The Multiple Sclerosis patients unfortunately today are often discriminated against and stigmatized. Multiple sclerosis and associated diseases in its various variants are still a mystery to most citizens. Ignorance and lack of knowledge about this pathology, the lack of information of the people and the lack of training of professionals in various areas are factors that impair the protection of the rights of people with M.S.
ANEM daily work to clarify the doubts, the falsar ideas about this disease. Here we present a set of questions that put us we think are relevant to be shared.
Several questions that we are asked weekly, such as click on the question :
When I apply for a job I am obliged to inform you that I suffer from MS?+
The applicant or employee is not obliged to inform your employer who has multiple sclerosis, given that this disease does not appear in the list of notifiable diseases in accordance with the Code of the 10th Revision of the International Classification of Diseases, pursuant to Resolution No. 313/97, of 27 July and constant Ordinance No. 1071/98, of 31 December.
However remember that there is a rule that the employee must inform the employer of relevant aspects for the provision of labor activity, otherwise be in violation of good faith inherent to the employment contract (art. 102º and 106 º, nº 2 do CT).
Thus, if your physical condition is not suitable for function or is limiting function should inform the employer of such a situation.
It convirá, clarify that the employer can and should have carried out tests or medical examinations for admission or continued employment for evidence of physical or mental conditions, when they have as their purpose the protection of the employee or third parties, or when particular requirements inherent in the activity warrant, It should be provided in writing to the employee the respective grounds (art. 19º do CT – Lei nº 7/2009, of 12 February).
The tests and medical tests will be done by the doctor's work that can only communicate to the employee if it does not qualify for the activity, but you can not tell the employer to suffer from any condition (art. 19º, nº 3 do CT).
The worker with MS is positively discriminated by the Portuguese labor law?+
The answer is clearly yes!
First the carrier M.S. is framed as a worker with a disability or chronic disease which allows him to exercise some specific duties relating to their situation.
From logo, worker with multiple sclerosis can not be required to provide additional or overtime (art. 88º CT), as it is released from the performance of work if it can harm your health or your job security, in situations of organized schedules according to the bank of hours or concentrated time or in the case of provision of night work between 20 h and a day 7 pm the following day (art. 87º).
Last, our legislation requires that the employer take adequate measures to ensure that the disabled person has access to employment, can progress, have professional training and adequate working conditions, under penalty of very serious offenses (arts. 84º, 85º e 86º do CT).
My son has MS. It will be that, I have more rights as a parent?+
From logo, parents are entitled to leave for a period of 6 months and may be extended up to 4 years to assist a child with a disability or chronic illness (art. 53º, nº 1 do CT).
In the case of children with 12 or more years of age assistance must be confirmed by a medical certificate (art. 53º. nº 2 do CT). Also in relation to faults there is a possibility that employee may be absent from work in order to provide urgent and essential care to the child with a disability or chronic illness to 30 days a year or throughout any period of hospitalization (art. 49º do CT).
For example, if the parents have a newborn with disabilities or chronic illness to one year, both parents are entitled to a reduction of five hours of normal weekly hours of work or other special conditions to watch son (art. 54º, nº 1 do CT), should the employer must adjust the working hours resulting from the reduction taking into account the employee's preference (54º, nº 5 do CT).
Another example, a worker with child with a disability or chronic illness are entitled to work flexible hours scheme, within hours of beginning and end of the normal working day (56º, nº 1 and 2 do CT).
What happens if I do not inform the insurance company that I am person with MS?+
It is usual that the people who help us to enter into an insurance contract personal accident or life, are insurance agents, their intermediaries or bank employees. Help saying what we should and should not say when fill in the health surveys.
We think we are helping to make life easier and, so we left satisfied and gladly accept all advice. Do not declare who has the disease, X, Y ou Z, do not say taking drugs, not tell who smokes, or drinking, etc.. The problem comes after. For regra, when fill in the health surveys should do so before a doctor and should be truly informed of the responsibility to fill in these forms normally with squares. Give one or more false answers is put into absolute risk the validity of such document.
In the case of multiple sclerosis omissions worsen because of the stigma of the disease and the risk that the insurance proposal is likely to be refused. This risk exists, But every situation is always an individual case and should be subject to assessment by the insurer, depending on the exact health condition of the insured.
It is therefore important that the insured is present provided with detailed reports and medical certificates, precise about their health condition, in particular their skills and abilities.
In our opinion the person with MS should never omit their disease before the Insurance Company, both in its celebration, either the validity of the insurance contract. The policyholder is required before the contract is concluded to declare exactly know all the circumstances and influencing the assessment of risk by the insurer, as stipulated in Art. 24Of the Law of Insurance Contract (Dec.Lei nº 72/2008, of 16 April).
Because, if the tainted contract omissions or intentional inaccuracies is voidable, statement sent by the insurer to the policyholder, pursuant to article. 25º, nº 1 Law of Insurance Contract. That is to say that at the time the Company has to pay compensation to the insured, will determine your entire medical history and discovering who suffered from multiple sclerosis and not saying cancels the insurance contract, cancellation must be sent within 3 months of the knowledge (art. 25º, nº 2). Thus, Insurance Company not only pay compensation, as does their all amounts received by the insured, by this bad-faith (art. 25º, nº 4).
The insurance company may refuse to enter into an insurance contract? You can practice different prices for people with MS? The prices can be double or triple insurance premiums of any other person?+
It should be noted that the Law of Insurance Contract (Decreto-Lei nº 72/2008, of 16 April) establishes in its article 15 the prohibition of discriminatory practices in the celebration, implementation and termination of insurance contracts, breach of the principle of equality of article 13 of the Portuguese Constitution by Insurance Companies.
considers discriminatory practices "on grounds of disability or at risk of worsened health, the actions or omissions, intentional or negligent, that violate the principle of equality, implying for people in that situation less favorable than that which is given to another compatible situation in treatment. " (art.º 15º, nº 2).
However, are not prohibited discriminatory practices that are based on practical and technical assessment, selection and acceptance of own the insurance risk and which are objectively justified, based on rigorous statistical data.
As one can easily understand to be a contract of insurance must be a risk to insure, so there are risks that are "inseguráveis", as well as risks that are superior to others and as such will have insurance premiums too many. The higher the greater the risk premium, we can say.
In relation to personal insurance contract, where risks are covered for life, health or physical integrity, It will be crucial to say that everything will depend on the health and medical examinations to perform the insured person, aiming at assessing the risk.
Again it is reiterated that each case is a case of multiple sclerosis and each patient must be examined individually (art.ºs 175º, 177º and 178 º CT).
The questions of Insurers can practice different prices for people with multiple sclerosis and these prices can be double or triple insurance premiums of any other person, we will say that the prices could be effectively higher than those in relation to others, however Insurers should provide information to the applicant on the ratio of the specific risk factors and the risk factors of another person not affected by this disability or aggravated health risk.
So, is necessary for insurance companies in addition to use in good faith, provide an explanation of the reasons why are the prices higher than normal and the reasons for such discrimination.
Patients with MS, can be legally supported by an association to defend their interests?+
Associations such as ANEM could support legal and procedurally people with multiple sclerosis, pursuant to article 15 of Law No. 46/2006, of 28 August (Which law they were to object prohibit and punish discrimination, direct or indirect, on disability and the presence of increased health risk, and sanction the practice of acts that translate in violation of economic rights, social and cultural).
Thus, the ANEM can intervene with active legal standing on behalf or in support of stakeholders in the respective legal proceedings. The associations shall also enjoy the right to monitor its associated in misdemeanor proceedings and still have the right to constitute assistants in criminal cases.
|“MS is fatal”||
In the earliest epidemiological studies the life expectancy of patients with M.S. It was considered not very different from the general population, although in patients with high failure can occur early death from complications such as pneumonia. In more recent studies comparing and patients who were treated for 21 years with interferon beta with those who were not treated, it was found that in patients treated there was a longer survival, pointing to a benefit in the long term with treatment.
|“Sooner or later I will be in a wheelchair”||
It is likely that each of us know someone with M.S. in wheelchairs but this does not mean that all patients become wheelchair. It is difficult to predict the degree of disability but the use of disease modifying drugs to delay disease progression.
|“The treatments are all the same”||
Currently there are several therapies for M.S., Since drugs that treat disease (disease-modifying) treatment directed to the outbreaks and symptoms of the disease. Regarding disease modifying drugs, those approved in Portugal are interferon beta 1b (Betaferon® e Extavia®), interferon beta 1a (Avonex® e Rebif®), o acetato de glatiramero (Copaxone®), o natalizumab (Tysabri®) e o fingolimod (Gylenia®). They differ in the form of administration, the side effects and effectiveness. The first three are injectable and are approved as first-line drugs. Despite being injected and therefore less comfortable for the patients known to be safe in the long term it is. The other two are more effective and have been approved for aggressive forms of the disease because despite more convenient administration are considered less secure. Natalizumab requires pesquiza serology for JC virus and the positive patients should not make more than two years of treatment. The fingolimod requires cardiac monitoring in the first 6 hours and regular reviews of the control of lymphocytes and liver enzymes. to 4 months is also performed ophthalmologic evaluation for macular edema screening. For outbreaks are used corticosteroids that can decrease the duration of outbreaks and speed recovery. For the symptoms there is no pharmacological treatment (as physiotherapy) and drug as muscle relaxantes for a espasticidade, anticholinergics for urinary dysfunction, sildenafil for sexual dysfunction, antidepressants
|“People with MS can not have children”||
A E.M. affects 3 times more women than men in fertile age and so this question usually care much patients. However pregnancy phase is considered a protective phase with reducing the number of outbreaks especially during the 2nd and 3rd quarter and did not seem to affect the long-term disability.
|“I IN, so my children will also have the disease”||
A E.M. is not considered a hereditary disease and so the fact that the disease does not mean that your child too will have the disease. However studies suggest that children of parents with M.S. are approximately 4% of developing the disease, which is more frequent than in the general population.
|“My MS was triggered by an infection”||
It is thought that the etiology of M.S. be multifactorial, i.e, that there are several factors that may play a role in its onset. These include genetic predisposition, environmental factors such as viruses, Vitamin D and deficit associated with smoking a dysregulation of the immune system
|“People with MS can not sunbathe”||
Studies have shown that patients with M.S. They have Vitamin D deficit and so it is important sunbathing (if properly protected and avoiding peak hours) because vitamin D transmitted by the sun can benefit the treatment of M.S.
|“People with MS can not go to the gym”||
It was once thought that physical exercise worsened the disease, however now it is known that physical activity is important because it can improve many symptoms of M.S. but it should be adapted to the physical capabilities of the patient. It is known that overheating can worsen the symptoms of the disease and so it is important to avoid this extreme making frequent intervals.
|“MS is easy to diagnose”||
Symptoms of E.M. They can be observed in other neurological disorders, and therefore it is necessary that they be excluded before doing the diagnostic M.S. There must be evidence of demyelination at two points in time and at different sites within the central nervous system. There are several tests that may aid in the diagnosis such as MRI, Evoked Potentials and lumbar puncture. The latter is particularly important when there is diagnostic doubt.
|“I can not do anything to help my illness”||
There are many things that patients can do to have a balanced diet, do not smoke, exercising, sunbathing and take the medication prescribed by your doctor.
Ana Paula Sousa, Neurologist – Neurologic Senior Campus
In conclusion, have rights. We have the right to be informed and the duty to inform ourselves, but above all we must have the courage to fight for the defense of our rights if we want to progress and end discrimination that all patients experience in their day-to-day.
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