HUMAN RIGHTS IN PATIENT CARE

Assoc. Prof. Dr. Silviya Aleksandrova-Yankulovska, MD, PhD, MAS

DocumentsUniversal Declaration of Human

Rights (1948)Non-binding

instrumentsWMA Declaration of Lisbon

Binding treatiesInternational Covenant on Civil and Political Rights

Patients’ rights1. Liberty and security of person2. Privacy3. Access to information4. Bodily integrity5. Life6. Highest attainable standard of mental and p

hysical health7. Freedom from torture and other cruel, inhum

an or degrading treatment or punishment8. Participation in public policy9. Equality and freedom from discrimination10. Effective remedy

1. LibertyContent – protection of individuals

from arbitrary or unjustified confinement

Deprivation of liberty must be necessary and proportionate

1. and security of person Content – safeguards individuals’

freedom from bodily injuryGovernment must take measures to

protect individual from threats to bodily integrity

1. Liberty and security of person

MH* – protection from detention based solely on mental health without judicial review (special provisions in Bulgarian Health Act)

ID** – restrictive measures should respect individuals’ rights and guarantee judicial review

RH*** – recognition of individual’s reproductive choices

*MH – Mental Health**ID – Infectious Diseases*** RH – Reproductive Health

11. Privacy

Content – protects the individual from unlawful and arbitrary interference with his/her privacy

Meaning - any interference must be based on law and be proportionate to the end sought

11. PrivacyMH – In patient care, medical treatment or examination of a patient’s mental and physical state the law can constitute a violation of patient’s right to privacy

ID - legal protection of information- disclosure with patient’s consent- guiding principles and recommendations- laws on privacy and confidentiality

RH - report of cases of criminal abortion- women applying for a job can’t be asked

for contraceptive usage and can’t be subject of pregnancy tests

- confidentiality of adolescents

111. Access to informationContent – guarantee of individual

access to information (including medical information) concerning her/him, except when this information can be harmful to her/his life or health

Right not to be informed, unless the disclosure is need to protect another person’s life

111. Access to informationMH – information about mental state, treatment, criminal proceedings and charges against the patient should be accessible to him/her; in case of children – accessible to the parents

ID – public information campaigns to enable individuals to take informed decisions

RH - allows family planning - adolescents – information

without parental consent based on adolescent’s maturity level

1V. Bodily integrityContent – protection from bodily

injuryRelevant in cases of involuntary

medical treatment and experimentation

1V. Bodily integrityMH - protection from the use of coercive force and restraint unless following “a thorough and professional medical assessment”

- monitoring and reporting system of mental-health institutions

ID – quarantine – protection of PH should be balanced with the individual’s right and he/she is treated humanely

RH – forced sterilization, genital mutilation

V. LifeContent – protection from the

imposition of death sentence when the process on which the judgement is based does not meet the requirements under international human rights law

Wide interpretation – measures to increase life expectancy – provision of minimum level of health services and essential medication that ensures patient’s good health

V. Life

MH – health care measures for the protection of patients’ lives (example: depression)

ID - measures to eliminate epidemics - preventive measures

- access to medicines

RH - protection of women’s life via adoption of comprehensive abortion laws, especially in cases of rape, incest and therapeutic reasons (decriminalizing abortions)

- access to reproductive health services- availability of contraceptives

V1. Highest attainable standard of mental and physical healthContent – the right of everyone to

enjoy the highest attainable standard of both mental and physical health

State have the obligation to make available health care facilities, goods and services in sufficient quantity and accessible to everyone physically, economically and without discrimination.

Extends to determinants of health, such as access to safe and portable drinking water, and adequate supply of safe food, nutrition and housing.

V1. Highest attainable standard of mental and physical health

MH - training of personnel to care for patients with mental disabilities

- public campaigns against stigma and discrimination

- downsizing psychiatric hospitals and extend community care

ID - access affordable treatment and health services - establishment of effective PH surveillance and reporting systems

RH – UN Himan Rights Council declared maternal mortality as human rights violation and called states to take measures

V11. Freedom from torture and other cruel, inhuman or degrading treatment or punishment

Content – the State should prevent and protect people from, and punish acts of, cruel, inhuman or degrading treatment and torture.

“Untouchable” right even in exceptional circumstances, such as war

Applicable also to detainees and individuals under custody.

Concerns also denying pain relief, if it causes severe pain and suffering.

V11. Freedom from torture and other cruel, inhuman or degrading treatment or punishment

MH - applicable to every person incl. those in psychiatric hospitals

- improvement of hygienic conditions- provision of regular exercise and

adequate treatment- solitary confinement and food

deprivation are right’s violation

ID - intentional transmission of infectious diseases is prohibited - denying access to HIV-related information, voluntary testing, counselling etc.RH - forces sterilization is a breach of this right

- state’s failure to provide access to abortion services when it is necessary, is a violation of this right

V111. Participation in public policyContent – right of every person to

participate in political processes and policy decisions affecting their health.

Extended to participation in decisions about planning and implementation of health care services.

V111. Participation in public policy

MH – participation in public life on equal basis with others, directly or with chosen representative

ID – participation in designing and implementing policies that affect them

RH – participation to ensure that needs related to family planning and access to contraceptives are met

IX. Equality and freedom from discriminationContent – health services and

treatment must be accessible and provided without discrimination.

Poorer households should not be disproportionally burdened with health expenses as compared to richer households.

IX. Equality and freedom from discrimination

MH – protection from stigma, unnecessary institutionalization

ID – protection from stigmatization in fields of education, employment, housing and health care (awareness raising campaigns on HIV/AIDS)

RH – removal of legal and other obstacles that prevent women from accessing health care on the basis of gender

X. Effective remedyContent – remedies for human

rights violations should be accessible and effective.

States to establish mechanisms to ensure that human rights violations are effectively addressed at domestic level.

Appropriate compensations (example: public apology for Tuskegee study)

X. Effective remedy

MH – ability to access courts

ID – effective addressing of claims; states to address deleterious prison conditions

RH – redress in cases of involuntary sterilizaton

WORLD MEDICAL ASSOCIATION DECLARATION ON THE RIGHTS OF THE PATIENT /LISBON DECLARATION/

1. Right to medical care of good quality

2. Right to freedom of choice3. Right to self-determination4. The unconscious patient5. The legally incompetent

patient6. Procedures against the

patient’s will7. Right to information8. Right to confidentiality9. Right to health education10. Right to dignity11. Right to religious assistance

Informed consent related

1. Right to medical care of good quality

without discrimination; by a physician free to make clinical

and ethical judgements without any outside interference;

right to continuity of health care.

Lisbon Declaration

2. Right to freedom of choice

right to choose freely and change his/her physician and hospital or health service institution, regardless of whether they are based in the private or public sector;

right to ask for the opinion of another physician at any stage.

Lisbon Declaration

3. Right to self-determination

right to make free decisions regarding himself/herself;

right to give or withhold consent to any diagnostic procedure or therapy;

right to refuse to participate in research or the teaching of medicine.

Lisbon Declaration

4. The unconscious patient

informed consent must be obtained whenever possible, from a legally entitled representative;

if a legally entitled representative is not available, but a medical intervention is urgently needed, consent of the patient may be presumed.

physicians should always try to save the life of a patient unconscious due to a suicide attempt.

Lisbon Declaration

5.The legally incompetent patient

the patient must be involved in the decision-making to the fullest extent allowed by his/her capacity;

if the patient's legally entitled representative, or a person authorized by the patient, forbids treatment which is, in the opinion of the physician, in the patient's best interest, the physician should challenge this decision in the relevant legal or other institution.

in case of emergency, the physician will act in the patient's best interest.

Lisbon Declaration

6. Procedures against the patient's will

Can be carried out only in exceptional cases, if specifically permitted by law and conforming to the principles of

medical ethics.

Lisbon Declaration

7. Right to information

Exceptionally, information may be withheld from the patient when there is good reason to believe that this information would create a serious hazard to his/her life or health.

The patient has the right not to be informed on his/her explicit request, unless required for the protection of another person's life.

The patient has the right to choose who, if anyone, should be informed on his/her behalf.

Lisbon Declaration

8. Right to confidentiality

descendants may have a right of access to information that would inform them of their health risks;

confidential information can only be disclosed if the patient gives explicit consent or if expressly provided for in the law;

All identifiable patient data must be protected. The protection of the data must be appropriate to the manner of its storage.

Lisbon Declaration

9. Right to Health Education

The education should include information about healthy lifestyles and about methods of prevention and early detection of illnesses.

The personal responsibility of everybody for his/her own health should be stressed.

Physicians have an obligation to participate actively in educational efforts.

Lisbon Declaration

10. Right to dignity

• The patient is entitled to relief of his/her suffering according to the current state of knowledge.

• The patient is entitled to humane terminal care and to be provided with all available assistance in making dying as dignified and comfortable as possible.

Lisbon Declaration

11. Right to religious assistance

The patient has the right to receive or to decline spiritual and moral comfort including the help of a minister of

his/her chosen religion.

Lisbon Declaration

Movie – watch and answerWhich human and patient’s rights are violated in the movie?

Movie – watch and answer

Which human and patient’s rights were violated in the movie?

Right to libertyRight to lifeRight to highest attainable healthRight to freedom of tortureRight to effective remedy ………