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English Language Page Confidentiality is a manifestation of the inviolability of patient’s privacy, first and foremost of their personal information and everything that has to do with their social status and economic interests. Confidentiality in the medical law acts as a “medical secret.” This notion implies responsibility of not only doctors, but also that of all levels of staff and official personnel. Everyone who has come to possess such information is obligated to comply with the confidentiality requirement. All patients have the right to confidential communication with a lawyer and a clergyman, as well as to preservation of integrity of this communication, and this right is unconditional. As far as confidentiality of correspondence, meetings with relatives, etc. is concerned the law accounts for a possibility to restrict it at recommendation of the attending doctor (Article 37). One must admit that current conditions within the majority of psychiatric institutions prevent patients from fully implementing their right to confidentiality of meetings. If needed, a personnel room and sometimes the office of head physician are provided for a meeting with a lawyer or a clergyman. Apparently, this only applies to situations when the number of patients requiring such communication is minimal. If 20-25% of patients require private meetings institutions are not able to guarantee full protection of their privacy. Nevertheless, the readiness of institutions’ staff members to look for and find possibilities to ensure confidentiality is a positive factor and at least it indicates that should necessary conditions be created this right could be exercised to a much higher extent. At the same time there are still a certain number of institutions whose administrations do not view privacy of their patients as something important and are reluctant to provide conditions of confidentiality when they meet with lawyers and clergymen. One of the chief physicians commented on the right to confidentiality in the following manner: “What shall we do if he cripples this priest? Some patients ask for a chance to confess, we do not object as long as they agree to do it in the presence of an orderly or a nurse.” Physicians of other clinics did not deny the right of patients to confidentiality of meetings but stated that at present this issue was of no current importance. For example, the chief physician of the Bryansk regional psychiatric clinic #3 said: “None of our patients has ever requested a private meeting with a lawyer or a priest.” Confidentiality of correspondence is observed in approximately half of the surveyed clinics (47%). In the rest of them it is either incoming (in order to not hurt the patient) or outgoing (in order to not send out gibberish) mail that is censored, or both. Federal Law “On Psychiatric Care” allows physicians to do so in the interests of health and safety of other individuals. It is important to ensure however that the information contained in patients’ correspondence is protected by medical confidentiality as much as the information concerning their medical condition. Confidentiality of telephone conversations in the current conditions is absolutely unachievable. Telephone conversations using the clinic’s official phone that patients are sometimes, usually in the evening, allowed to have always occur under control of the personnel. Payphones are installed in 10 (11%) of the surveyed psychiatric institutions and only in one of them a payphone is installed in such a fashion so as to provide the caller with maximum possible privacy. Meetings in the majority of psychiatric institutions occur under control of personnel. In some of them this rule applies to all visitors (Kursk regional psychiatric clinic — “personnel must be in the room”; Kursk regional psychiatric clinic — in the presence of a nurse; Penza regional psychiatric clinic — in special rooms in the presence of a clinical staff member, Kuznetsk city psychiatric clinic of the Penza region — in the vestibule in the presence of an orderly, etc.). In a number of other institutions such restrictions do not apply when patients meet with their close relatives or custodians (Vladimir regional psychiatric clinic #4, Belgorod regional psychiatric clinic — “If we trust them, they can have privacy,” etc.). And finally, there are clinics where patients are allowed to meet with their visitors in privacy and even go out for a walk with them, but in each particular case the decision is made on an individual basis depending on the patient’s condition and “conscientiousness” of their visitors (Arkhangelsk regional psychiatric clinic #2, Bobrovo-Dvorskaya psychiatric clinic of the Belgorod region, Irkutsk regional neuro-psychiatric dispensary). The right to participate in elections Individuals suffering mental conditions have the full scope of rights and freedoms accounted for by the RF, Constitutions of republics within the Russian Federation, legislation of the Russian Federation and republics within the Russian Federation. Restriction of rights and freedoms of the citizen associated with their mental disorder is only allowed in cases accounted for by the law of the Russian Federation. According to this provision all citizens with mental disorders, including those in resident therapy, have the right to participate in elections. The only exceptions are persons recognized as mentally disabled in the court of law. Nevertheless, several years after the adoption of the law elections at psychiatric institutions were an exception rather than a rule. This situation changed in more recent years and now the exception is institutions whose patients do not participate in elections. As a rule, election rights are violated due to ineffective work of election commissions when voting is not organized in remote residential areas where some institutions are located. “Election authorities do not come to the clinic” (Chita regional psychiatric clinic #1). A similar situation is characteristic of the Prokhladnensk district psychiatric clinic of Kabardino-Balkaria which is located in a difficult to reach area. Sometimes election rights are violated because head physicians have biased opinions about the unreasonableness of patients’ electoral behavior. “Never! All patients have serious conditions and it is rarely when some of them can clearly express their will.” Some clinics restrict election rights of certain categories of patients. For example, at the Moscow psychiatric clinic #4 voting is not held in departments for patients of senior age, and at the Republican neuro-psychiatric dispensary of Kalmykia a commission of doctors decides whether or not to allow a certain patient to take part in the voting process based on their current condition. In the other 80 psychiatric institutions (86%) practically all capable patients are provided with opportunities to exercise their rights to participate in elections. Many large clinics provide their premises for the establishment of election precincts (Republican psychiatric clinic of Bashkortostan, Republican neuro-psychiatric dispensary of Buryatia, and some others) while others prefer to provide their patients with a vacation day so that they could participate in the voting at the place of their registration. For example, administration of the Penza regional psychiatric clinic identifies in advance which patients will not be able to vote at the place of their registration and submits lists of such patients to election precincts so that to enable them to vote at the clinic. According to some chief physicians (Vologda regional psychiatric clinic, Orenburg regional psychiatric clinic #1, Perm city psychiatric clinic) approximately 60-70% of patients usually vote. However, according to international norms it is not enough to simply provide a mental patient with the right to participate in elections. Yet in 1977 the 29th session of the Parliamentary Assembly of the Council of Europe in its recommendations concerning the situation with mental disorders (#818) petitioned to governments of all participating states, that: To ensure implementation of the election right of all mental patients capable of understanding the meaning of elections by carrying out necessary activities to facilitate the conduct of less-burdensome voting, ensure accessibility of information on social affairs, and inform mental patients of the procedure, timeframe, registration, etc… Thus, administrations of institutions must provide their patients with election information in the most comprehensive and adequate for them manner, which as a rule never happens. On one hand chief physicians are not concerned with such activity, on the other hand election commissions which are the sole legal source of information on the course of election campaign (Part 6, Article 20 of Federal Law “On Basic Guarantees of Election Rights and the Right to Take Part in a Referendum of Citizens of the Russian Federation”) do not always distribute information about candidates in a timely fashion. |
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