Forsiden til tvangslovutvalgets innstilling

Fellesuttalelse mot tvangslovutvalgets forslag

Forslaget til ny tvangsbegrensningslov svarer ikke på utvalgets mandat. Tvangslovutvalgets utredning gir heller ikke grunnlag for større lovendringer, hevder 13 bruker- og arbeidstakerorganisasjoner i et felles høringsinnspill.

Høring av NOU 2019: 14 Tvangsbegrensningsloven - forslag til felles regler om tvang og inngrep uten samtykke i helse- og omsorgstjenesten.

En sammenslutning av arbeidstaker- og interesseorganisasjoner ønsker med dette å gi et felles innspill til forslaget fra Tvangslovutvalget.

Det var som vi ser det, tre hensyn som lå bak nedsettelsen av lovutvalget;

  • omfattende tvangsbruk

  • behov for forenkling og samordning av regelverket

  • få regelverket i tråd med menneskerettighetene/ FNs konvensjon for rettigheter til personer med nedsatt funksjonsevne (CRPD).

Vi mener flertallets lovforslag ikke svarer godt på noen av de utfordringene. Organisasjonene som har undertegnet dette høringssvaret ser behovet for gjennomgripende endringer i tvangslovgivningen innen helse- og omsorgssektoren. Vi ser imidlertid ikke, at forslaget til ny tvangsbegrensningslov dekker behovet for lovendring. Tvangslovutvalgets utredning gir heller ikke grunnlag for større lovendringer.

Det er positivt at utvalget skriver at de har hatt som mål å gi Funksjonshemmede konvensjonen (CRPD) et konkret og forpliktende innhold i en norsk kontekst. Utredningen reiser imidlertid ikke de prinsipielle problemstillingene rundt konvensjonens stilling i norsk rett, og en helhetlig gjennomgang av konvensjonen uteblir.

De undertegnede organisasjonene er enige om:

  1. NOU 2019:14 er svært omfattende og lite tilgjengelig gjennom både språk, omfang og kompleksitet. Både utredningen og lovforslaget er svært krevende å sette seg inn i. Forslaget til ny tvangslov er mer enn dobbelt så lang som de fire eksisterende lovverkene den er ment å erstatte. De skjønnsmessige begrepene er vel så mange som i eksisterende lovverk og krysshenvisningene er enda flere. Det er et demokratisk og rettssikkerhetsmessig problem når både de som loven angår og de som skal forvalte den finner det problematisk å se hva forslaget vil medføre i praksis.

  1. FNs konvensjon for rettigheter til personer med nedsatt funksjonsevne (CRPD) representerer et paradigmeskifte for funksjonshemmede. Det er en stadfestelse av at alle menneskerettighetene gjelder for funksjonshemmede på lik linje med andre. Det er også skifte av forståelse, fra en medisinsk/barmhjertighetsmodell hvor mennesker er objekt for ivaretakelse til en menneskerettighets/ sosial modell hvor mennesker er subjekter med egne rettigheter. Funksjonshemmede konvensjonen (CRPD) har stor betydning for funksjonshemmede både internasjonalt og i Norge. Det er svært problematisk at utvalget i så stor grad avfeier funksjonshemmede konvensjonens (CRPD)betydning.

  1. Norge må følge anbefalingene fra FNs funksjonshemmedes komite som sikrer overgang fra den medisinske modellen hvor fokuset er å rette på personen, til den sosiale- eller menneskerettighetsmodellen, hvor fokuset er å legge til rette for den enkelte. Norge bør følge rådene fra «Avsluttende uttalelse om besøket i Norge fra FNs spesialrapportør for rettighetene til personer med nedsatt funksjonsevne, Catalina Devandas» fra 11. oktober 2019, hvor spesialrapportøren kommenterer Tvangslovutvalgets forslag:

    «Selv om jeg bifaller mange av utvalgets forslag, klarer disse fortsatt ikke å beskytte rettighetene til personer med nedsatt funksjonsevne i tråd med internasjonale menneskerettighetsstandarder, inkludert CRPD. Etter mitt syn bør drøftelsene fokusere på hvordan man iverksetter beslutningsbistand og alternativer til tvang framfor på endringer innenfor eksisterende rettslige rammer. Det er mulig å yte psykiatriske helsetjenester og psykososial støtte uten noen form for tvang, som dokumentert av to institusjoner jeg besøkte her i Norge, basaleksponeringsterapien (BEP) ved Blakstad sykehus og den medikamentfrie avdelingen ved Åsgård psykiatriske sykehus. Tvangstiltak strider ikke bare mot menneskerettighetslover, de er også ineffektive for å beskytte enkeltmennesker, og kan hindre at mennesker søker hjelp og helsetjenester.»

  1. Behovet for tvang stimuleres eller forebygges ofte gjennom ulike relasjons- og livsforhold eller situasjoner. Gode livsforhold og aktive og meningsfulle liv, utfra den enkeltes egne preferanser er viktige forutsetninger for å unngå tvang. Tvangslovutvalget har i svært liten grad sett på hva som kan gjøres for å sikre trivsel og unngå uheldige livsforhold og ugunstige situasjoner. Vi vil minne om Helsetilsynets oppsummering av tilsynet med tjenestene til mennesker med utviklingshemming fra 2016 hvor det stilles fundamentale spørsmål:

    «De alvorlige forholdene som dette tilsynet har avdekket gir grunn til å stille spørsmål om dagens rammer og ressurser for kommunenes tjenestetilbud er tilstrekkelige til å sikre gode og trygge tjenester til alle brukerne. Har kommunene nødvendige forutsetninger for å etablere og drifte forsvarlige tilbud – også til brukere med store og komplekse tjenestebehov? Gir staten tydelige nok krav, føringer og faglig støtte til kommunenes oppgaveløsning? Prioriterer spesialisthelsetjenesten bistanden til kommunene høyt nok?»

    Tvangslovutvalget har ikke besvart spørsmålene. Utvalget har heller ikke i hatt godt nok fokus på årsakene til atferd som i dag utløser behovet for å anvende tvang. Heller ikke hvordan en kan unngå dette, er vektlagt. Oppgavene som verken Helsetilsynet, andre kontroll og overprøvingsinstanser eller domstolene har maktet å løse til nå, overlates ifølge lovforslaget til tvangsreduksjonsnemdene. Hvordan skal tvangsreduksjonsnemndene ha mulighet til å utøve sitt mandat på en god måte? Det gir NOUen ikke noen gode svar eller eksempler på.

  1. Forslaget til lovverk fremstilles som en avveining mellom behovet for retten til helsehjelp og retten til selvbestemmelse, men overser skadevirkningene av tvang i denne avveiningen.

    Det eksisterer få kontrollerte studier som dokumenterer de helsebringende effektene av tvangsbehandling. Studiene som ligger til grunn for Paulsrudsutvalgets og Tvangslovsutvalgets konklusjoner gjelder frivillig behandling, ikke tvangsbehandling.

    En mangler god dokumentasjon for eventuelt helsebringende effekter av tvangsbehandling. Da står en igjen med det åpenbare som at den som er innelåst, ikke kan gå ut. Er kjøleskapet låst, så kommer en ikke inn i det eller at det er lett å følge med den som har vedtak om fotfølging.

  1. Godt miljøarbeid er å hjelpe personer som er avhengig av bistand til å foreta gode valg i samsvar med deres preferanser og vilje. Godt miljøarbeid setter både krav til kompetanse og arbeidsbetingelser. Det er veldokumentert, blant annet gjennom nasjonale tilsyn med tjenestene til mennesker med utviklingshemming at det er store utfordringer knyttet til bemanning og kompetanse. Rammene for å utøve godt miljøarbeid er ofte ikke tilstede. Tvangslovutvalget omtaler knapt denne problemstillingen og det er ingen effektive reguleringer av forholdene i lovteksten.

    Mens det i helse- og omsorgstjenestelovens kapittel 9 settes krav til kompetanse for å utøve planlagte tvangstiltak, så er disse kravene fjernet fra forslaget til ny tvangslov.

  1. Forslaget til ny tvangsbegrensingslov snevrer inn tvangsbegrepet til å gjelde tiltak som personen motsetter seg. Vi vet at relasjonen mellom den som kan risikere å underlegges tvang og de som kan få personen underlagt tvang, på ingen måte er likeverdig. Det å ikke yte motstand mot overmakten, kan være en fornuftig strategi for den avmektige. Det å yte motstand mot tiltak setter krav til forståelsen av tiltakets konsekvenser. Det er urimelig å sette slike krav til mennesker i en utsatt situasjon. I tillegg er det et viktig moment at læring og erfaring ofte tilsier at motstand kan gi negative konsekvenser for den enkelte, og det er årsaken til at motstand ikke ytes.

    Det virker også inkonsistent å kreve at mennesker som er fratatt sin beslutningskompetanse fordi de ikke ser konsekvensen av egne handlinger, skal kunne se konsekvensen av tvangstiltakene som de utsettes for.

Avslutning

Om det er mulig i dag innenfor den norske virkeligheten å gå direkte fra dagens lovverk til et lovverk som er 100 % i tråd med funksjonshemmede konvensjonen (CRPD) lar vi stå åpent. At man ikke beveger seg i retning av funksjonshemmede konvensjonens (CRPD) grunnleggende forståelse og skifte av modell er ikke akseptabelt. Dette lovforslaget bekrefter en medisinsk modell, og kan ikke sies å gi funksjonshemmede konvensjonen (CRPD) et konkret og forpliktende innhold i norsk kontekst.

For å ha et lovverk rustet for fremtidens helsetjenester må lovverket ta funksjonshemmede konvensjonen (CRPD) som utgangspunkt og bygge derfra, og det krever en annen tilnærming enn utvalget har vist.

Vi krever at utredning av beslutningsstøtte settes i gang umiddelbart.   

Disse organisasjonene står bak høringssvaret:

Foreningen Spekteret, Hvite Ørn, Fellesorganisasjonen (FO), Norsk Forbund for Utviklingshemmede (NFU), Stopp Diskrimineringen, We Shall Overcome (WSO), Uloba, Landsforbundet for utviklingshemmede og pårørende (LUPE), Vernepleierforbundet i Delta, Funksjonshemmedes fellesorganisasjon (FFO), Autismeforeningen (AiN), Samarbeidsforumet av funksjonshemmedes organisasjoner (SAFO), Foreningen JAG

2 desember 2019

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