Illustrasjon

Samtykkekompetanse eller selvbestemmelse

Folk som trenger hjelp til å velge eller å tilpasse seg, skal også sikres sine ønsker og behov. Personens vilje må ikke forveksles med helsepersonells fordommer.

I Stange bor en kvinne som fylkesmannen mener ikke har samtykkekompetanse verken til å bo med samboeren sin, velge sin verge eller sine nærmeste pårørende. Med hjelp av vergemålsloven og tvangsbestemmelsene i helse- og omsorgstjenestelovens kapittel 9, fikk myndighetene kastet ut kvinnens samboer fra kvinnens leilighet. Tvangsvedtaket er påklaget, men fylkesmannen i Hedmark mener at ingen som taler kvinnens sak har klagerett. Saken fra Stange er en av mange saker som gir god grunn til å være kritisk til bruken av samtykkekompetanse.

 

I den senere tid har begrepet beslutningskompetanse kommet inn som et alternativ til samtykkekompetanse. Det er en viss forskjell mellom begrepene. Det å samtykke er en beslutning, men en beslutning kan være langt mer enn å samtykke. Om begrepene brukes ulikt i praksis, er jeg tvilende til.

 

FN-konvensjonen om rettighetene til mennesker med nedsatt funksjonsevne (CRPD) fastslår at mennesker med nedsatt funksjonsevne har rettslig handleevne. Da er det nærliggende å hevde at alle voksne også både har samtykkekompetanse og beslutningskompetanse. CRPD-komitéen har et slikt syn.

 

Både samtykkekompetanse og beslutningskompetanse har noe iboende diskriminerende og kategorisk. I enhver sak, kan en dele menneskene i to grupper, de med og de uten beslutningskompetanse. Begrepene er autoritære og bygger på at fagfolk har en gudegitt innsikt på et nivå som langt overgår Snåsamannen.

 

Samtykkekompetanse knyttes til evnen til å se konsekvensen av egne handlinger. Går en langs denne linjen, kan en havne i de mest grunnleggende filosofiske debatter knyttet til den frie viljen. På det praktiske planet, har fagfolk som fratar mennesker med utviklingshemning samtykkekompetanse i det å velge samboer, verken bedre skilsmissestatistikk, lykkeligere ekteskap eller bedre oversikt over konsekvensen av av egen ekteskapsinngåelse enn resten av befolkningen.

 

Ingen ser konsekvensene av sine handlinger. Til og med Magnus Carlsen gjør feilvurderinger ved sjakkbrettet. Utenfor sjakkbrette er feilvurderingene vanligere. Den dagen Magnus Carlsen får seg kjæreste, kan det være at han gjør et feilvalg. Sergey Karjakin er allerede gift for andre gang. Selv de skarpeste blant oss ser ikke konsekvensene av sine handlinger, men vi godtar det. For folk flest blir det å forhindre feilvurderinger verken en oppgave for vergemålsmyndighetene eller helsevesenet.

 

I likhet med Magnus Carlsen og Sergey Karjakin, overser mennesker med utviklingshemning også konsekvensen av sine handlinger. Forskjellen er at det av og til skal svært lite til før vergemålsmyndighetene, helsevesenet eller omsorgstjenesten kommer på banen.

Utviklingshemmede umyndiggjøres ved å frata dem samtykkekompetansen. Fratakelse av samtykkekompetanse er middelet som benyttes for å kontrollere mennesker, – få dem til å oppføre seg som en lege, psykolog eller vernepleier mener de burde oppføre seg. Tvangsvedtak fattes på de fleste av livets områder, til og med på de mest private områder som seksualliv, valg av samboer, det å bestemme hvem som skal være ens nærmeste pårørende eller hvem som skal hjelpe en i viktige private spørsmål.

 

Når en person med utviklingshemning er fratatt sin samtykkekompetanse, så tar myndighetene vurderingen for gitt. Både dommere, advokater og saksbehandlere har, i likhet med alle andre, problemer med å innse sine egne fordommer. Myndighetene hviler på legens vurdering og problematiserer den ikke.

 

CRPD legger stor vekt på at den enkelte skal kunne handle i samsvar med egne preferanser og ikke underlegges andres normer. Beslutningsstøtte er en løsning i konvensjonen.

 

Av og til handler folk i strid med egne interesser. I forvirring, kan en gjøre både det som er dumt og det som er skadelig. Manglende leseferdigheter kan medføre at en ikke får med seg skriftlige advarsler. Manglende forståelse av de fysiske lovene som gjelder i dagliglivet, kan medføre at en handler i motstrid til egne interesser.

 

Beslutningsstøttesystemene (som Norge foreløpig ikke har påbegynt arbeidet med å utvikle), kan bidra til å få personen til å handle i samsvar med sine egne interesser, men slik vil det neppe være i enhver situasjon for alle. For å unngå at en person handler i strid med egne interesser, kan det være påkrevd å iverksette tiltak utover beslutningsstøtten.

 

Det å handle i strid med egne interesser, er et vilkår som er langt mer i samsvar med CRPD enn manglende samtykkekompetanse eller beslutningskompetanse. Innføres et vilkår av den typen i vergemålsloven og helselovgivningen, så kreves en argumentasjon ut i fra personens vilje, til tiltaket som en skal iverksette.

 

En blir ikke kvitt alle etiske problemene selv om en bygger på folks egene interesser eller det at en kan handle i strid med egne interesser. En kan i det uendelige diskutere når en er såpass forvirret at en handler i strid med egne interesser. Hvordan interessene til en person er, kan by på problemer hvis personen selv ikke uttaler sine interesser. Men om en ikke løser alle de etiske problemene, så kan omfanget av etiske problemer reduseres. Folk som kjenner dem som trenger hjelp og bistand, vil f.eks. i svært mange tilfeller kjenne personens interesser. Men det prinsipielle er det viktigste, nemlig at en tar utgangspunkt i personens vilje og ikke forveksler dette med helsepersonells fordommer.

Jens Petter Gitlesen

27 november 2016

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