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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!