Introduction

Considerable literature is available in the medical field regarding duties of doctors or the professional code that the doctor swears to uphold. But the medical man very conveniently forgets that because the doctor has duties towards the patient, the patients have certain rights. The World Medical Association has adopted both the International Code of Medical Ethics and the Declaration of Lisbon (1981).

These documents yield a set of duties and correlative rights that are far more stringent than any national law could impose on doctors in their capacity as individual citizens.

As patients are now considered as consumers as per the Consumer Protection Act 1986, here is an attempt to make the patients aware of some of their rights.

Considering the wide variety of medical services, though it is almost impossible to formulate the rights of all the patients, the following rights are affirmed.
The Patients has a right to:

• Choose his own doctor.
• Considerate and respectful care.
• Access to emergency services.
• Obtain from his physician complete current information concerning his diagnosis, treatment, prognosis and alternative therapies available, in the terms that the patient can reasonably be expected to understand.
• Know full details about the physician who is responsible for his care.
• Receive from his physician information necessary to give informed consent prior to the start of any procedure/treatment.
• Be informed of the medical consequences if he refuses a much needed procedure (informed refusal).
• Be treated in privacy and that the doctor should maintain professional secrecy.
• Receive complete information and explanation concerning the need for and alternative to any transfer to another facility. The institution to which the patient is to be transferred must first have accepted the patient for transfer.
• Consult another doctor.
• Refuse to participate in any research projects or human experimentation.
• Expect reasonable continuity of care.
• Examine and receive an explanation of his bill.
• Know what hospital rules and regulations apply to his conduct as a patient.
• Access to his hospital records.
• Complain and seek redressal.

All the rights of the patients should be posted conspicuously in all the hospitals and dispensaries. Copies of it should be furnished to the patients at the time of his admission to any hospital.

It is better to regard the patients rights as being an inherent property of a caring, mutually respectful and properly Hippocratic relationship. In other words, the doctor’s oath to pay first consideration to the health of their patients should guarantee patient’s rights.

The medical profession must take an active role in promoting and safeguarding patient’s rights by maintaining standards for medical practice that embody the ideas of the Declaration of Lisbon. They should accept and enforce the idea that patients have a right to respectful and competent care and that the doctors have a correlative duty to provide that care at a standard that exceeds anything that common law could intelligently require.

Disclosure

To make health care decisions and work intelligently in partnership with the physician, the patient must be well informed. Effective patient-physician communication can dispel uncertainty and fear and can enhance healing and patient satisfaction. Information should be disclosed whenever it is considered material to the patient’s understanding of his or her situation, possible treatments and probable outcomes. This information often includes the costs and burden of treatment, the experience of the proposed clinician, the nature of the illness and potential treatments.

However uncomfortable to clinician or patient, information that is essential to the patient must be disclosed. How, when and to whom information is disclosed are important concerns that must be addressed.

Information should be given in terms that the patient can understand. The physician should be sensitive to the patient’s responses in setting the pace of disclosure, particularly if the illness is very serious. Disclosure should never be a mechanical or perfunctory process. Upsetting news and information should be presented to the patient in a way that minimizes distress. If the patient is unable to comprehend his or her condition, it should be fully disclosed to an appropriate surrogate.

In addition, physicians should disclose to patients, information about procedural or judgment errors made in the course of care if such information is material to the patient’s well-being. Errors do not necessarily constitute improper, negligent or unethical behavior, but failure to disclose them might become so.

Informed Consent

Any unauthorized touching of a person is battery, even in the medical setting. The patient’s consent allows the physician to provide care. Consent may be either expressed or implied. Expressed consent most often occurs in the hospital setting, where written or oral consent is given for a particular procedure. In many medical encounters, when the patient presents his case to a physician for evaluation and care, consent can be presumed. The underlying condition and treatment options are explained to the patient and treatment is rendered or refused. In medical emergencies, consent to treatment that is necessary to maintain life or restore health is usually implied unless it is known that the patient would refuse the intervention. The doctrine of informed consent goes beyond the question of whether consent was given for a treatment or intervention. Rather, it focuses on the content and process of consent.

The physician is required to provide enough information to allow a patient to make an informed judgment about how to proceed. The physician’s presentation should be understandable to the patient, should be unbiased and should include the physician’s recommendation. The patient’s or surrogate’s concurrence must be free and uncoerced. The principle and practice of informed consent relies on patients to ask questions when they are uncertain about the information they receive, to think carefully about their choices and to be forthright with their physicians about their values, concerns, and reservations about a particular recommendation. Once patients and physicians decide on a course of action, patients should make every reasonable effort to carry out the aspects of care that are in their control or to inform their physicians promptly if it is not possible to do so. The physician is obligated to ensure that the patient or the surrogate is adequately informed about the nature of the patient’s medical condition and the objectives, alternatives, possible outcomes and risks involved with a proposed treatment.

All adult patients are considered competent to make decisions about medical care unless a court declares them incompetent. In clinical practice, however, physicians and family members usually make decisions without a formal competency hearing in the courts for patients who lack decision-making capacity. This clinical approach can be ethically justified if the physician has carefully determined that the patient is incapable of understanding the nature of the proposed treatment, the alternatives to it and the risks, benefits and consequences of it. When a patient lacks decision-making capacity (that is, the ability to receive and express information and to make a choice consonant with that information and one’s values), an appropriate surrogate should make decisions with the physician. Ideally, surrogate decision makers should know the patient’s preferences and act in the best interests of the patient. If the patient has designated a proxy, as through a durable power of attorney for health care, that choice should be respected. When patients have not selected surrogates, standard clinical practice is that family members serve as surrogates. Some states designate the order in which family members will serve as surrogates. Physicians should be aware of legal requirements in their state for surrogate appointment and decision making. In some cases, all parties may agree that a close friend is a more appropriate surrogate than a relative. Physicians should take reasonable care to ensure that the surrogate’s decisions are consistent with the patient’s preferences and best interests. When possible, these decisions should be reached in the medical setting by physicians, surrogates and other caregivers. Physicians should emphasize to surrogates that decisions should be based on what the patient would want, not what surrogates would choose for themselves. If disagreements cannot be resolved, hospital ethics committees may be helpful. Courts should be used when doing so serves the patient, such as to establish guardianship for an unbefriended, incompetent patient, to resolve a problem when other processes fail, or to comply with state law.

Decisions about Reproduction

The ethical duty to disclose relevant information about human reproduction to the patient may conflict with the physician’s personal moral standards on abortion, sterilization or contraception. A physician who objects to these services need not become involved, whether by offering advice to the patient or by involvement in a procedure. As in any other medical situation, the physician has a duty to refer the patient to an appropriate source for the full range of options so that the patient’s legal options are not constrained.

If a patient who is a minor requests termination of pregnancy, advice on contraception or treatment of sexually transmitted diseases without a parent’s knowledge, the physician may attempt to persuade the patient of the benefits of having parents involved, but should be aware that a conflict may exist between the legal duty to maintain confidentiality and the obligation toward parents or guardians. Information should not be provided to others without the patient’s permission. In such cases, the physician should be guided by his or her conscience in light of the law.

Medical Risk to Physician and Patient

Traditionally, the ethical imperative for physicians to provide care has overridden the risk to the treating physician, even during epidemics. In recent decades, with better control of such risks, physicians have practised medicine in the absence of risk as a prominent concern. However, potential occupational exposures such as HIV, multidrug-resistant tuberculosis and viral hepatitis necessitate reaffirmation of the ethical imperative.

Physicians should evaluate their risk for becoming infected with pathogens, both in their personal lives and in the workplace, and implement appropriate precautions. Physicians who may have been exposed to pathogens have an ethical obligation to be tested and should do so voluntarily.

Infected physicians should place themselves under the guidance of their personal physician or the review of local experts to determine in a confidential manner whether practice restrictions are appropriate on the basis of the physician’s compliance with infection control precautions and physical and mental fitness to work. Infection does not in itself justify restrictions on the practice of an otherwise competent health care worker. Health care workers are expected to comply with public health and institutional policies. As the diseases mentioned above may be transmitted from patient to physician and because they pose significant risks to physicians’ health and are difficult to treat or cure, some physicians may be tempted to avoid the care of infected patients.

Physicians and health care organizations are obligated to provide competent and humane care to all patients, regardless of the stage of the disease. Physicians can and should expect their workplace to provide appropriate means to limit occupational exposure through rigorous application of infection control methods. The denial of appropriate care to a class of patients for any reason is unethical. Whether physicians should disclose their condition depends on the likelihood of risk to the patient and relevant law or regulations in their locales. Physicians should remove themselves from care if it becomes clear that the risk associated with contact or with a procedure is significant even if appropriate preventive measures are taken. Physicians are also obligated to disclose their condition after the fact if a clinically significant exposure has taken place.

Physicians have several obligations concerning the risk of infection. They should help the public to understand the low level of this risk and put it in the perspective of other medical risks while acknowledging public concern. Physicians provide medical care to health care workers and part of this care is discussing with health care workers their ethical obligation to know their risk for such diseases as HIV or viral hepatitis, to voluntarily seek testing if they are at risk and to take reasonable steps to protect patients. The physician who provides care for a seropositive health care worker must determine the health care worker’s fitness to work. In some cases, seropositive health care workers cannot be persuaded to comply with accepted infection control guidelines or impaired physicians cannot be persuaded to restrict their practice. In such exceptional cases, the treating physician may need to breach confidentiality and report the incident to the appropriate authorities in order to protect patients and maintain public trust in the profession, even though such actions may have legal consequences.