Asst. Prof., Dept. of Medical EthicsAlfarabi Medical college, Riyadh

Dr. Ghaiath M. A. Hussein

Saudi Commission for Health SpecialtiesProfessionalism and Ethics Education for Residents (PEER)

Patients’ Rights

Ethical basis for patients’ rightsDefinition and classification of patient rightsPatient’s Right related to

Treatment Access to care Choice of care Participation in decision making Privacy and Confidentiality Seek for 2nd opinion or referral Compassionate Palliative and EOL care

Outline

What will we try to learn in this section of the course?

• Roles & duties of doctors (towards self & colleagues, patients & community)

• Patients' rights• Privacy, confidentiality and medical records• Informed consent to treatment • Discussions and cases

Before we start…where are we?

Patient

Doctor

Lab./X-ray

Social worker

Nurse

Manager

Educator

Doctors Are NOT the focus of the healthcare

The ethics behind care...Is there a moral obligation to provide healthcare to our patients?

• The duty to respect patient’s ability to decideAutonomy

• The duty to do good to patientsBeneficence

• The duty not to do harm to patientsNon-

Malificence• The duty to be fair to our patients• Fairness is not equity!Justice

Islamic Guidance behind care...1. Relieved patients from some religious commitments خففت عنهم

:التكاليف الدينيةنكم من الغآئط أو المستم النساء فلم تجدوا ماء • رضى أو على سفر أو جاء أحد م * )وإن كنتم م

با ( موا صعيدا طي فتيم

رضى( سورةالمزمل • ر من القرآن علم أن سيكون منكم م 20 * )فاقرؤوا ما تيس

ن أيام أخر( سورة البقرة• هر فليصمه ومن كان مريضا أو على سفر فعدة م 185 * ) فمن شهد منكم الش

أسه ففدية من صيام أو صدقة أو نسك( سورة البقرة • ريضا أو به أذى من ر .196 * ) فمن كان منكم م

عفاء وال على المرضى وال على الذين ال يجدون ما ينفقون حرج ( سورة التوبة • 91 * }ليس على الض

2. Visiting them is a duty (on everybody, not only doctors) جعلتعيادتهم حقا واجبا .

3. Referred to their health, mental, and social requirements نبهتعلى مسائل يحتاجونها: صحيا ونفسيا واجتماعيا .

Patients’ Rights on who?

State (MOH)

Providers

Family Community

ROLES & DUTIES OF DOCTORS TOWARDS THEIR PATIENTS

Patients’ rights

Muslim Doctors’ Duties Towards Patients

• Respect for Patient المريض احترام• Respect for Privacy المريض خصوصية ضمان• Comprehensive care للمريض الشاملة الرعاية• Respect for patient’s autonomy المريض استقاللية احترام• Inform the patient about his/her condition المريض تبصير

مرضه بطبيعة• Protect patient's interests المريض مصلحة حماية• Keep the patients’ secrets المريض سر كتمان

Source: Islamic Code of Medical & Health Ethics

DUTIES OF PHYSICIANS TO PATIENTSA physician shall• Always bear in mind the obligation to respect human

life.• Act in the patient's best interest when providing

medical care.• Owe his/her patients complete loyalty and all the

scientific resources available to him/her. • Whenever an examination or treatment is beyond the

physician's capacity, he/she should consult with or refer to another physician who has the necessary ability.

• Respect a patient's right to confidentiality.

DUTIES OF PHYSICIANS TO PATIENTSA physician shall• Give emergency care as a humanitarian duty unless

he/she is assured that others are willing and able to give such care.

• In situations when he/she is acting for a third party, ensure that the patient has full knowledge of that situation.

• Not enter into a inappropriate relationship with his/her current patient or into any other abusive or exploitative relationship.

The duties of a doctor (GMC)To be a doctor that patients are able to trust with their lives

and health, you must:• Make the care of your patient your first concern• Protect and promote the health of patients and the public• Provide a good standard of practice and care– Keep your professional knowledge and skills up to date– Recognize and work within the limits of your competence– Work with colleagues in the ways that best serve patients’

interests• Treat patients as individuals and respect their dignity– Treat patients politely and considerately– Respect patients’ right to confidentiality

The duties of a doctor (GMC)• Work in partnership with patients– Listen to patients and respond to their

concerns and preferences–Give patients the information they want or

need in a way they can understand–Respect patients’ right to reach decisions

with you about their treatment and care– Support patients in caring for themselves to

improve and maintain their health

The duties of a doctor (GMC)• Be honest and open and act with integrity– Act without delay if you have good reason to

believe that you or a colleague– May be putting patients at risk– Never discriminate unfairly against patients or

colleagues– Never abuse your patients’ trust in you or the

public’s trust in the profession.• You are personally accountable for your

professional practice and must always be prepared to justify your decisions and actions.

Patient’s RightRights directly related to Treatment

Receive treatment Consent to treatment ( accept or refuse ) Privacy Confidentiality Compassionate End of Life ( EOL ) Care

Right Not directly related to treatment

Respect Safety Protection for Physical assault ( specially vulnerable ) Spiritual care Participation in clinical trials

Treatment-Related Rights

• Access to care• Choice of Care• Participation in decision making• Privacy & Confidentiality• Seek 2nd Opinion/Referral• Compassionate Palliative • And EOL care• Complaint system

Saudi Commission for Health Specialties

1- Access to Care

Patients have the right to have access to healthcare that meets their needs at the time they need it at a cost they can afford.

Patients should not be denied access to care they need or discriminated against based on their colour, race, belief, disability, etc.

This includes their right to transport to hospital in case of emergency (Ambulance).

2- Choice of Care

These include: Receiving timely emergency care Treatment and rehabilitation Be seen of their doctor (of choice) Provision for special needs Counseling Palliative care Health information (education)

Participation in decision-making

Receive Relevant Information

Diagnosis

Treatment

Prognosis

Post-Discharge Care

Hospital policies

Consent to Treatment

Relevant facts explained

Patients are free from undue influence

Patients assign Substitute decision

maker

Right to Refuse Treatment

Relevant alternatives explained

Risks explained, and consent taken

Informed Consent to TreatmentCAPACITY VOLUNTARINESS DISCLOSURE

• The patients has the ability to:

• Understand medical information

• Appreciate the risks

• Memorize the information

• Freedom from undue influence:

• Money

• Social pressure

•Physical restraint

• Information:

•Diagnosis• Possible prognosis• Benefits and risk of treatment• Expected outcome• In a language understood by the patient

Saudi Commission for Health Specialties

4- Continued care, Seeking 2nd opinion & Referral The patients have the right to:

Receive uninterrupted care from his/her doctor. To be referred to other health care providers when necessary. Receive a second opinion when the patient or

his/her doctor requests one. The second opinion must be provided by a

qualified health care professional within the same organization.

Saudi Commission for Health Specialties

5- Compassionate EOL CareThe patient have the right to:

Have her physical pain assessed and managed Have Advance Directive Plan (Living Will) Assign a family member to be the SDM Have her/his emotional and spiritual needs

addressed

Ethical quiz: what to draw the line between “allowing your patient to die” and “helping your patient to die?”

Saudi Commission for Health Specialties

6- Appeal and Complaint SubmissionThe patient have the right to:

Be told on how to process her problems or complaints

Voice his/her concerns about the care she/he receives

Ask questions and express concerns about hospital health care and services, without fear of reprisal

Have his/her complaint responded to in a timely and satisfactory manner

Saudi Commission for Health Specialties

Key messages Make sure you know your patient's rights Train your colleagues on patient’s rights Knowing and providing these rights protects you ethically and

legally Patient rights guide you to achieve your ethical and

professional goals of availing the best service to your patients Rights are rights NOT gifts that you may not give!