The World Health Organization (WHO) admits that the concept of patient rights and responsibilities is variable and not definitive. This is because it varies from country to country and within some countries, from jurisdiction to jurisdiction (Purtilo et al, 2014). Within the USA, there are four general approaches towards patient rights closely intertwined with patient’s responsibilities. These are the paternalistic model, the informative model, the interpretive model, and the deliberative model. Within each of them, the rights and responsibilities of the patient differ in nature and scale. There are, however, also universal rights of patients that cut across all approaches and theories. These are the rights that are expressly provided for by local, federal, and international laws such as the 1948 Universal Declaration of Human Rights. Similarly, there are universal responsibilities of patients. The actual rights and responsibilities of each patient are, therefore, established through a careful balance between universal rights and responsibility alongside the specific approach and theory being utilized by the specific professional or healthcare institution.
Universal Patient Rights
Non-discrimination
Whatever theory or approach a medical institution or officer takes, the issue of discrimination is covered under international law, federal law, state laws, and even professional ethics. This is based on the understanding that every human being is deserving of human dignity. From an ethical perspective, doctors and nurses swear an oath to treat all patients equally without any form of discrimination. From a legal perspective, the Civil Rights Act of 1964 expressly states that no human being shall be denied a service or opportunity based on gender, race or creed (Purtilo et al., 2014). Whatever race a human being is from, whichever religions affiliation they adhere to and whatever gender they affiliate themselves to, biologically or practically, they have the fundamental right to receive equal treatment in a healthcare institution. This is among the areas where ethics meet laws. A breach of this fundamental right will thus be both an ethical breach that can have professional ramifications and a legal breach that might have legal consequences of a civil or criminal nature.
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The Right to Information
The right to information is another area where ethics meet laws but the combination of the two will sometimes make it a grey area. The issue of information, in some cases, will also fall within the approaches of the relationship between patients and medical officers. However, the right to information to some extent is also a universal right. According to HealthIT.gov. (2017), the Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides for the information rights available to every patient. This includes the right to be informed accurately about the diagnosis of the patient and the intended intervention. This information must also be provided in a language and manner that the patient will understand as much as possible. Further, upon request, the patient should be provided with copies of records relating to the diagnosis and treatment. HIPAA also provides avenues for patients to complain if they feel that their rights have been infringed (Purtilo et al, 2014).
The Right to Privacy and Informational Privilege
The right to privacy and privilege of information is another patient’s right that is protected both by written law and professional ethics, thus making it a universal patient right. HIPAA provides that every patient has a right to be informed about the privacy and privilege policy of a hospital before being accorded any treatment (Garrety et al, 2014). This will enable the patient to decide whether or not to receive treatment in that institution as under those policies. As a universal rule, every patient has a near-absolute right on relating to the particulars of treatment. Any exceptions to this rule ought to be addressed to the patient. The electronic means under which patient information is stored should also be privileged and secured. Information about a patient should only be shared with a third party when it is absolutely necessary such as when the patient is not in a position to make a crucial and urgent decision. The patient should, however, at the earliest opportune moment be informed that an exception to the privacy rules had been applied (Garrety et al, 2014).
The Right to Give an Informed Consent
The right to give an informed consent is a legal right that has now become an ethical provision for most healthcare professionals, mainly affiliated to nursing. Traditionally, the professional was presumed to know what a patient needs and would proceed to administer it unilaterally (Hall et al., 2012). This situation has changed with the patient being given the right to determine which procedures to accept and which ones to decline. For example, even when blood transfusion is absolutely necessary to save a patient’s life, if a professional is informed credibly that the patient does not want a blood transfusion, the decision by the patient is final. The same applies to procedures such as organ transplant and resuscitation. An absolute right to informed consent would, however, have become a great encumbrance to healthcare practice according to Hall, Prochazka, and Fink (2012). This has, however, been made simpler by court decisions that have introduced the reasonability rule to informed consent. Doctors and nurses determine the rights that a reasonable person would have wanted to know and seek informed consent based on those issues. It is also in the area of informed consent that the aforementioned approaches of the paternalistic model, the informative model, the interpretive model, and the deliberative model apply the most.
Transfer and Continuity of Care
Capitalism now dominates most of the developed world making finances an important bearing factor in all sectors. The USA, being among the capitalist centers of the world has had finance as an important consideration even in the healthcare sector. Modern laws have ensured that no patient who needs emergency intervention will be turned away from the ER of a hospital, more so when life is at risk (Mansukhani et al, 2015). However, after emergency treatment, the hospital is not under obligation to retain the patient in the case the patient is not in a position to pay hospital fees. It is at this point that the right to transfer and continuity of care comes in. The patient cannot just be asked to leave while still in need of medical attention. The hospital where the patient is has the obligation to ensure that the patient is transferred to an institution where care will continue. Further, the patient has the right to be informed about the transfer, why it is being undertaken and where the patient is being transferred to (Mansukhani et al, 2015).
The Responsibilities of a Patient
Cooperation and Participatory Responsibility
Few medical procedures, prescriptions, and treatment regimens can succeed without the cooperation and participation of the patient. This is one of the areas that sets apart hospitals from a lunatic asylum. Without the participation of the patient, most approaches to medical treatment would fail. Every patient, therefore, has the responsibility to cooperate with medical personnel and participate whenever necessary towards their own treatment. Part of the cooperation and participation includes giving the accurate and complete information to the medical team (Hall et al., 2012). For example, the answer a patient gives to the question about the existence of allergies can mean the difference between life and death for a patient. Other areas of participation are more practical in nature. For example, a nurse expects a patient to swallow medication when the same is put in the mouth. A patient who pretends to swallow then spits later is non-cooperative and a personal detriment author. Finally, most healthcare institutions have shared amenities with several patients being within the proximity of each other. Every patient should be mindful of the rights and privileges of other patients (Purtilo et al., 2014). Acts such as shouting, disturbing the peace or trying to read the charts of other patients would be in breach of the rights and privileges of other patients.
Responsibility to Seek for information
The reasonableness rule absolves the medical team from the obligation of giving out every detail about what is being done to the patient. Further, the HIPAA provisions for availability of medical records is limited to upon request by the patient. Patients, therefore, have the responsibility to inform the medical team about what they would want to know and what medical documents they would want copies of (Purtilo et al., 2014).
The Responsibility to Foot medical Bills
Whether or not a hospital is profit making, it still needs money. The bulk of hospital revenue comes from payment of medical bills. It is the responsibility of every patient, insured or otherwise to ensure that all outstanding bills are paid as promptly as possible (Purtilo et al., 2014). The monies being withheld from the hospital could make a death or life difference to the next patient attended at the hospital.
Conclusion
Balance permeates almost every right and responsibility outlined above due to the nature of healthcare practice. A patient may arrive at the hospital while comatose and never recover. This patient may never be able to shoulder any responsibilities but the patient’s rights cannot be alienated on that basis. Some right such as that of informed consent may also not apply in the situation, but the rights that can be given under the circumstances ought to be ensured. This eliminates the concept of absoluteness from the rights and responsibilities of patients thus requiring a balance based on reasonableness.
References
Garrety, K., McLoughlin, I., Wilson, R., Zelle, G., & Martin, M. (2014). National electronic health records and the digital disruption of moral orders. Social Science & Medicine , 101 , 70-77
Hall, D. E., Prochazka, A. V., & Fink, A. S. (2012). Informed consent for clinical treatment. Canadian Medical Association Journal, 184 (5), 533-540. doi:10.1503/cmaj.112120
HealthIT.gov. (2017). Your health information rights. Protecting your privacy & security. https://www.healthit.gov/patients-families/your-health-information-rights
Mansukhani, R. P., Bridgeman, M. B., Candelario, D., & Eckert, L. J. (2015). Exploring Transitional Care: Evidence-Based Strategies for Improving Provider Communication and Reducing Readmissions. P & T: A Peer-Reviewed Journal for Formulary Management , 40 (10), 690-694
Purtilo, R. B., Haddad, A. M., & Doherty, R. F. (2014). Health professional and patient interaction . Elsevier Health Sciences
