Patient’s Bill
of Rights and responsibilities
What is Patient’s Bill of Rights?
 List of guarantees for those receiving medical
care.
 Guarantees patients information, fair
treatment, and autonomy over medical
decisions, among other rights.
S No. 812 “Patient’s Bill of Rights in the
Philippines”
 It is a declared policy of the State to ensure
and protect the rights of patients to decent,
humane and quality health care. Therefore,
this proposed Magna Carta of Patients Rights
shall provide patients the basic rights
13 Patient’s Rights in the PH acc. to DOH
 Right To Appropriate Medical Care And
Humane Treatment
 Right To Informed Consent
 Right To Privacy & Confidentiality
 Right To Information
 Right To Choose Health Care Provider &
Facility
 Right To Leave
 Right To Religious Belief
 Right To Medical Records
 Right To Self-determination
 Right To Refuse Participation In Medical
Research
 Right To Correspondence & Receive Visitors
 Right To Express Grievances
 Right To Be Informed Of Rights And
Obligations As A Patient
Obligation and Responsibilities of
Patients
 Know Rights
 Provide Accurate and Complete Information
 Report Unexpected Health Changes
 Understand Purpose and Cost of Treatment
 Accept Consequences of Own Informed
Consent
 Settle financial obligations
 Relation to others
 Exhaust grievance mechanism
TERMS/DEFINITIONs
 INFORMED CONSENT
 Legal document that gives full knowledge of
risk/benefits of a certain action regarding the patient
 Valid reasons for patient to receive informed consent:
 Mentally & physically competent and a legal
adult
 Voluntary without coercion
 Thoroughly understands
 Can answer questions or all questions
answered
 The patient will not be subjected to any procedure
without his written informed consent except:
 in emergency cases, when the patient is at
imminent risk of physical injury
 when the health of the population is
dependent on the adoption of a mass health
program to control epidemic;
 when the law makes' it compulsory
 When the patient is: minor// legally
incompetent, in which case (third party
consent)
 when disclosure of material information
to patient will jeopardize the success of
treatment (third party consent)
 When the patient waives his right in writing.
 Third Parties:
 Spouse
 Son or daughter of legal age;
 Parent
 Brother or sister of legal age
 Guardian
 PROXY CONSENT
 process by which people with the legal right to
consent to medical treatment for themselves or for a
minor or a ward delegate that right to another person.
 3 Fundamental constraints on this delegation:
1. The person making the delegation must
have the right to consent.
2. The person must be legally and medically
competent to delegate the right to consent.
3. The right to consent must be delegated to a
legally and medically competent adult.
 2 Types of Proxy consent for adults
1. Power of Attorney to consent to medical
care delegates the right to consent to a
specific person
2. Living will - a written statement detailing a
person's desires regarding their medical
treatment in circumstances in which they
are no longer able to express informed
consent
  CONFIDENTIALITY
 Right of an individual to have personal, identifiable
medical information kept private. Such information
should be available only to the physician of record
and other health care and insurance personnel, as
necessary.
 Exceptions to Confidentiality of Patient Records:
 Disclosure will benefit public health
and safety
 Interest of justice and upon the order of
court
 when the patients waives in writing
 for continued medical treatment or adv
ancement of medical science
vices of a
fraud
 Defined as false representation of fact, made with a knowledge
of its falsehood, or recklessly, without belief in its truth with
the intention that it should be acted upon by the complaining
party and actually inducing him to act upon it
 HC provider does fraud when he tampers the medical records of
his patient, or willfully changes some data in the official record
pride
 Defined as feeling of gratification arising from association with
something good or laudable
 Pride is the root of all vice/sin and the strongest influence
propelling us to sin
 Pride is the sovereign of vices
 HC provider laden with pride dishonors the HC profession. He
should counter it with humility so he can forget about his
achievements and focus on how to help his patient come to
terms with recovery or well-being
Greed / Avarice
 Defined as the excessive desire for wealth or professions
 One of the Seven mortal sins in Catholic Religion
 HC provider with greed might become disloyal to his patients,
steal from them, or even display violence against them;
betraying the inherent trust mandated to him
Virtues of a
FIDELITY
 keeping one’s promises. The nurse must be faithful and
true to their professional promises and responsibilities by
providing high quality, safe care in a competent manner.
honesty
 Honestly “Honestus” = to honor
INTEGRITY
 Integrity “enteros” = whole  Integrity can make a human
person whole or complete
 Practiced when HC provider does his duties and obligations as
a HC provider according to the beliefs, principles, and values
he claims to embrace and cherish
 He brushes away hypocrisy since he willfully adheres to the
ethical code of the profession he is practicing
humility
 Humbleness
 HC provider ceases to think of his own needs as he transcends
his attention to the needs and welfare of his patients
Respect
 An act through which one takes notice of others, regarding
them with special attention, esteem, care, or to consider them
worthy of esteem and honor
compassion
 Feeling of deep sympathy and sorrow for someone struck with
misfortune, accompanied by desire to alleviate that suffering –
Random House Webster’s College Dictionary (2001)
 Merciful feeling because nurse is expected to be sympathetic,
sensitive and manifest genuine sorrow to the patient’s distress
and suffering
prudence
 One of the cardinal virtues according to St. Augustine
 Defined as an exercise of good judgement, common sense,
and caution in the conduct of practical matters
 HC provider exercises wisdom, discretion, and carefulness to
avoid embarrassing and distressing situations as he fulfills his
task in the tour of his duty
Courage
 One of the virtues taught by Aristotle
 Quality of the mind or spirit that enables a person to face
difficulty, danger and pain without fear
 It also means confidence, resolution, and conscious self-
sacrifice for the sake of something greater than one’s own self-
interest
 HC provider should be bold in undertaking a very sensitive job
 Basic ethical
Stewardship
 Panizo argued 4 conditions that must be presented for
 God gave humans the gift of life, intellect, and freedom. With
intellect, humans sought to discover the truth; with freedom,
humans became creative
 Consequently, in the context of stewardship humans must respect
the sanctity of life and the world
 Any act, therefore, that would defile the blessedness of life and
thee world is deemed against the principle of stewardship
 The principle of stewardship declares that human life comes from
God, and no individual is the master of his body. As stewards of life
and the divine gifts of nature, humans, to this extent are
accountable to life and the world
TOTALITY
 Principle that pursues the issue of the dignity of the whole
person, the integrity of human life. It demands respect for the
self and respect for others.
 “Do unto others what you want others do unto you” by Kong
Zi/Confucius in the Golden Rule
 Sine quo non “without which not” – refers that respect is a
necessary condition for everyone so they can sustain their
place in the society as a nurse, physician or etc. Because they
are the building blocks of the society, without whom this
society will lack its vitality and totality
 Principle that nurse or healthcare providers
 Principles of totality can be seen in situations:
 Legislators draft and pass laws to punish violators of
the dignity and value of human life
 Applied to the human body, specifically in the scope
of health: It is acceptable that some people alter
 So a nurse should dispense herself from a
themselves (e.g. surgery) on the premise that the
intention is meant to safeguard the totality of the
well-being of the body
 The principle of totality can also be seem in the
 E.G Nurse should refuse cooperation in cases
context of the journey of human life, from conception
to the time of death: Test tube babies may lack the
issue of totality because they were not nourished by
the unique and amazing experiences of the varied
facts of existence by the natural born babies
- E.G. person commits suicide jumping from a
building, killing a beggar by landing on top
of him. He is morally exempted because
that person had no intentions of such evil
effect but he is immoral for attempting to
end his life. He is, however, not legally
exempted because he is evidently
responsible for the death of the beggar
a person to be allowed to perform the so-called
double effect act (an action that has good effects but
also bad effects):
1. Action must be morally good in itself
2. Good effect of the act must precede the
evil effect
3. There must be grave or sufficient reason in
doing the act
4. Evil effect should not outweigh the good
effect
- E.G. Pregnant women therapeutic terminates
pregnancy due to risk of cervical cancer
detrimental to her survival. The act itself is
morally good because of the assurance of her
good health which preceded the health of the
fetus (bad effect of the operation). Although the
fetus has intrinsic dignity, its future cannot be
yet ascertained compared to the mother who
may still later become pregnant, and deliver
and raise healthy babies
COOPERATION
should pursue with prudence/ cautiousness
only on matters that would protect the
integrity of the healthcare profession, and the
interest and welfare of their parents
cooperation that involves or results to her
personal and integral scandal or immorality of
the healthcare profession
of abortion wherein it is done on the grounds
of scandalous pregnancy (married woman is
impregnated by a different man or a single
woman who wants to hide her pregnancy to
save face)

DOUBLE-EFFECT ACT
 Principles that one act can embrace two effects – an intended
good effect and an unintended bad effect
 Glenn argues 3 conditions that make a person responsible for
the evilness of his actions:
1. Person foresees the evil effects of his actions
2. Person is free to refrain from doing that which the
cause of the evil effect
3. If person knows that he is morally bound not to do
that which is the cause of the evil effect
 C O R E VA L U E S O F A
Autonomy / self determination
 Defined as the moral right to choose
 3 Basic Elements of Autonomy:
 Ability to decide (having adequate information &
intellectual competence)
 Power to act upon one’s decision
 Respect for individual autonomy for others
veracity
 is being truthful with patient; nurses must not withhold the
whole truth from clients even if may lead to patient distress.
Non-maleficence
 is doing no harm, as a stated in the historical Hippocratic Oath
concerning:
 Patients’ right to not be killed
 Patients’ right to not have bodily injuries or infliction
of pain
 Patients’ right to have confidentiality or confidence to
reveal to others
 Negligence – consequences that are resulted from a
conduct/action which falls below standard which occur in
common grounds of:
 Failure to assure patient safety
 Improper treatment/negligent performance
 Failure to monitor patient and report significant
findings
 Medication error
 Malpractice – professional misconduct, or knowingly being
involved in procedures that result to unlawful medical practices
(intentional)
beneficence
 To do good & provide benefits to patient in ways of:
 Fair play (e.g. considering to treat based on severity
of condition rather than beneficial gain)
 Keeping promises
 Role commitment – sticking to the oath of your
profession
Empathy / caring
 An innate instinct of human beings to take care to each
other.
 A nurse should be empathetic and have willingness to care
for their patients
Justice
 Nurses must be fair when they distribute care
Ethical
 "Deon" = duty DEONTOLOGY
 Rightness or wrongness of the situation depends on:
a. What is known to be universally right/wrong given in
set of guidelines and rules
b. What is known to be our duty to fulfill (e.g.
Duty/promise not to cheat on your spouse)
c. One's intention while doing the act "e.g. Difference
between murder & killing in self-defense“
d. Does not depend on consequences
 Immanuel Kant's work: groundwork of the metaphysic of morals
= says that different answers on how we can discover our
duties, we should use 'pure reasoning'
 E.G. Male students are obligated to have a certain appropriate
haircut in accordance to school rules to be able to enter the
campus (one fulfills his duty not based on what is pleasant or
beneficial, but rather upon the obligation itself
UTILITARIANISM
 Ethical theory that determines right or wrong based on what
action or outcome produces the greatest good for the greatest
number
 fathers of utilitarianism: Jeremy Bentham & Stuart Mill
 Utilitarianism is relevant under teleological theory
 E.G. Denying a single individual access to a heart transplant if
the money could be spent on providing vaccine for thousands
teleological
 -"Telos" = end
 Theory that judges the rightness or wrongness of decisions
based on outcomes or predicted outcomes
 E.G. You spent many days prior the exams to do everything but
study, and on the day of the exam you come emptyhanded.
After the incident is when you realized that is was wrong that
you neglected to study because now the results are out and
you've got a negative result.