Bältesläggning och sondmatning - om patientens rätt till en rättssäker vård

Sammanfattning: In compulsory psychiatric care it is not uncommon for patients with anorexia nervosa to require enteral nutrition. Health care professionals sometimes use medical restrain to enable enteral nutrition. This has been criticised several times because the legislative support is not sufficiently clear, which affects the patient’s legal protection. The aim of this paper has been to study how medical restrain in connection with enteral nutrition without consent relates to the patient’s right to a legally secure health care. This includes the issue of whether enteral nutrition can be concluded in such treatment that can be given without consent by the Compulsory Mental Care Act, and the issue of which impact necessity has. The paper has concluded that there are many shortcomings in this field. It is not entirely clear whether it is permissible to give a patient enteral nutrition without consent according to 17 § of the Compulsory Mental Care Act, since this is a somatic treatment. However, the conclusion on this issue is that enteral nutrition can be included since the nutrient supply can contribute to the recovery from anorexia nervosa. It is however criticised that this is not more clearly regulated since it becomes difficult for the patient to predict which coercive measures the patient may be subjected to. The paper further discusses the issue of medical restrain in connection with enteral nutrition without consent. As medical restrain is a violation of integrity, it should be applied restrictively. Therefore, medical restrain as well as enteral nutrition without consent, must always be considered as a coercive measure. Medical restrain in connection with enteral nutrition without consent constitutes a double use of coercive measures in order to provide the patient with nutrition. Therefore, it cannot be considered lawful. However, the legislation is unclear on this point, giving rise to different interpretations by different actors. Thus, the patient’s right to a legally secure health care is not looked after. In light of this conclusion, the necessity was also studied to see whether it could change the assessment of this issue. The conclusion was that necessity does not change the lawfulness of medical restrain in connection with enteral nutrition without consent in the compulsory psychiatric care. The exception is if medical restrain is a necessary condition to accomplish enteral nutrition in cases where the patient’s life or health risks being acutely threatened without immediate nutrient supply. This therefore only applies to the most extreme cases. It is problematic from the point of view of the rule of law, that the legislation provides such scope for interpretation as it does today. Although it may enable individual assessments, it also makes it difficult for patients to predict the coercive measures they may be subjected to, which is especially important when it comes to interventions in bodily integrity. A thorough reform of the Compulsory Mental Care Act is therefore required to fulfil the requirements of the patient's right to legally secure health care.