Patient’s rights

1. Patient’s rights Dr. Tsonka Miteva, PhD

2. WHAT ARE RIGHTS? Rightsareconsidered to bethefundamental to civilization, basis of societyandculture. Rightsarelegal, socialorethicalrulesaboutwhatisallowed to peopleorowed to people, according to somelegalsystem, socialconventionorethicaltheory

3. WHAT ARE RIGHTS? • InStanfordEncyclopedia of Philosophyrightsaredescribedwithmanyaspects: • Whatistheaction, stateorobjectsthattheassertedrightpertains to? • Whoisalleged to havetheright? • Whytherightholderhastheright? • Howtherightcanbeaffectedbytherightholder’saction?

4. WHAT ARE RIGHTS? • Definition Patient rights encompass legal and ethical issues in the provider-patient relationship, including a person's right to privacy, the right to quality medical care without prejudice, the right to make informed decisions about care and treatment options, and the right to refuse treatment.

5. WHAT ARE RIGHTS? • Purpose The purpose of delineating patient rights is to ensure the ethical treatment of persons receiving medical or other professional health care services. Without exception, all persons in all settings are entitled to receive ethical treatment. • SPECIFIC GOALS of patient’s rights: • To help patients feel more confident in the health care system. • To stress the importance of a strong relationship between patients and their health care providers. • To stress the key role of patients play in staying healthy by laying out rightsand responsibilitiesfor all patients and health care providers.

6. TYPES OF RIGHTS Rights connected with specific procedures

7. TYPES OF RIGHTS Activerights– theprivilegeandthepowerareactiverightsthatconcerntheirholders’ownbehaviour“Onehastherightto make decisions by himself” Passiverights– theclaimandtheimmunityare“passiverights” thatregulatetheactions of others“Onehastherightthatsomeoneelseis informing him/her regrding the health problem”

8. TYPES OF RIGHTS Negativerights – a holderisentitled to “non-interference” E.g. a rightagainstviolenceatworkingplace Positiverights– a holderisentitled to “provision of somegoodorservice” E.g. a right to treatment Both negativeandpositiverightsarepassive

9. TYPES OF RIGHTS moral–respect for dignity and human life. Moral right is validated by moral principles and rules legal– enshrined in various legal acts - laws, regulations, declarations, conventions. social– rights that one has as a citizen of a country

10. ELEMENTS OF RIGHTS 1. theprivilege (theliberty) – yourright to… isaprivilegeifyoudonothave a duty to… 2. theclaim– yourright to… is a claimifandonlyifsomeoneelsehas a duty to you to… 3. thepower– youhavethepowerifandonlyifyouhavetheabilitywithin a set of rules to alteryourownoranother’sprivilegesorduties 4. theimmunity– youhavetheimmunityifandonlyifsomeoneelselacksability to change yourprivilegesorduties (anabsence of a powerinsomeotherparty to altertherightholder’snormativesituationinsomeway).

11. HISTORY OF RIGHTS The Universal Declaration of Human Rights is the foundation of international human rights legislation. Adopted on 10th December 1948 by the UN General Assembly as a result of the experience of the Second World War. The international community vowed never again to allow atrocities like these of the war happen again The Declaration has to guarantee the rights of every individual everywhere. The UDHR states the equity in terms of dignity, rights and freedoms, without distinction of any kind – race, colour, sex, religion, political or other opinion, national or social origin, property, birth or other status, or the political, jurisdictional or international status of the country to which a person belongs.

12. HISTORY OF RIGHTS PRIOR 1960s common-law rights - protections consisted only of the right to not be treated without consent, the confidentiality of statements made to a physician during treatment, the right to damages in event of malpractice, and, to some extent, the confidentiality of a patient's hospital records. PATIENTS' RIGHTS, a movement that grew out of the push for individual rights of the 1960s and 1970s, gave rise to the idea of a set of rights for protection of patients and succeeded in having those rights enacted into law in many states.

13. HISTORY OF RIGHTS • In 1973 BILL OF RIGHTS - an advance in patients' rights approved by the American Hospital Association (AHA) It promised patients: • considerate and respectful care • the right to know hospital rules and regulations relating to patient conduct • the right to know the identity of the physician in charge of care • sufficient information to enable patients to make informed decisions with respect to their treatment • the right to obtain information concerning diagnosis and treatment as well as prognosis if medically advisable • the right not to be a subject of experiment • the confidentiality of clinical records, and the right to receive an explanation of the hospital bill.

14. HISTORY OF RIGHTS • THE BILL OF RIGHTS adopted by most of the association's members was of little or no legal value because it was voluntary. • Nonetheless, it achieved: • establishment of public awareness of patients' rights • set the stage for a second advance that took place between 1975 and 1985, when one-third of the states enacted patients' rights statutes.

15. HISTORY OF RIGHTS Humanrightsnormsareincorporatedinthecodesanddeclarationsonpatients’rights: • UniversalDeclarationonBioethicsandHumanRights–adoptedby UNESCO General Conference, October, 2005 • EuropeanConventiononHumanrightsandbiomedicine–adoptedbytheCouncil of Europein 1997 • EuropeanCharter of Patients’Rights, 2002, • WMA Declaration of LisbonontheRights of thePatient,1981, amended 1995 andeditoriallyrevised 2005 – theonlydeclarationthatincorporatesproceduresagainstthepatient’swill

16. LISBON DECLARATION OF PATIENTS’RIGHTS • The Declaration acknowledges the changing and complex nature of the relationship between physicians, their patients and broader society • It states that while a physician should always act according to his/her conscience and always in the best interests of the patient, equal effort must be made to guarantee patient autonomy and justice. • The Declaration represents some of the principal rights of the patient that the medical profession endorses and promotes. • In case of denials of these patients’ rights by legislation, government action or any other administration or institution, physicians should pursue appropriate means to assure or to restore them.

17. LISBON DECLARATION OF PATIENTS’RIGHTS • Rightto goodqualitymedicalcare • Right to freedom of choice • Right to self-determination • Rights ofunconsciouspatient • Thelegallyincompetentpatient - thephysicianshouldchallengeintherelevantlegalinstitutionsthedecisionfortreatmentrefusaldonebythepatient’slegalrepresentativeor a personauthorisedbythepatient. Incase of emergencythedoctorwillactinthepatient’sbestinterest • Proceduresagainstthepatient'swill - Diagnosticprocedures ortreatmentagainstthepatient'swillcanbecarriedoutonlyinexceptionalcases, ifspecificallypermittedbylawandconforming to theprinciples of medicalethics. • Right to information • Right to confidentiality • Right to healtheducation • Right to dignity, relief of sufferingandhumanterminalcare • Right to religiousassistance

18. EUROPEAN CHARTER OF PATIENTS’RIGHTS Each of the national health systems of the EU countries manifests quite different realities with respect to patients’ rights. Some systems have patients’ rights charters, specific laws, administrative regulations, charters of services, bodies such as ombudspersons, specific procedures, etc. Others may have none of these. The European Charter of patients’ rights can reinforce the degree of protection of patients/citizens’ rights in the different national contexts, and can be a tool for the harmonisation of national health systems that favours citizens’ and patients’ rights.

19. EUROPEAN CHARTER OF PATIENTS’RIGHTS • Thedefinition of rightsimpliesbothdutiesandresponsibilities. • TheCharterapplies to allindividuals, irrespectively of thedifferences, suchasage, gender, religion, socio-economicstatusandliteracyetc. • TheCharterdefinesrightsastheyarevalidincontemporaryEuropeanhealthsystems. Itshallthereforebereviewedandmodified to allowfortheirevolution, andthedevelopment of scientificknowledgeandtechnology. • Thefourteenrightsexpressthefundamentalrightsand, assuch, theymustberecognisedandrespectedindependently of financial, economicorpoliticalconstraints. • Eacharticle of theCharterrefers to a rightanddefinesandillustratesit, withoutclaiming to foreseeallpossiblesituations.

20. EUROPEAN CHARTER OF PATIENTS’RIGHTS Right to preventive measures Right to access Right to information Right to consent Right to free choice Right to privacy and confidentiality Right to respect patient time Right to the observance of quality standards Right to safety Right to innovation Right to avoid unnecessary suffering and death Right to personalized treatment Right to complain Right to compensation

21. Documentsconcerning patient’s rights in Bulgaria Health Law Health Insurance Act Law on Drugs and Pharmacies in Human Medicine Law for transplantation of organs, tissues and cells Low for Professional Organizations National Framework Contract Ordinance for the insured persons access to hospitals and outpatient care Decree №39 for prophylactic examinations and dispensary Decree №38 determining the list of diseases for which NHIF pays Decree №40 for determining the basic package of health services guaranteed by the NHIF budget Ordinance №5 Ministry of Health (02/20/1987 d) LabourCode, art. 333, paragraph 1