Patient Rights And Ethics (2023)

Continuing Education Activity

Patient rights are a subset of human rights. Whereas the concept of human rights refers to minimum standards for the ways persons can expect to be treated by others, the concept of ethics refers to customary standards for the ways persons should treat others. As such, rights and ethics are usually flip sides of the same coin, and behind every ‘patient right’ is one or more ethical principle from which that right is derived. This activity discusses how the interprofessional team can ensure that ethical principles are followed and the patient's rights are assured.

Objectives:

  • Summarize the common ethical principles that apply to patient care.

  • Outline the history of ethical principles applied to patient care.

  • Review the meaning of the sanctity of human life.

  • Explain how the interprofessional team can work together to achieve ethical principles in caring for patients.

Access free multiple choice questions on this topic.

Introduction

"Rights aren't rights if someone can take them away. They're privileges." - George Carlin, "It's Bad for Ya," March 1, 2008.

Patient rights are a subset of human rights. Whereas the concept of human rights refers to minimum standards for the ways persons can expect to be treated by others, the concept of ethics refers to customary standards for the ways persons should treat others. As such, rights and ethics are usually flip sides of the same coin, and behind every ‘patient right’ is one or more ethical principles from which that right is derived, which are defined here but reviewed in more detail in a companion article.[1]

Establishing clearly defined patient rights helps standardize care across healthcare fields and enables patients to have uniform expectations during their treatment. According to the American Cancer Society, organizations should develop patient bills of rights “to empower people to take an active role in improving their health, to strengthen the relationships people have with their health care providers, [and] to establish patients’ rights in dealing with insurance companies and other specific situations related to health coverage.” As with other bills of rights, modern bills of patient rights establish that persons can expect certain treatment regardless of their socioeconomic status, religious affiliation, gender, or ethnicity.

Commonly established rights tend to derive from a core set of ethical principles, including autonomy of the patient, beneficence, nonmaleficence, (distributive) justice, patient-provider fiduciary (trusting) relationship, and inviolabilityof human life. The establishment of whether one principle is of greater inherent value than another is a philosophical endeavor that varies from authority to authority. In many situations, beliefs may directly conflict with one another. When a legal standard does not exist, it remains the obligation of the health care provider to prioritize these principles to achieve an acceptable outcome for the patient.

This essay analyzes patient rights with respect to their associated ethical principles with accompanying historical perspectives. It also specifies laws or the lack thereof that affect patient rights in the United States.

Common sense dictates that rights established to preserve the well-being of an individual person do not always trump the well-being of a collective society. A recent applicable phenomenon includes measures that authorities taketo minimize public disease caused by the SARS-CoV-2 virus (COVID-19), such as through the use of vaccines and respiratory tract masking. Medical therapy essentially always involves a risk vs. benefit determination. The focus of this article is not to establish ethical and legal heuristics or algorithms for prioritizing measures designed to minimize risks to public health that concurrently expose individual persons to theoretical risks.

Function

Brief History of Medical Ethics and Human Rights

Writings that specify ethical obligations (both in general and by physicians) predate by millennia writings that specify human rights (both in general and for patients). The earliest writings containing ethical principles date from the Old Kingdom of the Egyptians, e.g., the autobiography of Nefer-seshem-re, circa 2340 BCE. Ethics began to flourish as a scholarly discipline during the golden age of Greece (the time of Socrates, Plato, and Aristotle) in the 5th century BCE. In these respective cultures, discussions of physicians’ ethical duties date to the same times, e.g., an inscription on the tomb of Nenkh-Sekhmet, “chief of the physicians,” circa 2400 BCE, and the writings of the Hippocratic school of Cos in the 5th century BCE. Deontological or “duty” ethics (which stems largely from the writings of Immanuel Kant in the late 18th century and is a dominant form of ethics within modern law and healthcare) imposes on persons the obligation to preserve the rights and freedoms of others.

Whereas the Cyrus Cylinder (from the 530s BCE) is an exception, human rights writings are a relatively late development in civilization. The Magna Carta (1215 CE) first established political rights for citizens living in Western society. However, human rights did not enter into Western scholarly or philosophical circles until the 1600s and 1700s by Enlightenment thinkers such as John Locke. Whereas patientshad earlier been enabled to establish “rights” through civil suits against their healthcare providers after adverse outcomes (1374 CE)[2], the first policy-making body to establish prospective patient rights was the First Geneva Convention (1864) on behalf of wounded soldiers. The World Health Organization (formed in 1948) created the first bill of health rights intended for application to all persons. Since then, the movement to expand patient rights has become increasingly widespread across all of healthcare.

As the rationale for patient rights depends on the ethical principles that predated them, the moral principles will be discussed first, followed by a discussion of how they result in related patient rights.

Overview of Core Ethical Principles in Modern Western Medicine

Beneficence

Beneficence is doing what is in the best interest of the patient throughout the process of diagnosis and treatment. The physicians of the Hippocratic school of Cos vowed to "help the sick"in a general sense. In recent times, such as with the development of osteopathic medicine, Western physicians have begun to renew the call for a more holistic approach to benevolence, which entails addressing the patient’s emotional, social, and spiritual well-being in addition to the care of the body.

Of the other principles, a physician's intent for beneficence conflicts most often with patient autonomy. This conflict has led to the development of documentation in which the patient must demonstrate their understanding of the predictableconsequences of his decision to act against medical advice. When disagreements arise between a healthcare provider and a patient, the health care provider must explain the reasons for their recommendations, allowing the patient to make a more informed decision.

(Video) Patient Rights and Responsibilities from the Ethics 6.0 online course.

Patient Autonomy

Autonomy (literally “self-rule”) refers to the capacity to live according to one's own reasons and motives. Concerning the autonomy of ordinary citizens, Western society has undergone a radical change in the last 350 years. Before the Enlightenment, most persons lived under the rule of a monarch or similar type of authority. Early Enlightenment philosophers (e.g., Hobbes, Locke, and Rousseau) advocated what is now called social contract theory. This is the view that persons' moral and political obligations should depend on an agreement amongst themselves regarding which rules will hold in their particular society.

Later philosophers argued for individual autonomy to an even greater degree than championed by social contract theorists. Autonomy as a fundamental aspect of human existence was advanced largely by two moral and social philosophers, John Stuart Mill (early 19th century; of the school of utilitarian liberalism) and Immanuel Kant, respectively. Kant proposed that each person of sound mind should first live in moral autonomy, imposing moral decisions regarding himself or herself on himself or herself and secondly allow all other persons to do the same. Mill advocated autonomy with regard to a person’s capacity to governoneself, and subsequent philosophers and jurists expanded autonomy to include other forms of self-expression. Western post-Enlightenment philosophy and law are no longer concerned with whether autonomy in its various forms is a human right but instead to whom it extends and to what degree.

A patient who can defend his or her judgments has the right to make decisions that do not coincide with what the physician believes is beneficial to that patient. This philosophical concept has become a legal right essentially throughout the Western world. As legal precedents have advanced the requirements for patient autonomy to a greater degree than the requirements for health care provider beneficence, patient autonomy has arguably become the dominant principle affecting patient rights. For example, a patient may refuse treatment that the physician deems to be an act of beneficence. In such cases, the unwritten social contract between patient and physician requires that medical professionals still attempt to inform the patient of the potential consequences of proceeding against medical advice. A patient's autonomy is violated when family members or members of a healthcare team pressure a patient or when they act on the patient’s behalf without the patient’s permission (in a non-emergency situation).

Nonmaleficence (“Do no harm”)

Complementary to beneficence, nonmaleficence seeks to ensure a patient will be no worse off (physically, emotionally, or otherwise) after treatment than before. Nonmaleficence dates to the medical writings of the early Egyptians, as cited earlier. The Hippocratic Oath lists specific acts of nonmaleficence, including euthanasia, abortion, an attempt by the professional at procedures outside of his area of expertise, stealing property, making sexual advances, and violating privacy. The consideration of whether a treatment plan is or is not malevolent extends to all types of treatments, including medications, physical manipulations, and invasive procedures.

In relation to other ethical principles, nonmaleficence most commonly conflicts with beneficence. Despite the potential reason why treatment is beneficial, the therapy may have unintended harm. Examples include procedures in which a surgeon must cut into a patient’s body or certain drugs (such as chemotherapies). The body is essentially poisoned so that it may have the opportunity to heal later. In each case, the odds and degree of harm must be weighed against that of benefit. Physicians cannot control all responses to treatments. So a physician can still act under the principle of nonmaleficence if the physician takes measures to minimize the chances of harm and informs the patient prior to taking the risk so that the patient has the opportunity to accept or decline the risk.

Patient-Provider Fiduciary Relationship

Not unique to the medical profession, but essential to its function, is the trust (Latin: fiducia) that the client places in the professional. Primarily, the belief is that the health careprofessional will act in such a way as to serve the client’s best interests. There is inherently unequal power within a patient-physician relationship. As stated by the Illinois Supreme Court,

“[T]he physician-patient relationship has its foundation is on the theory that the former [physician] is learned, skilled and experienced in those subjects about which the latter [the patient] ordinarily knows little or nothing, but which are of the most vital importance and interest to him since upon them may depend the health, or even life, of himself or family. [T]herefore, the patient must necessarily place great reliance, faith, and confidence in the professional word, advice, and acts of the physician."

Patients have different preferences for thedegree of passiveness or proactiveness they exert within the fiduciary relationship. Emanuel and Emanuel described four patient-physician relationship models within the history of Western medicine.[3] In each model, the patient and physician relate to each other with a varied degree of passiveness or proactiveness.

  • In a paternalistic relationship, the doctor decides on behalf of the patient. This is the most passive type ofrelationship for the patient.

  • In an interpretive relationship, the doctor first discerns what the patient’s goals and values are and then offers options that help achieve those goals and preserve those values. The patient remains passive in this relationship.

  • In an informative relationship, the doctor provides information to assist with a decision and, without swaying the patient, allows the patient to decide for himself or herself.

  • In a deliberative relationship, the doctor and patient collaborate essentially as equals. They work together. This model is the most likely to achieve a patient’s healthcare goals and preserve his or her values.

Justice

In healthcare, justice refers explicitly to the philosophical concept of “distributive justice.” This principle asserts that all persons (patients) will be treated fairly and equitably. It meansnot only respecting the rights of individuals but also treating all patients ina givensituation the same regardless of who they are. Laws and policies within healthcare use the principle of justice to establish access for all persons to obtain healthcare required to preserve life, such as in emergency situations. Some governing bodies, such as the Canadian federal government, have extended justice in healthcare far beyond emergency care. Distributive justice, as defined by John Rawls, can be understood as equal respect for persons – entitlement of persons having a given need to the same rights and services as other persons with the same need and the provision of services of a more significant benefit offered to personswith greater need.

Sanctity and Dignity of Human Life

In addition to prescriptions regarding moral behavior, the belief in a creator god or set of gods is a common feature of the earliest literate societies. Before 500 BCE, the Egyptians, Babylonians, Assyrians, Vedic culture of ancient India, Greeks, and Israelites all wrote regarding theology in conjunction with moral behavior. The ethical codes of all these early civilizations condemned lay citizens from ending the lives of other citizens. For the ancient Egyptians, preparation for one’s afterlife was a major facet of one’s present life. Ancient Greek philosophers, including Plato and Aristotle, taught extensively about the notion of humans having souls.

The Israelites (founders of a nation of people later to be known as Jews) originated the notion of a divinity that placed value on the lives of all members of the society of believers. The Jews also were original in believing that the divinity itself was the author of the societal moral code, that the divinity created humans in Its image, and that human life itself, therefore, is sacred or holy. The idea that a person is created “in the image of God” is mentioned several times in the book of Genesis alone (Genesis 1:26-27, 5:1-2 9:6). The book of Psalms echoes this concept when the psalmist asserts that God was responsible for his formation, in contrast to the notion that the psalmist may have been formed solely by biological mechanisms (Psalms 139:13). Christianity retained the holy books of Judaism and much of the Jewish philosophy pertaining to the sanctity of the lives of its adherents. The book of Acts, for example, professes that God gives life and breath to all people (Acts 17:25).

Christian culture fused with Greco-Roman culture in the 4th century CE upon the Christianization of the Roman emperor Constantine and his family. This fusion eventually resulted in the dissemination of Judeo-Christian beliefs on the value of human life throughout the West geographically and, later, through the development of all three North American countries. Judaism has become the second-largest religion in North America. Islam, the third-largest religious group in North America, shares much in common with Judeo-Christian belief, not onlyconcerning its traditional stories and notions of God but also concerning notions of the sanctity of human life. Although Mexico, the United States, and Canada's governments were based on the separation of religion and state, the moral teachings of the Abrahamic religions have nevertheless greatly influenced the health care policies of these three countries both in the laws at the national and state level and in the rules set by medical societies and medical administrative organizations. Furthermore, the belief that human life is sacred is not limited to the Abrahamic faiths. As just one example, the Hippocratic physicians (living in a polytheist society) vowed not to take measures to end human life either prior to conception or in the setting of gravely ill patients.

Despite the division of religion and national government politics that occurred in many Western countries starting after 1700 CE, the fusion of religion and politics that existed for thousands of years had effects that persist in the ethical and legal codes of secularized countries today. Western secularization has resulted in the substitution of religious terms (e.g., sanctity) with secular terms (e.g., inviolability) and arguments. The right of a person to maintain one's property, originated by Jean Jacque Rousseau and championed by John Locke, continues to be used in secular defenses that one human cannot legally destroy the life of another.

Scientific advancement has allowed the study of human fetal development and options for the care of sick and dying adults to a more advanced degree than what was possible for ethicists of earlier centuries. The question of modern debate no longer is at what point an embryo is biologically human but at what point it be granted rights as one. Similarly, in many instances, physicians no longer wonder how to prolong the life of a suffering individual but whether it is the morally correct decision to do so. Instances have occurred in which patients have been pronounced clinically dead or in a persistent vegetative state but have later regained consciousness.[4]It is not possible to determine when a soul departs a body.

Drafted shortly after World War II in response to Nazi experimentation on humans and an increased need for international standards, the Declaration of Geneva (Physician’s Pledge) and the International Code of Medical Ethics both included language protecting the rights of the unborn. However, revisions in subsequent decades gradually made the language vaguer prior to eventually removing it altogether. Under the 1948 Declaration of Geneva, it was the duty of a doctor to respect human life “from the time of conception.”[5] In 1994, the phrase was revised to respect human life “from its beginning” and in 2005 was retracted altogether.

(Video) VI: CLIENTS RIGHTS: Ethical And Legal Issues

As with all ethical dilemmas, reaching a morally acceptable decision requires examination of how each of the core ethical principles interplay. For example, while abortion proponents emphasize beneficence and patient autonomy for the mother, pro-life supporters place greater emphasis on nonmaleficence and the sanctity of human life for the unborn child.

Issues of Concern

Patient Rights in Modern Medicine

The 1973 American Hospital Association patient bill of rights was the first bill of rights written specifically for patients. Patient bills of rights by non-legal entities are limited with respect to the enforceability of the number of people they protect.

Many North American laws do protect a variety of patient rights. In 1984, Canada passed the Canada Health Act. In 1986, the United States passed 42 Code of Federal Regulations § 482.13, which established a list of patient rights that hospitals must provide patients in order to be eligible for Medicare reimbursement. In 2005, Mexico passedArticle 4 as part of its national Constitution. In 2010, the United States improved patient rights when passing the Patient Protection and Affordable Care Act.

However, none of these countries has a specific law outlining a general patient bill of rights, in contrast to multiple European countries. The North American countries' "bills of rights" protecting human rights do not relate to healthcare per se. The closest that a North American government has come to pass an actual patient bill of rights was in 2001. That year saw the failed American Bipartisan Patient Protection Act, the failed Canadian Standing Senate Committee on Social Affairs, Science and Technology bill, and the failed Canadian C-261 bill. Many individual states and provinces have created their ownspecific patient rights policies. In the states that have no plans, the decision regarding whether or not to use such a system is up to the individual hospital. Thus, there continues to be considerable variation in standards from region to region andfrom hospital to hospital.

Examples of patient rights in common usage are listed below. Some rights are influenced by only one of the principles discussed above, some rights are affected by several principles, and others are influenced byother ethical principles altogether.

Informed Consent

The right to informed consent is composed of two parts: first, the right tobe informed of potential harm to one’s property (one’s body) caused by a hired agent, and second, the right to autonomy. It was not until the 19th century that physicians began to advocate that a patient should be given an adequate amount of information to understand his or her state of health.[6]After landmark decisions by judges in the 20th century, especially in the 1970s with Canterbury v. Spence, Cobb v. Grant, and Wilkinson v. Vesey, in 1981 the American Medical Association recognized for the first time informed consent as "a basic social policy" necessary to preserve patient autonomy even at the expense of a healthcare provider’s desire for beneficence.

The roots of informed consent stem from the social contract theorists of the 1600s and 1700s mentioned previously. Under this social construct, patients own their bodies (their“property”). Medical therapies may have a genuine possibility of damaging that property. Thus, patients have the right to decide independently what risks and costs to incur regarding their bodies. The null assumption by physicians for most of the history of Western medicine has been that the patient is interested in whatever plan the medical professional thinks is best. In contrast, the null assumption under the moral philosophy of autonomy is that the physician has no way of knowing what patients want and must enable patients to decide for themselves whenever the patient has the mental capacity to do so. American courts have established that a risk of harm as low as 1% must be explained to the patient before submitting the patient to any therapy if that harm entails death or a life-altering complication, such as paralysis (Canterbury v. Spence).

In the United States, the right to informed consent is protected to some degree by legislation at both the state and federal levels. 42 CFR § 482.13 states that the "patient or his or her representative (as allowed under State law) has the right to make informed decisions regarding his or her care. The patient's rights include being informed of his or her health status, being involved in care planning and treatment..." Nearly all states have statutes that provide more detail than the US Congress with respect to the specifics of informed consent rights in their particular jurisdictions. Nevertheless, in large part, because of the vagueness of informed consent rights specified by executive branches of government, the judicial branch of government is usually the branch that enforces informed consent rights as part of tort claims brought by patients against healthcare providers.

The following are the requiredelements for documentation of the informed consent discussion: (1) the nature of the procedure, (2) the risks and benefits and the procedure, (3) reasonable alternatives, (4) risks and benefits of alternatives, and (5) assessment of the patient's understanding of elements 1 through 4.

Refusal of Treatment (by both patient and physician)

A patient may refuse treatment that thehealthcare providerdeems to be an act of beneficence out of the principle of autonomy. In the United States, the right to refuse treatment is protected by 42 CFR § 482.13. Conversely, a physician may refuse to offer a treatment out of nonmaleficence because the physician believes the treatment would cause greater harm than good. Physician refusal of treatment is a more complicated issue that depends on the situation. That is primarily addressed in the United States at the state level by statutes or judicial decisions. Either way, the medical professional must provide informed consent regarding the issue when it is possible to do so (i.e., in a non-emergent condition).

Medical Treatment in an Emergency

The right to medical care in an emergency is derived from the principles of beneficence and justice, and its concept dates to the Hippocratic Writings. Life-saving measures must be taken to the point of stabilization, regardless of the patient’s ability to pay for treatment. At present, medical institutions differ in their extension of this right. First, institutions differ regarding precisely what constitutes an emergency. Second, they differ in the determination of what point a patient is considered stable enough to discontinue treatment or to require some guarantee of future compensation before providing additional treatment. These differences mean that patient experiences can vary from institution to institution when receiving care in an emergency. In the United States, the right to obtain medical treatment in an emergency was established in 1986 by 42 U.S. Code § 1395dd, better known as the Emergency Medical Treatment and Active Labor Act (EMTALA) as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA).

Confidentiality

Confidentiality stems both from the physician-patient fiduciary relationship and from autonomy. The patient trusts that the physician will not allow others to know particulars of the patient’s illness or situation, informationthat could be used by others to take advantage of or otherwise harm the patient. By preservation of confidentiality, patients are granted autonomy in that they retain control over who has access to know the status of their health. In the United States, the right to confidentiality is protected by42 CFR § 482.13.

Exceptions to confidentiality include imminent danger to the patient or others and certain infectious diseases. Reportable sexually transmitted infections (STIs) include Human papillomavirus, genital herpes, Chlamydia, gonorrhea, HIV/AIDS, and syphilis. Parental consent is needed in most situations but this excludes contraception, STI treatment, and mental health care.

Continuity of Care

Continuity of care refers to a patient’s ability to choose future relationships with healthcare providers. A patient has the right to have a role in accepting or refusing referrals to certain specialistsand home treatment plans. This is in the patient's best interest (beneficence) because it empowers the patient to make decisions over his or her own treatment (autonomy). Additionally, continuity of care helps preserve a patient-physician fiduciary relationship. Joint physician-patient decision-making is enhanced when care is continued beyond the initial encounter. Continuity of care also necessitates that a patient receives an explanation of how to maintain health beyond the hospital or clinical setting. If transfer to another facility or provider is required, then the patient is entitled to an explanation of why this is necessary. In the United States, continuity of care is not currently a legal right, but the Affordable Care Act did create payment incentives for organizations in order to promote continuity of care.

Ability to Speak Against Unfair Treatment

The ability for a patient or patient representative to elevate a concern to a higher level when it is not being addressed by healthcare providers in the immediate care setting helps protect a patient from persons who have been subjected to treatment that places provider desires above patient well-being. This right is protected in the United States by42 CFR § 482.13.

Other Patient Rights in the United States at the Federal Level

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In 1986, 42 CFR § 482.13 established patient rights

  • limiting physical restraint or seclusion and

  • enabling visitation.

In 2010, the US Congress passed the Patient Protection and Affordable Care Act (ACA), although many of its rules did not go into effect until years later. Patient rights established by the ACA are distributed across 45 CFR § 146, 147, 148, 153, 155, 156, and 158.

The ACA established the following patient rights:

  • Right to insurance despite having a preexisting health condition, in many circumstances (e.g., for children) without facing additional charges

  • Right to many types of preventive care for free

  • Right to essential health benefits without lifetime and yearly dollar limits on coverage

  • Right to maintain health insurance despite becoming sick

  • Right to have some choice of healthcare provider

  • Right to some protections against employer retaliation

  • Right to some previously non-insured health benefits, such as benefits for mental conditions

Patient Rights in Other First World Countries

Patients in many other first world countries have rights beyond those established by the American laws cited above. In contrast to many other first world countries, in the United States, a citizen’s ability to obtain treatment for a common non-life-threatening condition at a heavily subsidized cost is not a right. Some countries protect a patient’s finances from seizure by the patient's healthcare provider and healthcare insurer.

Patient Declaration or Bill of Rights at Private Institutions

Some organizations, as a way of educating patients about their rights and/or as a way of adding rights not stipulated by law, use their own declarations of patient rights. The term "bill," when used formally, refers to a document that contains language that legislators evaluate for merit in becoming a law. However, when used informally, the expression "bill of rights" can refer to any declaration of rights (usually published in the form of a list). As an example of a current patient bill of rights, Indiana University Health's patient bill of rights includesthe following patient rights:

Patient rights are a subset of human rights applied in the specific context of medical treatment. The establishment of patient rights standardizes the application of ethical principles to particular medical situations. Such documentsprovide the framework by which a patient can expect to receive care and by which members of a healthcare team can best promote the rights for each patient. Knowledge of certain ethical principles is necessary for understanding the context by which patient rights are created. Patient rights extend to the whole person. They preserve aspects of the patient’s relationship with their health care provider, even extending to third parties such as a health care insurer in some cases. Although patient rights can be traced to ancient cultures, the idea of a formal patient bill of rights is a relatively recent development, with the first such composition occurring in 1973. Though American federal laws enforce some patient rights nationally, many issues pertaining to patient rights vary by the healthcare institution.

Clinical Significance

Ethical principles and patient rights should guide all encounters with patients. Although there is not formal legal guidance in North America, many individual states and provinces have created their ownspecific patient rights policies. In the states with no plans, the decision regarding whether or not to use such a system is up to the individual hospital.The failure to observe ethical and legal guidelines can lead to patient dissatisfaction, medical malpractice, and loss of clinical privileges or medical license. Issues that need to be addressed are patient competence, consent, right to refuse treatment, emergency treatment, confidentiality, and continuity of care.

Proper awareness of the ethical principles and the ability to apply them to specific circumstances is relevant to all clinical specialties and settings. Without the appropriate understanding of patient rights, the healthcare team may at times be prone to various tendencies such as a failure to respect patient autonomy. This can be demonstrated in several ways, such as acting in an overly paternalistic manner or making clinical decisions on behalf of the patient and or family. Other ways it can occur include cases in which not all options, risks, or side effects may be appropriately disclosed. Furthermore, there is the ethical question when the provider chooses to leave out certain options, risks, or side effects due to an extremely low likelihood or clinical judgment. While it may be timesaving or be in what the provider believes to be the best interest of the patient, there is the question as to whether the patients are indeed fully informed, or simply informed enough. Examples of this can occur in emergent situations, when there is little time, as well as in end-of-life decisions when the family may not know the extent to which “doing everything” may entail, but it can happen in all settings. While a failure to respect patient autonomy is only one example, other patient rights can be infringed upon if members of the healthcare team are not careful. By clearly and regularly collaborating with the patient regarding their goals of care and engaging in shared decision making, as well as properly understanding the various components of patient rights, such infringements can be minimized.

Enhancing Healthcare Team Outcomes

It is imperative that the interprofessional team is aware of patient rights and ethical issues. Each physician, nurse, and allied health provider must strive to provide care within these guidelines. In this way, optimum medical outcomes are more likely. Legal or ethical consequences are less likely.

As discussed above, utilizing shared decision-making is a helpful tool for both patients and members of the healthcare team to incorporate elements of patient rights. Working together to arrive at an appropriate plan is helpful to balance between two extremes. On one end is paternalism, in which the patient has no say, and the opposite is when the patient is given an overwhelming amount of information and options then left to decide on their own without an appropriate clinical recommendation. When used appropriately, shared decision-making can encourage the patient rights of beneficence, non-maleficence, patient autonomy, patient-provider trust, and more, particularly as it helps to clarify patient goals for both the patient and the members of the healthcare team. This is becoming increasingly well-documented as studies continue to look at shared decision-making.

In a review of 105 randomized controlled studies that involved over 31,000 participants, Stacey et al[7](Level I) found that utilizing shared decision-making exposing patients to decision aids led to them feeling more knowledgeable, better informed, and having increased clarification of values. They also probably have a more accurate perception of risk and a more active decision-making role. Other studies show shared decision-making as effective across the spectrum of medicine. In the treatment of depression in the primary care setting, utilizing a shared decision-making approach resulted in better treatment and increased patient satisfaction without longer consultation times[8](Level 2). Benefits are not limited to primary care; a recent study published in the Journal of the American Academy of Orthopaedic Surgeons also demonstrated shared decision making to increase patient knowledge and satisfaction by empowering them to make decisions that are educated and align with their views[9](Level 2).Numerous other studies regarding the efficacy of shared decision-making have shown similar positive results in many other specialties and settings. By using this tool and others, as well as continuing to educate on and encourage best ethical practices, providers and other members of the healthcare team will enable the flourishing of patient rights and improved outcomes.

Nursing, Allied Health, and Interprofessional Team Interventions

Every member of the interprofessional team should observe patients' rights. Allied health providers are often the first to have contact with patients and their families. They must maintain patient confidentiality and observe the right to refuse treatment. Nurses should also be involved in informed consent, medical treatment in an emergency, and continuity of care. Physicians are ultimately responsible for ensuring ethical care and for adherence to hospital policies and legal requirements.

References

1.

Young M, Wagner A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 5, 2022. Medical Ethics. [PubMed: 30570982]

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Chapman CB. Stratton vs. Swanlond: the fourteenth-century ancestor of the law of malpractice. Pharos Alpha Omega Alpha Honor Med Soc. 1982 Fall;45(4):20-4. [PubMed: 6764815]

3.

Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA. 1992 Apr 22-29;267(16):2221-6. [PubMed: 1556799]

4.

van Erp WS, Lavrijsen JC, Vos PE, Bor H, Laureys S, Koopmans RT. The vegetative state: prevalence, misdiagnosis, and treatment limitations. J Am Med Dir Assoc. 2015 Jan;16(1):85.e9-85.e14. [PubMed: 25528282]

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INTERNATIONAL code of medical ethics (World Medical Associaion, London, October 1949). Madjalah Kedokt Indones. 1959 Oct;9:462. [PubMed: 13857590]

6.

Physician and Patient; or a Practical View of the Mutual Duties, Relations, and Interests of the Medical Profession and the Community. Br Foreign Med Chir Rev. 1850 Oct;6(12):503-510. [PMC free article: PMC5199443] [PubMed: 30164814]

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7.

Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017 Apr 12;4:CD001431. [PMC free article: PMC6478132] [PubMed: 28402085]

8.

Loh A, Simon D, Wills CE, Kriston L, Niebling W, Härter M. The effects of a shared decision-making intervention in primary care of depression: a cluster-randomized controlled trial. Patient Educ Couns. 2007 Aug;67(3):324-32. [PubMed: 17509808]

9.

Wilson CD, Probe RA. Shared Decision-making in Orthopaedic Surgery. J Am Acad Orthop Surg. 2020 Dec 01;28(23):e1032-e1041. [PubMed: 32925380]

FAQs

What are the 7 principles of healthcare ethics? ›

There are seven primary ethical principles of nursing: accountability, justice, nonmaleficence, autonomy, beneficence, fidelity, and veracity.

What are patient ethics? ›

It means not only respecting the rights of individuals but also treating all patients in a given situation the same regardless of who they are.

What are the 4 elements of the patient's right? ›

For example, a legal definition is as follows; patient rights is general statement adopted by most healthcare professionals, covering such matters as access to care, patient dignity, confidentiality, and consent to treatment.

What are the 4 basic principles of medical ethics? ›

The four principles of Beauchamp and Childress - autonomy, non-maleficence, beneficence and justice - have been extremely influential in the field of medical ethics, and are fundamental for understanding the current approach to ethical assessment in health care.

What are the 7 C's in healthcare? ›

The 6Cs of nursing are a mix of qualities that all nurses live by when working with service users – Care, Compassion, Competence, Communication, Courage, and Commitment.

What are the 10 rights of patient? ›

Patients Rights
  • Right to Appropriate Medical Care and Humane Treatment. ...
  • Right to Informed Consent. ...
  • Right to Privacy and Confidentiality. ...
  • Right to Information. ...
  • The Right to Choose Health Care Provider and Facility. ...
  • Right to Self-Determination. ...
  • Right to Religious Belief. ...
  • Right to Medical Records.

Why are patient rights important? ›

Every person has a right to a continuity of good quality Health Care without discrimination and within the limits of the resources, manpower and competence available for health and medical care. In the course of such care, his human dignity, convictions, integrity, individual needs and culture shall be respected.

Why are ethics important in patient care? ›

Ethics within healthcare are important because workers must recognize healthcare dilemmas, make good judgments and decisions based on their values while keeping within the laws that govern them.

What are the 5 P's of patient care? ›

During hourly rounds with patients, our nursing and support staff ask about the standard 5 Ps: potty, pain, position, possessions and peaceful environment. When our team members ask about these five areas, it gives them the opportunity to proactively address the most common patient needs.

What are the 5 P's in healthcare? ›

By broadening their outlook to include the new 5 Ps of Patients, Physicians, Professional Healthcare Administrators, Policy Makers, and Payers, healthcare marketers can position their brands for long-term success in this brave new world of healthcare.

What is the most important patient right? ›

An important patient right is informed consent. This means that if you need a treatment, your health care provider must give you the information you need to make a decision. Many hospitals have patient advocates who can help you if you have problems.

What are the six values in medical ethics? ›

Therefore, the new measure was developed to assess the importance of six medical ethical principles; non-maleficence, beneficence, autonomy, justice, confidentiality and truth-telling.

What is the most important ethical principle in healthcare? ›

Of the four principles of health care ethics, non-maleficence is the one that is generally the one most commonly prioritized. Non-maleficence means that you as a health care professional must do no harm.

What are 10 codes of ethics? ›

Ethics Statement Examples for Associations
  • “Contribute to society and to human well-being, acknowledging that all people are stakeholders in computing.
  • Avoid harm.
  • Be honest and trustworthy.
  • Be fair and take action not to discriminate.
  • Honor confidentiality.
  • Perform work only in areas of competence”
17 Sept 2021

What are basic ethics? ›

The expression "basic ethical principles" refers to those general judgments that serve as a basic justification for the many particular ethical prescriptions and evaluations of human actions.

What are the 3 C for patients? ›

PEMs play an important role in boosting patient experience. Their contribution can be summed into the 3 Cs of Improving Patient Experience in Healthcare: Communication, Collaboration, and Caring.

What are the 6 NHS values? ›

What are the NHS Values?
  • Working together for patients.
  • Respect and dignity.
  • Commitment to quality of care.
  • Compassion.
  • Improving lives.
  • Everyone counts.

What are the seven 7 patient rights? ›

The charter outlined what every person could expect when receiving care and described seven fundamental rights including: access; safety; respect; partnership; information; privacy; and giving feedback.

What patient rights means? ›

To courtesy, respect, dignity, and timely, responsive attention to his or her needs. To receive information from their physicians and to have opportunity to discuss the benefits, risks, and costs of appropriate treatment alternatives, including the risks, benefits and costs of forgoing treatment.

How can we protect patients rights? ›

What Are Patient Rights in Health Care?
  1. Ask questions about treatment and health.
  2. Be treated by medical staff who respect patient confidentiality and privacy.
  3. Be treated with dignity, respect, and courtesy.
  4. Discuss with doctors the costs, risks, and benefits of different treatments.
  5. Get a second opinion.

What is patient rights and responsibilities? ›

Receive necessary care, regardless of your race, gender, language, origin or source of payment. • Be respected for your cultural, spiritual and personal values, dignity, beliefs and preferences. • Privacy during care, examination, treatment and conversations with your physician and other health care providers.

What ethical issues affects patient care? ›

5 Ethical Issues in Healthcare
  • Do-Not-Resuscitate Orders. ...
  • Doctor and Patient Confidentiality. ...
  • Malpractice and Negligence. ...
  • Access to Care. ...
  • Physician-Assisted Suicide.

What is your moral responsibility to a patient? ›

In medicine, obligations such as acting in patients' best interests (beneficence) or avoiding harm (non-maleficence) are more stringent than general duties that all people have to help others and avoid harming them. Doctors can be held to account for these professional role responsibilities.

What is an example of ethics in healthcare? ›

Ethical decision-making in healthcare.

For example, a patient may refuse care due to cultural/religious views, or may want an unnecessary treatment which may not be in his or her best interests; euthanasia is another example of a provider's sense of morals conflicting with his or her ethical obligations.

What are the 5 C's in NHS? ›

The 6 Cs of care
  • Care. Care is our core business and that of our organisations; and the care we deliver helps the individual person and improves the health of the whole community. ...
  • Compassion. ...
  • Competence. ...
  • Communication. ...
  • Courage. ...
  • Commitment.

What is a priority 5 patient? ›

Priority group 5

You're receiving VA pension benefits, or. You're eligible for Medicaid programs.

What are the patients 5 rights? ›

One of the recommendations to reduce medication errors and harm is to use the “five rights”: the right patient, the right drug, the right dose, the right route, and the right time.

What are the 5 different types of patient? ›

5 Types of Patients (and How They've Changed in the Last 15 Years...
  • The Independent Skeptic. One of the toughest to deal with, this type of patient is naturally skeptical about expert advice. ...
  • The Researcher. ...
  • The Passive Dependent. ...
  • “I'm flexible” ...
  • The Open-minded “Explorer”
5 Feb 2013

How do you prevent patient falls? ›

3.2. 1. What are universal fall precautions?
  1. Familiarize the patient with the environment.
  2. Have the patient demonstrate call light use.
  3. Maintain call light within reach.
  4. Keep the patient's personal possessions within patient safe reach.
  5. Have sturdy handrails in patient bathrooms, room, and hallway.

What is the definition of Hipaa law? ›

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge.

What are the 10 patient responsibilities? ›

Patient's Responsibilities
  • Providing information. ...
  • Asking questions. ...
  • Following instructions. ...
  • Accepting results. ...
  • Following facility rules and regulations. ...
  • Showing respect and thoughtfulness. ...
  • Meeting financial commitments.

What defines good patient care? ›

It means providing care that is free from harm, minimizes redundancy and waste, allows timely access to needed services, follows best practices, and incorporates patients' preferences and treatment priorities.

What are two important patient responsibility? ›

Patients are responsible for reporting if they do not understand the planned treatment or their part in the plan. health personnel. Patients are responsible for keeping appointments. Patients are responsible for treating others with respect.

What are 5 fundamental principles? ›

It is divided into three sections, and is underpinned by the five fundamental principles of Integrity, Objectivity, Professional competence and due care, Confidentiality, and Professional behaviour.

What are some examples of ethics? ›

Ethics, for example, refers to those standards that impose the reasonable obligations to refrain from rape, stealing, murder, assault, slander, and fraud. Ethical standards also include those that enjoin virtues of honesty, compassion, and loyalty.

What are examples code of ethics? ›

The classic example is the Golden Rule: "Do unto others as you would have them do unto you." Other examples of societal ethical behavior include: Respect - Citizens must respect another's property, choices and lives. Loyalty - People put their family and friends' needs before their own.

What is a Doctors code of ethics? ›

A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

What are the ABC's of healthcare ethics? ›

Overview. Health care ethics (a.k.a “clinical ethics” or "medical ethics") is the application of the core principles of bioethics (autonomy, beneficence, nonmaleficence, justice) to medical and health care decisions.

What is ethical behavior in healthcare? ›

The Core Principles of Bioethics

Beneficence: duty to help the patient advance their own good and to act in a patient's best interest. Autonomy: duty to honor a patients right to make their own decision and to be self-determining. Nonmaleficence: duty to do no harm to the patient.

What are examples of the 7 principles? ›

Match
  • Popular Sovereignty. We choose and elect the president, senator, governer etc- we are the source of their power.
  • Republicanism. ...
  • Federalism. ...
  • Seperation of Powers. ...
  • Checks and Balances. ...
  • Limited Government. ...
  • Individual Rights. ...
  • Compromise.

What are the 8 guiding principles of healthcare ethics? ›

The final Washington e-Health Code of Ethics sets forth guiding principles under eight main headings: candor; honesty; quality; informed consent; privacy; professionalism in online health care; responsible partnering; and accountability.

What are the 5 basic principles? ›

Match
  • Popular sovereignty.
  • Limited government.
  • Separation of powers.
  • Checks and balances.
  • Federalism.

What are 6 basic principles? ›

Summarize What are the six underlying principles of the Constitution? The six underlying principles of the Constitution are popular sovereignty, federalism, separation of powers, checks and balances, judicial review, and limited government.

What are the 5 universal principles? ›

Golly has identified five universal principles for managing their in-class conduct:
  • Being Respectful.
  • Modeling Behaviors.
  • Having Clear Expectations.
  • Maintaining Routines.
  • Dealing with Chronic Misbehaviors.

What are the top 5 ethical issues in healthcare? ›

5 Ethical Issues in Healthcare
  • Do-Not-Resuscitate Orders. ...
  • Doctor and Patient Confidentiality. ...
  • Malpractice and Negligence. ...
  • Access to Care. ...
  • Physician-Assisted Suicide.

What are the 5 pillars of medical ethics? ›

Five Major Moral Principles in Health Care:
  • I. NON MALFEASANCE.
  • II. BENEFICENCE.
  • III. UTILITY.
  • IV. DISTRIBUTIVE JUSTICE.
  • V. AUTONOMY.

What are the Code of ethics in Healthcare? ›

Healthcare quality professionals work competently and impartially, practicing within the scope of their education and expertise. They advocate for processes that are fair, transparent, and consistent with evidence-based practices. They remain current on industry trends and best practices.

Videos

1. Patient Rights Made Simple
(TrainingABC)
2. Patient Rights and Responsibilities
(The Agenda with Steve Paikin)
3. Patient Healthcare Rights
(Skills Development)
4. Ethics and Patient Rights: Lesson 16
(GW Cancer Center)
5. Psychiatric Mental Health Nursing: Introduction, Patient Rights -@Level Up RN
(Level Up RN)
6. Patient’s Rights and Ethics in the USA: Professionalism in Patient Care
(Book Publisher International)
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