Public attitudes and health law in conflict: somatic vs. mental care, role of next of kin, and the right to refuse treatment and information

Abstract

Background Norwegian law and regulations regarding patient autonomy and the use of coercion are in conflict with the Convention on the Rights of Persons with Disabilities (CRPD) and the Oviedo Convention on several points. A new law concerning the use of coercion in Norwegian health services has been proposed. In this study we wanted to investigate the attitudes of the Norwegian lay populace with regards to some of these points of conflict. Methods An electronic questionnaire with 9 propositions about patient autonomy, the use of coercion, the role of next of kin, and equality of rights and regulations across somatic and mental health care was completed by 1617 Norwegian adults (response rate 8.5%). Results A majority of respondents support the patient’s right to refuse treatment and information in serious illness, that previously expressed treatment preferences should be respected, that next of kin’s right to information and authority in clinical decision-making should be strengthened, and that this kind of legal regulations should be equal across somatic and mental health care. Conclusions The findings in this study suggest that the opinions of the Norwegian lay populace are in conflict with the national law on several points relating to patient autonomy, the role of next of kin and use of coercive measures, and different legal regulation of somatic vs. mental health care. The study suggests that the populace is more in line with the CRPD, which supports equal rights across somatic and mental health care, and the Oviedo Convention, which does not allow for the same degree of strong paternalism regarding coercive measures as the current Norwegian law. This can be taken to support the recently proposed legislation on the use and limitation of coercion in Norwegian health services.

Positive attitudes to advance care planning – a Norwegian general population survey

“…Respondents wanting next of kin rather than health care personnel to have the final say is supported by other studies [10,12,49]. In the Norwegian legal context, opinions of next of kin should not be decisive in end-of-life decision-making.…”

“…The survey question did not state that the patient lacked decision-making competence and competent Norwegian patients do have rights in consenting to healthcare decisions. Nevertheless, Norwegian law give physicians vast judicial power in decision-making when patients lack decision-making competence or in emergency care situations (independent of decision-making competence) [ 10 ]. However, our results may indicate that the public values patient, next of kin or shared decision-making over leaving decisions to health care personnel.…”

“…Next of kin should instead contribute by relaying previous statements and values stated by the patient. Contrary to Norwegian law, there are indications that a majority of the Norwegian populace want decision-making authority [ 10 ]. Although in practice, next of kin seems to be receiving more responsibility in end-of-life decision-making than they ought to according to the law [ 50 ].…”

“…Certainly, Norwegian law acknowledges a patient’s right to consent to care and to participate in decision-making. However, Norwegian health laws can be considered quite paternalistic with much power given to physicians and other health care personnel, especially during emergency situations (health personnel act §7) and when patients have reduced/lost competence to consent (patient and user rights act §4–6) [ 10 ]. For patients without decision-making competency, the role of next of kin is limited to relaying what the patient has previously expressed about his/her wishes, and does not involve making decisions on the patient’s behalf (patient and user rights act).…”

Norwegian Cross-Cultural Adaptation of the Social and Communities Opportunities Profile-Mini for Persons with Concurrent Mental Health and Substance Use Disorders

“…Norway has a semi-decentralized health care system, where the state is ultimately responsible for specialist care, which is administered by four regional health authorities, whereas municipalities are in charge of primary care (Ringard et al, 2013). Modifying the items regarding contact with health care due to mental or physical health problems may therefore have been suitable for the Norwegian situation, where mental and physical health care and the corresponding legislation are still split (Wikstøl et al, 2021). Further, the shortening of item 13 about further education to whether the person had obtained a qualification form the course is reasonable from a cultural perspective and regarding participation in society, since this information is not essential for the outcome of the assessment tool, namely social inclusion and societal participation.…”