to apply to the court for protecting the interests of such person. The legal representative of a person recognized as incapable in accordance with the procedure established by law shall notify the guardianship and guardianship authority at the place of residence of the ward of the refusal of medical intervention necessary to save the life of the ward, no later than the day following the day of this refusal.

6. The persons specified in parts 1 and 2 of this article, in order to receive primary health care, when choosing a doctor and a medical organization for the period of their choice, give informed voluntary consent to certain types of medical intervention, which are included in the list established by the authorized federal executive body authorities.

7. Informed voluntary consent to medical intervention or refusal of medical intervention is drawn up in writing, signed by a citizen, one of the parents or other legal representative, a medical worker and is contained in the patient's medical records.

8. The procedure for giving informed voluntary consent to medical intervention and refusal of medical intervention in relation to certain types of medical intervention, the form of informed voluntary consent to medical intervention and the form of refusal of medical intervention are approved by the authorized federal executive body.

9. Medical intervention without the consent of a citizen, one of the parents or other legal representative is allowed:

1) if medical intervention is necessary for emergency reasons to eliminate the threat to a person’s life and if his condition does not allow him to express his will or there are no legal representatives (in relation to the persons specified in part 2 of this article);

2) in relation to persons suffering from diseases that pose a danger to others;

3) in relation to persons suffering from severe mental disorders;

4) in respect of persons who have committed socially dangerous acts (crimes);

5) when conducting a forensic medical examination and (or) a forensic psychiatric examination.

10. The decision on medical intervention without the consent of a citizen, one of the parents or other legal representative is made:

1) in the cases specified in clauses 1 and 2 of part 9 of this article, by a council of doctors, and if it is impossible to convene a council, - directly by the attending (duty) doctor with such a decision entered into the patient's medical records and subsequent notification of medical officials organization (head of a medical organization or head of a department of a medical organization), a citizen in respect of whom a medical intervention was performed, one of the parents or other legal representative of the person specified in part 2 of this article and in respect of which a medical intervention was performed;

2) in relation to the persons specified in paragraphs 3 and 4 of part 9 of this article - by the court in the cases and in the manner established by the legislation of the Russian Federation.

11. Compulsory medical measures may be applied to persons who have committed crimes on the grounds and in the manner established by federal law.

What is informed voluntary consent of the patient - the concept

Informed voluntary consent of the patient is the provision by an employee of a medical institution of information to the patient about the goals of medical intervention, methods of treatment, possible consequences and the intended result.

The full list of information with which the doctor is obliged to familiarize the patient is as follows:

about the purpose of medical intervention,
possible methods of providing medical care,
about the risks of medical intervention,
options and consequences of medical intervention,
about the expected results of medical care.

Please note that the legislation does not specify the amount of information provided, so the doctor, at his discretion, must familiarize the patient with all possible methods and methods of treatment in a form that is understandable to him. At the same time, information must be conveyed in the correct form, so as not to harm the psychological health of the patient. After familiarizing the patient with the necessary information, it can be considered that a voluntary informed decision has been received. It must be remembered that obtaining information should be a priority, after which medical services are provided in full.

Important! In accordance with current legislation informed voluntary consent to receive medical care is mandatory and without it, any medical assistance (except for) cannot be carried out.

Consent to conduct honey. assistance is in writing. To enter into legal force, the consent to receive medical care must be signed by the medical officer and the patient, or his legal representative. Voluntary consent is filed into the patient's card and stored in the archive.

To date, by order of the Ministry of Health of Russia dated December 20, 2012 No. 1177n (Registered in the Ministry of Justice of the Russian Federation under the number 28924), the procedure and requirements for giving informed voluntary consent to medical intervention and refusal of medical intervention have been developed. Medical institutions are required to act in accordance with the norms and requirements, as well as to use the developed forms for drawing up voluntary consent. However, these requirements and procedures apply only to medical institutions providing free medical care under the state guarantee program. Other medical institutions may not use the forms proposed by the Ministry of Health and the requirements established by Order No. 1177n, but are obliged to fully inform the person about the methods and consequences of medical intervention. All medical staff, without exception, regardless of the institution, must obtain consent or refusal of medical intervention before carrying out procedures of any nature.

Consent Form

In the photo below - the consent form for medical intervention approved by the Ministry of Health of the Russian Federation.

Consent is given by the patient at the time of the first visit to the medical facility. This document comes into force after signing by the parties and is valid throughout the entire period of provision of primary health care. Alas, many employees of medical institutions do not respect the rights of patients, and often information about the methods and consequences of medical intervention is not provided in full. Many patients sign a voluntary informed consent without even having studied the document and without talking to their doctor. Based on this, disputes arise between the parties, which subsequently leads to various lawsuits.

In what cases consent is given not by the patient, but by the legal representative

Due to various circumstances (capacity or lack thereof, as well as the age of the patient), situations arise when the patient cannot independently sign a voluntary consent, the law provides for the signing of this document by legal representatives. Legal representatives include parents, adoptive parents, trustees or guardians who consent to medical intervention in relation to a person:

teenagers under the age of 15.
drug addicts under the age of 16.
minors under the age of 18 who need a transplant of human organs and tissues.
declared incompetent in accordance with the legislation of the Russian Federation.
to minors with drug addiction when they are provided with drug treatment, as well as during an examination to establish drug or other intoxication.

Subject to the requirements of Article 26 of the Civil Code of the Russian Federation, a person who has reached fourteen years of age may independently enter into transactions (conclude contracts for the provision of medical services) with the written consent of legal representatives. However, only upon reaching the age of 15, the patient acquires the right to dispose of his health, that is, to give voluntary informed consent to medical intervention.

Consent in Primary Health Care

At the time of seeking medical care, the patient signs a voluntary informed consent for certain medical actions. After signing the consent, the patient is provided with primary health care, which includes several options for medical services. There are several groups of medical interventions that can be provided at the time of the first visit to a medical institution:

Conducting a survey, identifying complaints, collecting anamnesis.
Conducting an initial inspection. Palpation, percussion, auscultation, rhinoscopy, pharyngoscopy, indirect laryngoscopy, vaginal examination (for women), rectal examination.
Conducting anthropometric studies.
Carrying out thermometry.
Carrying out tonometry.
Non-invasive studies of the organ of vision and visual functions.
Non-invasive examination of the organ of hearing and auditory functions.
Study of the functions of the nervous system.
Clinical, biochemical, bacteriological, virological, immunological research methods.
Electrocardiography, daily monitoring of blood pressure and electrocardiogram, spirography, pneumotachometry, peak flow, rheoencephalography, electroencephalography, cardiotocography (for pregnant women).
X-ray methods of examination, fluorography and radiography, ultrasound, Doppler studies.
The introduction of drugs as prescribed by a doctor, including intramuscularly, intravenously, subcutaneously, intradermally.
Medical massage.
Physiotherapy.

Informed consent for medical. Informed voluntary consent to medical intervention

When is informed consent required?

Disagreements between parents

More on the topic Article 20. Informed voluntary consent to medical intervention and refusal of medical intervention:

What is informed voluntary consent of the patient - the concept

Consent in Primary Health Care