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Obligations of patients as subjects of medical legal relations
It should be noted that the study of the responsibilities of persons receiving medical care as an integral part of the legal status of patients is a poorly studied area of modern legal support for the field of medical activity. The reasons for this legal situation are a number of factors, which may include the following.
1. Perception of patients as a more vulnerable category of subjects of medical legal relations in the system of "medical worker-patient"
2. The essence of the provision of medical care implies that some individuals (entities receiving medical care), due to a deterioration in their health status, acquire the right (but not obligation) to receive medical care, while others (entities providing medical assistance) , by virtue of their professional affiliation, are given the duty (but do not have the right at will) to alleviate the suffering of the patient.
3. The constitutional norm, testifying to the fact that every citizen has the right to protection of health and medical care. It is, first of all, about citizens who seek medical help and are endowed, in this regard, with the rights of the patient. The norms that give the patient any obligations in the field of medical activity, the basic law of the country does not contain. In particular, article 41 of the Constitution of the Russian Federation states that "in the Russian Federation, federal programs for the protection and promotion of public health are financed, activities (italics A.P.) that promote human health are encouraged ..." * (128). That is, the activity of citizens aimed at improving health by the state is encouraged, but citizens are not burdened with the performance of duties related to maintaining or improving their health.
Do the facts cited indicate the absence of obligations on patients and, in this regard, on the unnecessary inclusion of a sign called "duties" in the legal status of patients? According to the author, the answer is no. In previous studies on the legal relationship between medical workers and patients, the author has already dwelled on this problem. In particular, when receiving medical care, the patient has the right to receive information and manage the process of correcting his painful condition, without possessing, at the same time, the necessary knowledge. At the same time, a medical professional who has professional training, and, at times, considerable experience, is obliged to obey the desires and whims of the patient. In this situation, the medical worker is responsible for the course and result of the treatment process, which he is not able to fully control. In other words, we are moving from medical authoritarianism to the exact opposite - consumer extremism * (129).
So what are the patient’s responsibilities? It seems that the current state of the regulatory framework, the rich history of the legal regulation of medical activity in Russia, the influence of the moral, ethical and biomedical principles and provisions mentioned above indicate the possibility and necessity of highlighting the following patient responsibilities:
- compliance with the instructions of the attending physician regarding the administration of medicines and the implementation of prescribed medical diagnostic procedures,
- compliance with the regime of work and rest, physical activity, diet, associated with the correction of the patient's painful condition;
- compliance with the internal rules of the medical institution and the implementation of the recommendations of medical personnel in the case of medical care in a hospital;
- the implementation of periodic preventive medical measures at the time recommended by medical personnel;
- compliance with sanitary and hygienic requirements and rules of behavior that prevent the spread of dangerous infectious diseases (tuberculosis, hepatitis, HIV infection, sexually transmitted diseases, etc.).
If the legal consolidation of the listed obligations of patients at the level of legislative acts can still be considered only in the future, then, within the framework of bilateral contracts for the provision of medical care, at the level of by-laws (departmental) regulatory legal acts, it is perfectly acceptable to assign to patients the fulfillment of these and other duties.
It is advisable, in particular, to fix in the protocols for the treatment of certain diseases (approved by orders of the Ministry of Health and Social Development of the Russian Federation) the fulfillment by patients of certain duties aimed at improving the state of health and increasing the effectiveness of the performed medical intervention.
For example, Order of the Ministry of Health and Social Development of the Russian Federation of November 22, 2004 N 239 "On approval of the standard of care for patients with atherosclerosis" contains three sections: patient model, diagnosis and treatment without exacerbation at the rate of 6 months * (130). In particular, recommendations on adhering to the work and rest regimen, diet, medical appointments, albeit in a mild form, but nevertheless, could be expressed in the form of the patient’s responsibilities aimed at achieving a positive result of the treatment, which would certainly be very helpful. This approach to the legal relationship of medical workers and patients can be very effective, since both subjects of medical-legal relations will be interested in improving the patient’s health and in minimizing the negative consequences, complications, the development of which is possible in the process of providing medical care.
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