Poročilo Varuha človekovih pravic Republike Slovenije o izvajanju nalog državnega preventivnega mehanizma za leto 2011 Implementation of the Duties and Powers of the National Preventive Mechanism in 2011 Patients’ clothing during daytime Oblačila pacientov v dnevnem času V PB Begunje smo ugotovili, da so pacienti in pacientke na oddelkih pod posebnim nadzorom tudi podnevi v nočnih oblačilih (pižamah). Čeprav tovrstna oblačila zapoveduje tudi hišni red, pa je vodstvo bolnišnice poudarilo, da pacientom vseeno omogočajo vsaj delno uporabo dnevnega oblačila (ogrinjalo in podobno). Vodstvo bolnišnice meni, da je to vprašanje sporno in da je bilo o njem (še) premalo razprave. Poudarili so, da tudi stališče Razširjenega strokovnega kolegija za psihiatrijo pri Ministrstvu za zdravje (RSK za psihiatrijo) ni bilo enotno. Bolnišnica meni, da tu ne gre le za bolnike na oddelkih pod posebnim nadzorom. Tudi na drugih oddelkih so nekateri pacienti v pižamah, drugi v oblekah. So pa tudi oddelki, kjer so vsi v svojih oblekah. Vodstvo bolnišnice meni, da bi nekateri pacienti, če bi imeli svojo obleko, lahko hodili iz bolnišnice po alkohol. Sprašujejo se, ali je bolj »človeško« posameznika omejiti znotraj oddelka pod posebnim nadzorom ali pa mu omogočiti večji krog gibanja, a ga vseeno »omejiti« z uporabo pižame. 34 In PB Begunje, we observed that the patients in secure wards spent the day wearing night clothes (pyjamas). Although such clothing is prescribed by the house rules, the hospital management pointed out that the patients were allowed to wear, at least partially, daytime clothes (dressing gowns). The hospital management believe that this issue is disputable and has not been sufficiently discussed. They stressed that even the Expanded Professional Board for Psychiatry at the Ministry of Health (RSK for Psychiatry) are not unanimous on this issue. According to the hospital, the issue does not concern only patients in secure wards. In other wards, some patients wear pyjamas and some wear clothes. And there are wards where all patients wear their own clothes. The hospital management believe that if some patients wear their own clothes, they would go out of the hospital to buy alcohol. They wonder whether it is more ‘humane’ to limit an individual within a secure ward, or allow them a wider freedom of movement, but ‘limit’ them by using pyjamas. Ker veliko pacientov pride higiensko zanemarjenih, PB Begunje poskrbi za njihova oblačila v pralnici, ki jim to omogoča. Če je treba, jim tudi priskrbi čisto obleko. Vodstvo bolnišnice tako misli, da so pižame boljše za primere, ko se pacient ponečedi, torej tudi s higienskega vidika, še posebej pri akutnih primerih. Ker sta oddelka majhna, si prizadevajo, da bi bili pacienti na njih čim krajši čas. Zato tudi v pižamah praviloma niso dolgo. Velika želja po svoji obleki je praviloma le pri bolnikih, ki še niso sprejeli svojega bolezenskega stanja in zdravljenja. Z nasprotovanjem nošnji pižame poskušajo dokazovati, da so zdravi in da ne potrebujejo zdravljenja. Ko so premeščeni na odprti oddelek, nošnji pižame praviloma ne nasprotujejo več. Bolnišnica je tudi pripomnila, da v splošnih bolnišnicah ni izbire, saj morajo tam bolniki nositi pižamo. Opozarja, da bi tisti, ki bi ne mogli dobiti dnevne obleke oziroma jim iz nekega razloga nošnje dnevnega oblačila ne bi dovolili, to jemali kot krivico, da jo drugi imajo. Since many patients on admission are hygienically neglected, PB Begunje takes care of their clothing in the laundry. If necessary, clean clothes can be provided as well. According to the hospital management, pyjamas are more appropriate when a patient defecates, i.e. in terms of hygiene, especially in acute cases. Because the wards are small, the hospital makes an effort to reduce the time spent there to a minimum. So patients usually do not spend much time wearing pyjamas. Only patients who have not accepted their medical condition and therapy have a strong desire to wear their own clothes. By refusing to wear pyjamas, they try to prove they are healthy and do not need treatment. When they are transferred to the open ward, they usually stop refusing to wear pyjamas. The hospital also noted that general hospitals do not offer a choice; pyjamas are mandatory. They point out that patients who could not get daytime clothing or would not be permitted to wear them for any reason, while others could, would consider it unjust. Razlogi PB Begunje, zakaj na oddelku pod posebnim nadzorom vztrajajo pri obvezni uporabi nočnega oblačila (pižame) tudi v dnevnem času, so lahko tehtni v posameznem primeru. Vendar pa smo tudi tokrat poudarili, da splošna ureditev, ko je nošnja nočnega oblačila na sprejemnem oddelku obvezna tudi podnevi, po našem prepričanju ni primerna. Znova smo opozorili na strokovno mnenje RSK za psihiatrijo, da je oblačilo, ki ga nosijo hospitalizirani na varovanih oddelkih psihiatričnih bolnišnic, izredno pomembno tudi za njihovo samopodobo in osebno dostojanstvo. Zato RSK tudi na teh oddelkih spodbuja nošnjo osebnih oblačil in jo utemeljuje s strokovnimi in humanističnimi dejavniki, razen v zelo izjemnih primerih, ko to otežujejo ali celo onemogočajo posebnosti telesnega zdravstvenega stanja bolnika oziroma potrebe po medicinskih posegih. RSK je še pojasnil, da spodbuja nošnjo osebnih oblačil tudi pri osebju na psihiatričnih oddelkih. S tem (strokovnim) stališčem se v celoti strinjamo. Zato smo predlagali, da o njegovem upoštevanju razmisli tudi PB Begunje. Hkrati smo predlagali, da bolnišnica spremeni hišni red tako, da na oddelkih pod posebnim nadzorom ne bo več splošne zapovedi nošnje bolnišničnih oblačil. To bo PB Begunje omogočilo, da pacientom, pri katerih bi bila nošnja dnevnih oblačil mogoča in smiselna, omogoči nošnjo tovrstnih oblačil (morebiti najprej delno, kot se glede na navedbe ob obisku že dogaja) in jih k temu tudi spodbuja. Bolnišnica se na naše pomisleke oziroma predloge ni odzvala. The reasons for PB Begunje making night clothes (pyjamas) mandatory wear during the day might be well-founded in particular cases. However, we emphasised that, in our opinion, the general regulation prescribing the mandatory wearing of night clothes in the reception ward also during the day is not appropriate. Again, we pointed out the opinion of the RSK for Psychiatry stating that clothes worn by hospitalised patients in secure wards of psychiatric hospitals are extremely important for their self-image and personal dignity. The RSK thus encourage the wearing of personal clothes in these wards and support this with professional and humanistic factors, except in rare cases when the particulars of a patient’s physical health or need for medical treatment make it more difficult or even prevent it. The RSK also added that they encourage the personnel working at psychiatric wards to wear personal clothing. We fully agree with this (professional) point of view. We therefore proposed that PB Begunje consider implementing it. At the same time, we suggested the hospital amend the house rules to eliminate the general prescription to wear hospital clothes in the secure wards. PB Begunje will thus be able to allow patients for whom the wearing of daytime clothing is possible and reasonable to wear such clothes (perhaps partially at first, as already occurs, according to the indications during the visit) and encourage them to do so. The hospital has not responded to our considerations or proposals. V nasprotju s PB Begunje v PB Ormož bolniki, ki bivajo v odprtih oddelkih, lahko nosijo svoja oblačila, tisti v ženskem in moškem oddelku pod posebnim nadzorom pa nosijo bolniško trenirko in majico. V pižamah so le tisti, pri katerih je to medicinsko zapovedano. Po besedah direktorice sicer niso zapazili, da bi bilo zaradi civilne obleke kaj več pobegov iz bolnišnice, kot jih je sprva tudi skrbelo. Kot je DPM že večkrat poudaril, dnevna oblačila po našem prepričanju pripomorejo h krepitvi človekovega dostojanstva in samospoštovanja, zato pozdravljamo omogočanje oziroma spodbujanje pacientov k nošnji dnevnih oblačil (razen takrat, ko je potrebna stalna nega). Unlike PB Begunje, patients in PB Ormož accommodated in open wards are allowed to wear their own clothes, and those in female and male secure wards wear hospital track suits and T-shirts. Pyjamas are worn only due to medical considerations. According to the manager, they have not noted an increased number of runaways due to ordinary clothing, as they had expected. As the DPM has stressed several times, we believe that daily clothes contribute to strengthening human dignity and self-respect; therefore, we are satisfied that patients are offered or encouraged to wear daytime clothing (except when constant care is required). Državni preventivni mehanizem v Republiki Sloveniji po Opcijskem protokolu h Konvenciji OZN proti mučenju in drugim krutim, nečloveškim ali poniževalnim kaznim ali ravnanju National Preventive Mechanism in the Republic of Slovenia under the Optional Protocol to the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment 35