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Last updated on March 30th, 2023 at 03:58 pm
Since the Patient’s Rights and Responsibilities Bill, 2019 has not yet been passed in Uganda, many observers argue that health rights are key in ensuring patient safety and enhancing patient empowerment through legislation.
And I will be looking at what health rights exist and how they relate to patient safety in ensuring patient safety and enhancing patient empowerment.
The Word Health Organization Constitution affirms that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.
Patient safety is a fundamental principle of health care. Patient care refers to the prevention, treatment, and management of illness and the preservation of physical and mental well-being through services offered by health professionals.
Patient care consists of services rendered by health professionals (or non-professionals under their supervision) for the benefit of patients.
A patient is a user of health care services whether he or she is healthy or sick. Patients are entitled to a full range of human rights.
Health care providers must respect each patient’s dignity and autonomy, right to participate in making health care decisions, right to informed consent, right to refuse medical treatment, and right to confidentiality and privacy.
The attention, treatment, and care that each health care provider gives to a patient must respect the human rights of every one of his or her patients. Patient empowerment is the process by which patients gain control over their health and health care
Patient safety is about working to prevent errors in health care that cause harm to patients – harm in this context means injury, suffering disability or death. The errors that occur in health care are usually the result of the systems individuals work in, patients should be treated in safe environment and be protected from avoidable harm; patients should be treated in clear surroundings with minimal risk of infection.
The equipment used should be in good working order and used in the correct way. Medicines should be given on time. Tests, investigations and treatments to patients should be appropriate for their condition with procedures performed correctly and in a timely and effective manner. Care should be delivered in a coordinated way by competent healthcare staff who work in an effective team.
The concept of health rights in patient care refers to the theoretical as well as practical application of the general human rights principles into the context of patient care including to both patients and health care providers. It can be said that human rights apply to protect patients as well as health care providers. Patient safety is a discreet and important concept of the right to health that merits attention and scrutiny. Patient rights include right to medical care, prohibition of discrimination, participation in decision making, confidentiality and privacy; inferred consent and refusal to medical treatment.
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They also include the right to information which relates to patient safety and enhancing empowerment in a way that patients are often unaware of their rights, including the right to information on their condition and the right to access their medical records.
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Patients have the right to information about their health status, treatment options and reasonable alternatives, and the likely benefits and risks of proposed treatment and non-treatment. In Sidaway v. Bethlem RHG, the plaintiff had an operation on her spine to relieve pain. There were two possible risks; that a nerve root might be damaged in the area of operation and that the spinal cord might be damaged. Neither of these risks was statistically significant.
However, the consequences were very serious if either risk was to happen. She was left severely disabled with partial paralysis and sued the doctor who treated her. At the Court of Appeal, it was inferred that probably the doctor warned her about the first risk- damage to the nerve root , but not the second – risk damage to the spinal cord.
On appeal to the House of Lords, it had to decide whether failure to inform her of the risk of injury to the spinal cord was negligent. Lord Scarman held that a doctor who operates without consent of his patient is, save in cases of emergency or mental disability guilty of the civil wrong of trespass to the person; he is also guilty of the offence of assault.
The existence of the patient’s right to make his decision which may be seen as a human right protected by common law known as the doctrine of informed consent amounts to this where there is a real or material risk inherent in the proposed operation (however competently and skillfully performed).
A patient has a right to be informed of the inherent treatment proposed by the medical profession – it is said it should not be a judge in its own cause ; or less emotively but more correctly, the courts should not allow medical opinion as to what is best for the patient to override the patients right to decide for himself whether he will submit to the treatment offered to him.
Access to information on sexual and reproductive health is crucial for women to make free and informed decisions. Patients also have the right to access their medical chart and medical history, thus making the right to information critical in increasing accessibility and acceptability of medical services which ensures the right to information and plays a key role in ensuring patient safety and patient empowerment where health rights relate to patient safety.
Thus further, where it relates to the right to participate in decision making, this is instrumental in so far as it relates to patient safety and enhancing empowerment in a way that the patient must be involved in making decisions that he or she submits to and they have an impact on the patient’s life.
In ReMB,Court held that the patient must be able to comprehend and retain the information that is material to the decision especially the likelihood of the consequences of having the treatment in question. The patient must be involved through obtaining the patient’s consent. It may be orally or written.
In Aintree University Hospitals NHS foundation Trust v James, the House of Lords held that the most that can be said, therefore, is that in considering the best interests of this particular patient at this particular time decision makers must look at his welfare in the widest sense not just medical but social and psychological. They must consider the nature of the medical treatment in question, what it involves and its prospects of success; they must consider what the outcome of the treatment is likely to be, they must try and put themselves in the place of the individual patient and ask what his attitude to the treatment is or would likely be and they must consult others who are looking after him or interested in his welfare, in particular for their view of what his attitude would be.
This involvement in decision making helps the patient ensure he or she receives medical care that they deem fit for their health safety since it involves not only medical but social and psychological aspects as well as empowering them make the right choice of treatment thus putting into play the role of this health right in ensuring patient safety and patient empowerment where it relates to patient safety.
Right to non discrimination relates to patient safety in ensuring and enhancing empowerment by ensuring an individual or group of persons is not discriminated against or stigmatized on any grounds in violation of human dignity, human rights and fundamental freedoms.
The health services must guarantee equal access to everyone, without discrimination on the basis of financial resources, place of residence, kind of illness or time of access to services. This is key in safe guarding the health rights of persons with disabilities, children as well as persons who are mentally incapacitated thus ensuring they have access to health and upon access their safety will be paramount as well as acceptability.
This is also helpful where it relates to children’s rights in ensuring they are not discriminated against on whether they have capacity to consent. Whether they can be treated without the parents’ consent in instances where such a child has capacity. In Gillick v. West Norforlk and Wisbech Area Authority and another, Mrs Gillick objected to the provision of contraceptives to her daughters without prior knowledge and consent so long as they were below 16 years.
The court recognized the right of a mature minor to consent to her own medical treatment as Lord Fraser stated that: ” it seems to me verging on the absurd to suggest that a girl or boy of fifteen could not effectively consent for example of some trivial injury to his or her body or even to have a broken arm. Of course the consent of the parents should normally be asked but they may not be immediately available.
” Provided the patient whether a boy or girl is capable of understanding what is proposed and of expressing his or her own wishes, I see no good reason for holding that he or she lacks the capacity to express them validly and effectively and to authorize the medical man to make examination or give the treatment that he wishes.”
From this case, it’s seen that discriminating a person on ground of age and yet they have the capacity to give the consent is discriminatory. The right to non discrimination empowers them by giving them access when it’s in the interest of the child and they are mature enough to understand.
When it comes to the right to privacy and confidentiality, which relates to patient’s safety and is key in ensuring patient safety and enhancing empowerment in that patients have the right to have their health information and data kept confidential.
“Health data may include not only a patient’s sensitive health status, but also those facts or circumstances that the patient reveals to [health care workers] as part of seeking medical treatment. The right to privacy and confidentiality must be applied sensitively, with respect for different cultural, social, and religious traditions.
For certain vulnerable groups, the right to privacy and confidentiality is an essential aspect of obtaining health care. For example, privacy and confidentiality are crucial to realizing sexual and reproductive rights for women and adolescents.
In General Comment 14 on the right to health, the Committee on Economic, Social and Cultural Rights states that: “[t]he realization of the right to health of adolescents is dependent on the development of youth-friendly health care, which respects confidentiality and privacy and includes appropriate sexual and reproductive health services.”
Privacy and confidentiality are also crucial for patients seeking diagnosis and treatment of illnesses with which stigma is attached, such as HIV/AIDS and mental illness. Depending on the type of care an individual is seeking, some health care centers may only allow specific providers to access the patient’s health information.
For example, a nurse who is vaccinating a patient may not access that individual’s private mental health records because the information is not relevant to the treatment being provided at that current moment.
The right to confidentiality of health information should not interfere with the right to access of private health information. While a holder of private health information should be prohibited from sharing that information with anyone who is not essential to providing health care to the individual, the holder must provide the individual access to their private health information upon the individual’s request.
Patients have the right to access their own health information, to be able to control how the information is shared with them (for example, being able to indicate to where mail or phone calls are directed), and to be able to authorize the disclosure of information when desired thus making this health right play a crucial role in ensuring patient safety and empowerment where it relates to patient safety.
Codification of patient’s rights plays an instrumental role in educating people about their health rights. In Uganda though we have the Uganda patient rights charter, it is not binding and has no impact on law and policy as it’s used as reference point to monitor and evaluate health systems in Uganda.
Where it relates to the right to informed consent in ensuring patient safety and enhancing patient empowerment, informed consent is not mere acceptance of a medical intervention, but a voluntary and sufficiently informed decision, protecting the right of the patient to be involved in medical decision-making, and assigning associated duties and obligations to health-care providers.
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Its ethical and legal normative justifications stem from its promotion of patient autonomy, self-determination, bodily integrity and well-being. The right to informed consent is central to the right to health. In Nicola McDonald v Graham Wroe, Court held that a patient who relies on informed consent bears the burden to prove on balance of probabilities, that the medical practitioner was negligent in so far as he failed to warn his patient of the particular risk or complication and the practitioner’s omission as such caused the damages suffered.
The court continued and stated that the defendants’ wrongful and negligent failure to warn the plaintiff of the risk involved resulted in the plaintiff consenting to the defendant performing the surgery. He performed the surgery correctly without negligence. The experts were unable to fault the manner in which he performed the surgery in any way. The harm which the plaintiff suffered is due to a risk which is inherent in the surgical procedure. The harm which the plaintiff suffered would have occurred in any event if the surgery had been performed by a specialist surgeon.
There is therefore no direct causal link in between the defendant’s negligence (in failing to warn the plaintiff of the risk) and occurrence of the harm, unless it is shown the plaintiff upon being warned of the risk would not have undergone the procedure at all. That wasn’t the plaintiff’s case.
Informed consent as a health right thus plays a key role in ensuring patient safety and enhancing patient empowerment in the interest of the patient so far as it relates to patient safety. The only challenge is Derogations, or departures, from the right to informed consent are necessary at times, but the question of when derogations may be permitted is a complicated one.
When a patient is unconscious, medical providers must seek consent from a legally entitled representative. However, if there is an emergency situation where the patient’s life is in danger, medical providers may presume that consent is given. Issues of informed consent also arise from public health policies that require compulsory testing, compulsory vaccinations, or mandated quarantine during epidemics.
Procedural safeguards are crucial to derogations from informed consent, to ensure that proper circumstances are met and to provide a means to challenge the departure from the law in ensuring patient safety and enhancing patient empowerment in so far as informed consent relates to patient safety.
In conclusion, for health rights to play a crucial role in ensuring patient safety and enhancing patient empowerment it calls for a range of measures such as having the Patient’s Rights and Responsibilities Bill, 2019 passed by parliament, strengthened laws, policies, and guidelines to ensure patient safety; training patients as well as health care providers about the health rights.
At the heart of patient’s rights lies consent which is recognized by most international, regional as well as national policies, Bills and Instruments. Consent is a key element where health rights relate to patient safety in so far as a patient agrees to subject themselves to medical treatment since the consent subjects the patient to medical treatment which calls for health rights to be observed in order to ensure patient safety and enhance patient empowerment where it relates to patient safety.
