PART IV PART III PART II PART I CHANCELLOR OF JUSTICE AS NATIONAL PREVENTIVE MECHANISM provision of health services affects a person’s body and spirit in one or another way, it is necessary that already prior to the commencement of the provision of the service a person could decide whether they wish the service to be provided or not. Therefore, the Chancellor proposed to ensure that patients coming to receive the nursing care service or their legal representatives are always immediately asked for a consent for the provision of the service and it is recorded in writing. To obtain a proper consent, it should be ensured that a patient’s treatment documents contain an explanation why the provider of nursing care services found that the patient had no capacity to decide or a patient with limited capacity was not able to weigh responsibly the pros and cons of the provision of the service. 8.4. Care corresponding to human dignity In the opinion of the Chancellor, in two of the institutions107 there was a risk of degrading human dignity of the patients during the provision of the nursing care service. It was found during the inspection that feeding of the patients was rushed and some patients had to go to sleep on an empty stomach. Some patients complained that the staff did not provide them sufficient information concerning their stay at the hospital, and in case of asking for assistance the response was angry. It was also found that no particular attention was paid to finding leisure activities for patients, including taking them outdoors. In addition, the Chancellor had a suspicion that the following situations may lead to the degrading of human dignity: −− patients are forced to wash in an insufficiently heated room; −− patients are forced to eat in the conditions where people would normally not eat voluntarily; −− lack of sufficient supervision of dementia patients creates a situation where one dementia patient can lie down to sleep next to another patient. § 10 of the Constitution gives rise to the principle of human dignity which is one of the main constitutional principles.108 The answer to the question when is a person’s dignity degraded in a manner which could amount to ill-treatment, i.e. when is the prohibition of degrading treatment under § 18 of the Constitution violated, depends to a large extent on the particular circumstances.109 For example, situations where treatment humiliates or debases an individual, showing a lack of respect for or diminishing their human dignity, or the behaviour which arouses feelings of fear, anguish or inferiority, could amount to a degrading treatment.110 Therefore, the Chancellor found that the above situations cannot be considered compatible with the principle of respect for human dignity and proposed to the institutions to ensure that nursing care patients are treated in line with human dignity in all situations. 8.5. Language barrier In one institution111 it was found that the patients speaking only Estonian had problems of communication with the Russian-speaking staff, as some of the Russian-speaking staff did 38 107 See the inspection visits to PJV Nursing Care Foundation (case No 7-9/140101) and Kallavere Hospital Ltd (case No 7-9/131434). 108 The principle of human dignity gives rise to the requirement to treat people as subjects regardless of their current situation. This means that people should be treated with respect and they should be seen as autonomous subjects with their own will. Persons may not be seen or treated as a thing. Similarly, they may not be forced into conditions which debase their dignity as humans. 109 The duration of the treatment, its impact on the person (both physical and mental), the person’s gender, age and health, the combination of different conditions and the situation of the particular person also have to be taken into account. 110 See also the European Court of Human Rights judgment of 9 January 2014 in case No 66583/11, Budanov v. Russia, para 64. 111 See the inspection visit to Kallavere Hospital Ltd (case No 7-9/131434).