Patient Rights

[Jonathan Buhacoff]

A “Patient Bill of Rights” describes rights specific to medical patients as a group.

These rights extend the fundamental rights and it should be possible to map each patient right to one or more fundamental rights.

The American Patient Rights Association published a set of 15 patient rights. Each of these can be mapped to one or more of the following fundamental rights: right to life, right to dignity, right to consent, right to privacy, right to kudos, right to equal opportunity.

From https://www.americanpatient.org/aha-patients-bill-of-rights/:

“These rights can be exercised on the patient’s behalf by a designated surrogate or proxy decision-maker if the patient lacks decision-making capacity, is legally incompetent, or is a minor.” If we were to rewrite this statement in accordance with the working definition here, it would be that a law should be enacted to allow designated people to make medical decisions on behalf of an incapacitated person or minor, and that everyone has a duty to fight for patient rights when they know of a violation.

“1. The patient has the right to considerate and respectful care.” This is covered by the right to life (the doctor or medical team must not do things to harm the patient) and the right to dignity.

“2. The patient has the right to and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment, and prognosis.” This is covered by the right to consent — the patient (or designated decision-maker) needs that information to make decisions. This is covered by the right to informed consent for waiver of rights (in case treatment doesn’t work or something goes wrong even when the doctor and medical staff are following best known practices).

“3. Except in emergencies when the patient lacks decision-making capacity and the need for treatment is urgent, the patient is entitled to the opportunity to discuss and request information related to the specific procedures and/or treatments, the risks involved, the possible length of recuperation, and the medically reasonable alternatives and their accompanying risks and benefits.” This is again the right to informed consent to waive personal rights, and also the right to life — the doctors and medical staff have a duty to fight for the patient’s life by providing medical care in the case of an emergency and in that situation, where they cannot practically get consent, they don’t need it because if they don’t act immediately the patient will die.

“4. Patients have the right to know the identity of physicians, nurses, and others involved in their care, as well as when those involved are students, residents, or other trainees.” This is again the right to informed consent because it could affect their decision. In most cases this information may be meaningless to patients but in cases where it has meaning, it’s important to decision-making, and therefore covered by the right to informed consent.

“5. The patient also has the right to know the immediate and long-term financial implications of treatment choices, insofar as they are known.” This is again the right to informed consent.

“6. The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. In case of such refusal, the patient is entitled to other appropriate care and services that the hospital provides or transfer to another hospital. The hospital should notify patients of any policy that might affect patient choices within the institution.” This is the right to consent for the patient, and also the right to consent for the doctor and of the director of the medical facility — if a patient refuses their recommended treatments, and they believe strongly that the patient will be harmed because of this refusal, the right to consent for the doctor and the director means they don’t have to agree with the patient’s requests or demands to get any other kind of treatment from them that they don’t believe would help the patient or that they believe would harm the patient. Transferring to another facility respects the patient’s right to travel and right to consent.

“7. The patient has the right to have an advance directive (such as a living will, health care proxy, or durable power of attorney for health care) concerning treatment or designating a surrogate decision-maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy. Health care institutions must advise patients of their rights under state law and hospital policy to make informed medical choices, ask if the patient has an advance directive, and include that information in patient records. The patient has the right to timely information about hospital policy that may limit its ability to implement fully a legally valid advance directive.” The advance directive itself is covered by the right to consent, and being informed of the hospital’s inability to implement the advance directive is also covered by the right to informed consent.

“8. The patient has the right to every consideration of privacy. Case discussion, consultation, examination, and treatment should be conducted so as to protect each patient’s privacy.” This is covered by the right to dignity. It can also be covered by the right to privacy if the doctor or medical staff tell the patient that they are in a private room, or a law is enacted to require all patient exam or operating rooms to be private rooms and patient information to be private information — then it would require the consent of the patient to disclose the information.

“9. The patient has the right to expect that all communications and records pertaining to his/her care will be treated as confidential by the hospital, except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law. The patient has the right to expect that the hospital will emphasize the confidentiality of this information when it releases it to any other parties entitled to review information in these records.” This is again the right to dignity and also covered by the right to privacy if the doctor or medical staff tell the patient that they are in a private room, or a law is enacted to require all patient exam or operating rooms to be private rooms and patient information to be private information — then it would require the consent of the patient to disclose the information. And again a duty to fight for the patient’s right to life (to protect the patient from abuse) and for the public’s right to life (to protect the public from health hazards created by the patient’s condition — for example a highly contagious and deadly viral infection).

“10. The patient has the right to review the records pertaining to his/her medical care and to have the information explained or interpreted as necessary, except when restricted by law.” This is covered by the right to information.

“11. The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and/or referral as indicated by the urgency of the case. When medically appropriate and legally permissible, or when a patient has so requested, a patient may be transferred to another facility. The institution to which the patient is to be transferred must first have accepted the patient for transfer. The patient must also have the benefit of complete information and explanation concerning the need for, risks, benefits, and alternatives to such a transfer.” This is covered by the right to equal opportunity, the right to travel, and the right to informed consult.

“12. The patient has the right to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patient’s treatment and care.” This is covered by the right to informed consent.

“13. The patient has the right to consent to or decline to participate in proposed research studies or human experimentation affecting care and treatment or requiring direct patient involvement and to have those studies fully explained prior to consent. A patient who declines to participate in research or experimentation is entitled to the most effective care that the hospital can otherwise provide.” This is covered by the right to informed consent and the right to equal opportunity.

“14. The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate.” To the extent that continuity of care is important in saving the patient’s life and whatever “when appropriate” means, this is covered by the right to life and the right to equal opportunity. However, when the hospital cannot do anything further for the patient and needs to transfer or discharge, this is more appropriate as a regulation than a right, for a procedure of briefing the patient prior to such movement.

“15. The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities. The patient has the right to be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics committees, patient representatives, or other mechanisms available in the institution. The patient has the right to be informed of the hospital’s charges for services and available payment methods.” This is covered by the right to informed consent, the right to petition, and the right to consent.

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