MORAL ISSUE OF PATIENTS’ RIGHTS

PRINCIPLE OF AUTONOMY
 RIGHT OF SELF DETERMINATION
 Greek word “autos” meaning “self” and “nomos” means “rule, governance, law”.
 Refers to freedom from external control
 includes the freedom of patients to select appropriate treatment without the influence of fear,
threat, deceit, fraud or duress
 Central element in the moral issue of Patient’s right.
 respecting others culture, religion or belief insofar as it positively affects their health.

PATIENT AUTONOMY
 The right of the patient to make decisions about their medical care without their health care
provider trying to influence the decision.
 Allows the health care provider to educate the client but it does not allow the HCP to decide for
the patient
 Patient has the right to accept or refuse any treatment

IMPLICATIONS OF THE PATIENT’S AUTONOMY

 The patient is responsible for his choices and decision
 His human dignity is upheld and recognized
 His personal value and worth are acknowledged
 His patient’s rights are protected and are not duly interfered
 He cannot be force to make decisions and perform actions against his will.

FORMS OF DISOBEDIENCE OF PTS. AUTONOMY

 Employment of intervention without the use of the patient capacity to make his choices and
decisions
 Employment of intervention against the patient’s choices and decisions
 Omission of an intervention that is in agreement with the patient’s choice and decision
 Withdrawal of the services of a health care professional and making a referral of the case without
the informed choice of the patient

EXCEPTION IN AUTONOMY
 During emergency cases as when the patient life would be in danger and patient competence to
make informed decision is absent.
 The patient freely decides to waive his consent for the necessary health care services and
delegates authority to persons whose professional competence in the field is noted.
 The patient has the ability to inflict harm upon oneself or others

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RIGHTS
 Is something mine or yours, something that belongs to a person by nature, it is sometimes but not
always reinforced by law.

PATIENT’S RIGHTS
 Refers to the moral and inviolable power vested in him as a person to do, hold, demand
something as his own.

 The physician must respect these rights.

 Right to be treated with respect
 Right to obtain medical records
 Right to confidentiality of medical records
 Right to make a treatment of choice
 Right to informed consent
 Right to refuse treatment
 Right to make decisions and choice about end life care

RIGHT TO INFORMED CONSENT

 The patient has the right to receive all necessary information concerning diagnosis and treatment
to be able to give consent.

RIGHT TO INFORMED DECISION

 Refers to the necessary information of and decision on a medical treatment before it is carried
out.

RIGHT TO INFORM CHOICE

INFORMED CHOICE
 Refers to the necessary information a patient should know about a medical treatment so that a
moral choice can be made.

RIGHT TO REFUSAL OF TREATMENT

 The patient has the right to refuse treatment to the extent permitted by law and to be informed of
the medical consequences of his action.

PATIENT’S BILLS OF RIGHTS

 is a document that provides patients with information on how they can reasonably expect to be
treated during the course of their hospital stay
 Recently renamed Patient Care Partnership

PATIENT’S BILLS OF RIGHTS

1. The patient has the right to considerate and respectful care.

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 2. The patient has the right to obtain from his physician complete current information concerning
his diagnosis, treatment and prognosis
3. The patient, has the right to receive from his physician information necessary to give informed
consent prior to start of any procedure or treatment
4. The patient has the right to refuse treatment to the extent permitted by law and to be informed of
the medical consequence of his action
5. The patient has the right to every consideration of his privacy concerning his own medical care
program.
6. The patient has the right to expect that all communications and records pertaining to his care
should be treated as confidential.
7. The patient has the right to expect that, within its capacity, the hospital must provide a reasonable
response to his/her request for services.
8. The patient has the right to obtain information regarding any relationship of his hospital to other
health care and educational institutions insofar of his care is concerned.
9. The patient has the right to be advised if the hospital proposes to engage in or perform human
experimentation affecting his care or treatment. The patient has the right to refuse to participate in
such research project.
10. The patient has the right to expect reasonable continuity of care.
11. The patient has the right to examine and receive an explanation of the hospital bill regardless of
source of payment.
12. The patient has the right to know what hospital rules and regulations apply to his/her conduct as a
patient.

IN CAPSULE: PATIENT’S RIGHTS

 P – rivacy
 A – utonomy
 T – treatment refusal
 I – nformation
 E – ducation
 N – ot to be restrained
 T – reated with confidentiality
 S – services

Limitations of Patient’s Rights

1. Patient’s rights do not include the right to be allowed to die.
2. A patient in a moribund condition does not possess the necessary mental or emotional stability to
make an informed choice.
3. Patient’s rights are not absolute

INFORMED CONSENT
o Refers to the knowledge or information about the consent to a particular form of medical
treatment before the treatment is administered.
o Necessary for admission to a health care agency, invasive procedures such as intravenous central
line

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 o insertion, surgery, chemotherapy and participation in research studies (Guido, 2014)
o A patient’s agreement to have a medical procedure after receiving a full disclosure of risk,
benefits, alternatives, and refusal (Westrick, 2014)
o Must be obtained and witnessed when the patient is not under influence of medications such as
opioids and narcotics
o Who must obtain the consent? PHYSICIAN or SURGEON.

4 Major Elements of Informed Consent

1. Competence
⤷ Patient’s capacity for decision making.

2. Disclosure
⤷ refers to the content of what a patient is told or informed about during the consent
negotiation.

3. Comprehension
⤷ refers to whether the information given has been understood.

4. Voluntariness
⤷ Consent must be voluntary.

Methods of obtaining Informed Consent (Medical Context)

1. Written Consent
⤷ is a consent form to filled up and signed by a patients as he/she checks in for admission in a
hospital.

2. Verbal Consent
⤷ Patient verbally signifies his/her willingness to undergo medical treatment informed consent
is met.

Characteristics of a Valid Consent

1. Proper explanation of the procedure
2. Explanation of possible outcome of the procedure
3. Explanation of alternative treatments and options
4. Description of the benefits derived from said treatment
5. Explanation of risk and cost
6. Explanation is understood by the patient. (Translation if needed)
7. The patient is given the chance to ask questions about the procedure.
8. The opportunity to refuse recommended treatment or procedure.
9. Right to withdraw or cancel prior consent if requested by the patient.
10. Mentally and physically able to give their personal consent

WHO CAN SIGN THE CONSENT?

o Parents/ legal guardians
o Patient who is in legal age

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 o Court

Types of Patients Who Cannot Give Informed Consent

1. Comatose or obtunded patients
2. Blind or illiterate patients
3. Under aged patients or those unable to understand the circumstances
4. Language-barrier patients

Situations Where Informed Consent is not Necessary

 In case of emergency
 Emergency justifying treatment without informed Consent
a) The patient is incapable of giving consent and no lawful surrogate is available to give consent
b) There is danger to life or danger of a serious impairment of health
c) Immediate treatment is necessary to avert these dangers

CONSENT BY PROXY
o is done when the patient is not capable of giving consent and it is legitimately represented by a
competent surrogate who acts on behalf
o The process by which the people with the legal right to consent to medical treatment for themselves
or for a minor, delegate that right to another person
o Unconscious, insane, child or minor

TWO TYPES OF PROXY CONSENT

1. Power of Attorney/Durable power of Attorney
⤷ Patient uses the power of atty to delegate the right to consent to a specific person if they are
incompetent by the medical care.
⤷ It is an authorization that enables any competent individual to exercise decision making if the
client is unable to make decisions personally.

2. Living Will
⤷ It is a written, legal document prepared by a competent adult that spells out medical treatment a
patient would or would not want to be used to keep him/her alive as well as his/her preferences
for other medical decisions
⤷ An expression of the person’s wishes regarding end of life care

CONFIDENTIALITY AND PRIVACY

 CONFIDENTIALITY
⤷ The obligations of professionals who have access to patient records or communication to hold
that information in confidence
⤷ Keeping the information secret (Surbhi, 2018)
⤷ In medical professions, the information shared between the patient and the nurse or doctor and
the patient, will not be told to the third party.

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 ⤷ The information should be kept in private and the record is accessible only to those who provide
care to the patient

 PRIVACY
⤷ Free form public interruption and intrusion
⤷ Refers to condition where a person is apart from public attention and observation

Examples of Violations of Patient’s Privacy

o Taking photograph of the patient
o Use of patient’s name
o Leaving the curtains or room door open while treatment or procedure is performed
o Allowing individuals to observe a treatment or procedure without the patient consent
o Interviewing a patient in a room with only a curtain between patient where conversation can be
overheard

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APPLICATION OF ETHICAL THEORIES
 NATURAL LAW ETHICS
⤷ Right to informed consent is Morally Legitimate.
⤷ The patient consent must be FREE and not in the form of deception or coercion or intimidation.

NLE/Stewardship/Inviolability of Life
o Against the patient’s right to refusal of treatment if the means is an act of commission/omission
resulting to self-killing/ euthanasia.

KANT’S ETHICAL PRINCIPLE

o Patients must not be deceived by their physicians no matter how good their intension may be.

UTILITARIANISM’S Principle of Utility

o Requires HCP to design medical treatment in a way that minimizes suffering and harm.
o Informed consent is not required for the social good as they involve as research subject.

RAWL’s Principle of Justice

o Do not allow medical treatment or experiment that make use of coercion and deception violate
the freedom of a patient.
o Voluntary informed consent is required of all subjects in research.

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