Ar Lietuvos Respublikos teisės aktais užtikrinama kokybiška sveikatos priežiūra asmenims atliekantiems laisvės atėmimo bausmę? ; Does the Legislation of the Republic of Lithuania Ensure Quality of Health Care for the Persons under Sentence of Imprisonment?
This aim of this Master's thesis is to carry out the analysis of health care quality of people serving imprisonment sentences. There are several works and studies of foreign authors on this theme, however Lithuania is unlikely to have at least one scientific work dealing with health care quality of prisoners. Non-governmental organizations and defenders of human rights draw attention to the serious existing problems of health care quality assurance in places of detention. The existing international, regional and national legislation establish a person's right to health, the best possible mental, emotional and social well-being. The prisoners are not an exception. It is noted that the freedoms of prisoners must be the same, equivalent health care services that are available in the country without discrimination based on their legal status. However, the practice is different. Persons that are in custodial places lose access to health care services that were available to them while they were outside of prison. Often in prison certain health care services are not available, what is more, when a person ends up in an imprisonment institution the treatment given while such person was free is unilaterally terminated and other treatment or no treatment at all is given, as an argument is given legal regulation, the treatment adjustment to the detention regime, as well as the environment. The paper has analyzed in detail the international, regional, national legislation and other documents, as well as case law of Lithuania and European Court of Human Rights relating to legal regulation and guarantee of health care of persons serving imprisonment sentences. In the international and regional level the right to health is established by common principles and standards, and in the national legislation according to the international and regional sources, the organizational features of the person's right to health care are provided in detail. As for the regulation of prisoners' health, it is a bit confusing in the same national law, i.e. the general and special regulations are intertwined. In the national law, in the norms of health protection the assurance features of prisoners' health care are often separately stated, and on the contrary, in some areas the prisoners' health care is determined exclusively by mere general regulation. Also, certain areas are regulated by both the general and the special laws. Concepts of general health health care includes preventive medical care, emergency medical services, diagnosis and treatment, rehabilitation, sanatorium treatment, and care. Prisoners' health care is derived from the principle of equality, and the content of this right is analogous to the content of the general concept of health care. Given the conditions of detention, treatment and other factors, the method of provision of these services and their scope may differ. However, these differences must be objectively and reasonably justified. Paper has analyzed the features of prisoner's health care according to the most problematic aspects. This part has been also intended to reveal the basic standards, principles and attitudes describing security of prisoners' health care. The right to quality mental health care is not assured for the persons serving prison sentences. Current legal regulations do not provide treatment according to the individual indications, ignores that individuals with mental illness are more vulnerable, and they need a higher level of constant care. The availability of adequate specialized health care institutions is not assured, the health care institutions of penitentiaries do not have authority to issue instructions for treatment in a specialized institution. Equivalent services are not assured, the general regulation of mental health care is not followed, forced hospitalization in specialized institutions is solved only on the basis of criminal law. It has also been found out that the persons serving imprisonment sentences are not guaranteed access to quality treatment of mental and behavior disorders caused by drugs or psychotropic substances. When a person ends up in an imprisonment institutions the continuity of treatment is not ensured, the treatment is unilaterally terminated by the prison doctor. The availability is not guaranteed, i.e. in places of detention such treatment that is available being free is not available (substitution supportive treatment). The access to rehabilitation for addiction is restricted, there are selection criteria, and violations of procedure deprive a person's right to rehabilitation for one year. Also, the persons serving imprisonment sentences are not guaranteed the right to good quality health care. If the person serving imprisonment sentence was recommended some treatment in a public health institution, but in the prison it is not possible to provide such treatment, it is replaced by a similar treatment or is terminated as unnecessary. Such treatment as rehabilitation is not possible at all. The main finding of the thesis is that health care services are ensured for the prisoners, but their quality is poor. It is officially declared that the health care services of equivalent quality must be available to prisoners as those available outside of prison, it is aimed to formally establish the provision of such services. However, the reality is different. There is stigmatization and discrimination of the prisoners' legal status from not only the prison authorities but also the courts. The equal health care is not ensured, as the existing legal regulation does not provide availability, continuity, and provision of health care services according to indications on individual and environmental factors, does not provide the strategy for health care services (for a dual legal regulation, the general and special, the legal clarity is lost). After a review of the European Court of Human Rights and the sources that discuss the prisoners' health, it must be concluded that because of the conditions of detention and the treatment itself, the objectively and reasonably justified differences in society and in prison in the area of health care vary in their extent, their method and order. However, the principle of equality ensures that the person does not lose the right to adequate, affordable preventive medical care, emergency medical services, diagnosis and treatment, rehabilitation, sanatorium treatment, and care. The study leads to the conclusion that the laws of the Republic of Lithuania do not guarantee high-quality health care services for the prisoners.