Vaksine

Tvangsvaksinasjon

Helsedirektoratet har gitt sin forståelse av hva som er lov når det gjelder koronavaksinering av personer uten samtykkekompetanse. Premissene er uklare, ikke verifiserbare og tildels ikke eksisterende. I stedet for å skrive uklart om tvangsvaksinering, bør Helsedirektoratet skrive klart om tiltak for å unngå tvang. 

De som ikke motsetter seg vaksinering

Helsedirektoratet skriver om personer som ikke samtykker, men heller ikke protesterer mot vaksineringen:

"Det ansvarlige helsepersonell må finne at vaksineringen er i den enkeltes interesse og at det er sannsynlig at personen ville ha gitt tillatelse til vaksineringen. Der det er mulig, skal det også innhentes informasjon fra personens nærmeste pårørende om hva personen ville ha ønsket. Det er viktig at det er personens antatte ønske, og ikke pårørendes ønske, som skal avklares. Det presiseres også at det er ansvarlig helsepersonell, og ikke pårørende, som tar den endelige avgjørelsen.

Ansvarlig helsepersonell skal samrå seg med annet kvalifisert helsepersonell før avgjørelsen tas. Selv om det i de fleste tilfeller er en lege som er ansvarlig for vaksineringen, kan vedkommende gjerne samrå seg med en sykepleier som har ansvar for daglig oppfølging og kjenner personen godt."

En bør stille spørsmål med:

  • Hvordan skal ansvarlig helsepersonell finne ut hva den enkeltes interesser er og sannsynligheten for at personen ville ha gitt tilltatelse til vaksineringen  [dersom vedkommende var samtykkekompetent]? Har helsepersonell denne kunnskapen? Hvis de mener å ha kunnskapen, hvor er kunnskapsgrunnlaget?
  • Hvem er "annet kvalifisert helsepersonell" som besitter kompetansen om den ikke samtykkekompetentes interesser?
  • Hvem har "sykepleier med ansvar for daglig oppfølging"?

De som motsetter seg vaksinering

For personer uten samtykkekompetanse og som motsetter seg vaksineringen, skriver Helsedirektoratet:

"Det er for det første et krav at tillitsskapende tiltak har vært forsøkt. Hensikten er å få personen til å forstå at det er i vedkommendes interesse å motta vaksinen. En trygg behandlingssituasjon med kjent helsepersonell er ofte av avgjørende betydning i det tillitsskapende arbeidet. Dersom helsepersonellet ikke når frem med tillitsskapende arbeid, kan det fattes vedtak dersom følgende vilkår er tilstede:

a) en unnlatelse av å gi vaksinen kan føre til vesentlig helseskade for personen, og

b) vaksinen anses nødvendig, og

c) tvangstiltakene står i forhold til behovet for vaksinen.

I tillegg må det vurderes at vaksineringen etter en helhetsvurdering fremtrer som den klart beste løsningen for personen.

Den (legen) som er faglig ansvarlig for vaksineringen må foreta en individuell vurdering av om vilkårene er oppfylt. Det må tas utgangspunkt i den enkeltes helsetilstand og ut fra det vurdere faren for vesentlig helseskade. Det må videre vurderes om vaksinering er nødvendig for å forhindre covid-19 sykdom, her må blant annet risiko og sannsynlighet for smitte vurderes. Videre må virkningen av å gjennomføre vaksineringen med tvang klart oppveie ulempene ved tvangstiltaket. Dersom vaksineringen ikke lar seg gjennomføre uten å benytte fysisk tvang, skal det mye til for å si at tiltaket er forholdsmessig.

I tillegg må vaksineringen fremstå som den klart beste løsningen for den enkelte. Det må spesielt ses hen til eventuelle bivirkninger av vaksineringen og det vises til FHI sin vaksineringsveileder og særlig avsnittet "vaksinering av svært skrøpelige og syke pasienter". Andre relevante momenter i helhetsvurderingen, er hvordan den enkelte vil oppleve isolasjon og behandling ved en eventuell covid-19 sykdom".

  • Hva er tillitsskapende tiltak og hvem besitter den nødvendige kompetansen?
  • Unnlatelse av å gi vaksine kan utvilsomt gi helseskade hvis en blir smittet, alvorlig syk eller dør. Det å gi vaksine til dem som motsetter seg, kan også gi helseskade. Hvordan skal avveiningen foretas?
  • Når må en anse det som nødvendig å bli vaksinert?
  • Når står tvangstiltakene i forhold til behovet for vaksine?
  • Hvordan skal behandlende lege kunne vurdere "om virkningen av å gjennomføre vaksineringen med tvang klart oppveie ulempene ved tvangstiltaket"? Selv vaksineprodusentene gir ingen dokumentasjon eller registrering av negative virkninger av tvangsvaksinering.

Helsedirektoratet bør vri fokus til hvordan en kan unngå tvangsvaksinering

Det kan stilles flere spørsmål enn lærde kan gi svar. Helsedirektoratet synes å ha en overdreven tro på legers innsikt i preferanser ønsker til mennesker med utviklingshemning. Fakta som skal legges til grunn før tvangsmedisinering kan gjennomføres, er i stor grad fakta som ingen kjenner til. Reaksjoner på tvangsmedikasjon synes å være berenset til rent kropslige reaksjoner.

Det at vaksinen ikke er testet ut på personer uten samtykkekompetanse, nevnes ikke. Heller ikke at dokumentasjonen av mulige bivirkninger av tvangsvaksinering, er fraværende.

Det vi derimot vet, er at kommunene ikke nødvendigvis følger lover, forskrifter eller anbefalingene fra Helsedirektoratet. Da bør Helsedirektoratet være ytterst forsiktig med å presentere uklare tekster og fortolkningsrom.

Vi er rundt 5,3 millioner nordmenn. En kan sikkert finne en og annen person med manglende samtykke som både lek og lærd mener bør tvangsmedisineres. Men Helsedirektoratet bør ikke begynne med unntakene. Før det skrives uklart om tvangsvaksinering, bør de skrive klart om hvordan kommunene kan legge tilrette for at flest mulig kan vaksineres uten bruk av tvang.

Jens Petter Gitlesen

28 januar 2021

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