Smitte

Når smitten kommer

Kanskje er allerede noen med utviklingshemming smittet av koronaviruset. Uansett vil det første tilfellet komme i nær fremtid. Flere vil etter hvert ha vært i kontakt med noen som er smittet. For ikke å smitte andre, vil det bli snakk om karantene eller isolasjon. Hvordan en skal gjennomføre slikte tiltak på en skånsom og god måte, er det blitt sagt lite om.

Mange vil bli smittet og flere vil ha vært i kontakt med smittede

I forrige uke estimerte MRC Centre for Global Infectious Disease Analysis ved Imperial Colleg at drøyt 20.000 nordmenn var smittet av koronaviruset. Folkehelseinstituttet mente at tallet var misnt det dobbelte. Hver av de som er smittet, smitter i gjennomsnitt kanskje i overkant av en annen. Smitterne er nok stort sett ikke klar over at de er smittere. For det første kan en smitte andre før en blir syk. For det andre er det slett ikke sikkert at en blir syk selv om en er smittet. Island har testet store deler av befolkningen. Det viser seg at halvparten av de smittede ikke har merket noe som helst til viruset.

Avisene er fulle av skrekkhistorier om grufulle lidelser som følge av komplikasjoner med sykdommen. Det er ingen grunn til å betvile avishistoriene, men for det store flertallet, så vil det å bli smittet enten ikke merkes eller føre til en lett influensalignende sykdom. For noen, vil det bli langt mer alvorlig. For eldre mennesker, synes det å være svært farlig.

Vi blir neppe kvitt smittefaren før det kommer en effektiv og godkjent vaksine og massevaksinasjon er gjennomført. Når det måtte skje, vet en ikke, men det blir neppe i år.

2020 vil utvilsomt bli smittebegrensningens år. Hovedtiltakene er å sette de som har vært i kontakt med smittede i karantene og de som er smittet i isolasjon. Disse reglene gjelder alle, også mennesker med utviklingshemming.

Karantene og isolasjon av mennesker med utviklingshemming

Karantene av dem som har vært i kontakt med smittede og isolasjon av dem som er smittet, er blant de viktigste tiltakene for å begrense smittespredningen. I de absolutt fleste tilfellene baseres ordningen på tillit. Men om en ikke følger kravene, så finnes sterkere virkemidler.

En kan ikke forvente at tjenesteytere vil jobbe ubeskyttet overfor smittede eller personer med stor fare for å være smittebærere. Mange med utvilingshemming vil nok finne det rimelig uproblematisk å være isolert i en to ukers tid og stort sett bare møte tjenesteytere i beskyttelsesdrakter. Overfor disse, kan selvpålagt karantene og isolasjon fungere bra.

Men slik vil det slett ikke være for alle. Det å oppføre seg i samsvar med reglene for karantene og isolasjon krever blant annet at en forstår situasjonen, ønsker og evner å etterleve kravene til selvpålagt karantene og isolasjon.

Jeg kjenner personer som reagerer sterkt på¨selv de minste avvik fra faste rutiner. Å være innelukket i leiligheten og kun møte tjenesteytere i en slags romdrakt, kan skremme vettet av folk. I enkelte tilfeller kan det utløse utageringer. Mot utageringer hjelper heller ikke virusbeskyttelse. I andre tilfeller kan situasjonen bidra til depresjon, traumer og psykiske plager som vedvarer.

Lovgrunnlag

I utgangspunktet plikter kommunen å yte forsvarlige tjenester, dvs. tjenester av god kvalitet. I smittesituasjoner vil det si individuell tilrettelegging, godt miljøarbeid, god dialog med den saken gjelder, eventuelt med pårørende og verge. Ofte vil en nok finne slike løsninger. Med det finnes knapt kontroll med om det ytes forsvarlige tjenester til vanlig. I disse koronatider er kontrollen enda svakere.

Hvis karantene eller isolasjon ikke etterleves, så er ett alternativ å bruke tvang. Men tvangsbestemmelsene er heller ikke utarbeidet med tanke på mennesker med utviklingshemming og smittesituasjonen. Eksisterende tvangsbestemmelser er lite formålstjenelige.

Helsedirektoratet har utarbeidet en liste av aktuelle tvangsbestemmelser. Her gjengis aktuelle tvangsbestemmelser, i ulike situasjoner, overfor mennesker med utviklingshemming som motsetter seg tiltaket. Litt forkortet og forenklet, sier Helsedirektoratet:

Mangelfull hygieneHelse- og omsorgstjenestelovens kapittel 9 Rettssikkerhet ved bruk av tvang og makt overfor enkelte personer med psykisk utviklingshemning. Helsedirektoratet nevner også muligheten av å benytte pasient- og brukerrettighetslovens kapittel 4a. Jeg ser ikke helt hvordan håndvask etc. skal kunne defineres inn i kapittel 4a.

Sosial distanseHelse- og omsorgstjenestelovens kapittel 9 Rettssikkerhet ved bruk av tvang og makt overfor enkelte personer med psykisk utviklingshemning.

KaranteneHelse- og omsorgstjenestelovens kapittel 9 Rettssikkerhet ved bruk av tvang og makt overfor enkelte personer med psykisk utviklingshemning.

Undersøkelse/testingSmittevernloven § 5-2. Helse- og omsorgstjenestelovens kapittel 9 Rettssikkerhet ved bruk av tvang og makt overfor enkelte personer med psykisk utviklingshemning.

Isolasjon Smittevernlovens § 5-3 og § 5-4 Helse- og omsorgstjenestelovens kapittel 9 Rettssikkerhet ved bruk av tvang og makt overfor enkelte personer med psykisk utviklingshemning.

Helsehjelp ved sykdomPasient- og brukerrettighetsloven kapittel 4a. Helsepersonell loven § 7

Vi står overfor to overordnede problemer på feltet:

  1. Det gripes for lett til tvang i utgangspunktet. Rettsikkerheten er i utgangspunktet også svært lav, noe en f.eks. har registrert med alle ulovlige tiltak som er innført i landets bofellesskap.
  2. Ingen av tvangsbestemmelsene er laget med tanke på mennesker med utviklingshemming i situasjonen vi i dag står overfor.

Dagens tvangsbestemmelser fremmer bruk av nødrett

NFU er sterkt i mot dagens tvangslovverk. Men dette er ikke problemstillingen nå. Nå må vi forholde oss til lovverket som eksisterer.

  • Helse- og omsorgstjenestlovens § 9-5 åpner for tvangsbruk i form av
    1. skadeavvergende tiltak i nødssituasjoner
    2. planlagte skadeavvergende tiltak i gjentatte nødssituasjoner
    3. tiltak for å dekke brukerens eller pasientens grunnleggende behov for mat og drikke, påkledning, hvile, søvn, hygiene og personlig trygghet, herunder opplærings- og treningstiltak.

Punkt b ville i utgangspunktet vært naturlig å benytte i mange situasjoner. Imidlertid setter slike tiltak store krav til saksbehandling og saksbehandlingstid. Dersom en person med utviklingshemming skal i karantene nå, så kan en ikke vent i tre måneder på et overprøvet tvangsvedtak

Da vil en stort sett stå igjen med punkt a, nødrettsbestemmelsen. Problemet med nødrettsbestemmelser, er at rettsikkerheten stort sett er fraværende. En handler der og da for så å rapportere tvangbruken til fylkesmannen i ettertid. Når fylkesmannen får meldingen, så vil stort sett karanteneperioden over og eventuelle overgrep er utøvd.

Smittevernloven er om mulig enda mer mistilpasset. Her hjemles tvungen legeundersøkelse og tvangsisolering på sykehus. Når mange sliter med besøks- og utgangsforbud i bofellesskapene, så vil forholdene ikke bli bedre om en tvangsplasserer dem på sykehus.

Sykehusene vil heller ikke være interessert i å få økt belegg med utviklingshemmede som skal gjennomføre enkelt undersøkelse eller eventuelt tvangsisoleres. Sykehusene jobber med å frigjøre kapasitet slik at de kan ta i mot en forventet bølge av koronasmittede med komplikasjoner.

Pasient- og brukerrettighetslovens kapittel 4a har som formål å forhindre vesentlig helseskade og kan vel strengt tatt kun brukes overfor dem som er syke og trenger helsehjelp eller overfor dem som står i fare for å få vesenlig helseskade.

Helsepersonellovens § 7 sier at helsepersonell plikter å gi øyeblikkelig hjelp når det trengs og vil ha ytterst begrenset relevans i smittevernssammenheng.

Kort oppsummert: Ingen av tvangsbestemmelsene er spesielt egnet overfor mennesker med utviklingshemming i simittesituasjoner. Men tvang er blitt brukt. Fremover vil en se mye mer bruk av tvang. Når ingen av tvangsbestemmelsene er velegnet, så vil en få en kraftig økning i bruken av nødrett (§ 9-5, pkt. a i Helse- og omsorgstjenesteloven). Nødrett vil bli brukt, ikke fordi det er nødrettsituasjoner, men fordi den kan brukes. En kan f.eks. ikke bruke et vedtak som en ikke har.

Problemet med nødrettsbestemmelser, er at det knapt er rettsikkerhet for dem som rammes av tvangsbruken. Tjenesten kan gjøre hva de måtte mene. Rettsikkerheten begrenses til at fylkesmannen etter at tiltaket er opphevet i versefall kan si til kommunen: Dette var ikke bra, her har dere handlet ulovlig.

Kommunene bør etablere beredskapsplaner

I stedet for å iverksette utlovlig tvangsbruk i massivt omfang, bør kommunene forberede seg på at mennesker med utviklingshemming blir underlagt karantene og isolasjon. Det finnes mange muligheter uten bruk av tvang. Kommunen bør snarest mulig gå i dialog med den enkelte tjenestemottaker og deres pårørende med tanke på å komme frem til gode tiltak som kan fungere hvis det skulle bli aktuelt med karantene eller isolasjon. Habiliteringstjenesten bør også kunne bidra med forslag til tiltak.

Du kan hjelpe med tips, tanker og ideer

Mange har sikkert tenkt gjennom situasjonen og har forslag til tiltak og tilrettelegging som kan være fornuftige for noen med utviklingshemming som må være i karantene eller isolasjon. Det vil være fint om de som har tanker og ideer deler disse med oss andre. Skriv dine tanker i kommentarfeltet under. Slik kan du hjelpe andre.

 

Jens Pettet Gitlesen

6 april 2020

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