Presentation on theme: "HUMAN RIGHTS IN PATIENT CARE Assoc. Prof. Dr. Silviya Aleksandrova-Yankulovska, MD, PhD, MAS."— Presentation transcript:
HUMAN RIGHTS IN PATIENT CARE Assoc. Prof. Dr. Silviya Aleksandrova-Yankulovska, MD, PhD, MAS
Documents Universal Declaration of Human Rights (1948) Non-binding instruments WMA Declaration of Lisbon Binding treaties International Covenant on Civil and Political Rights
Patients’ rights 1. Liberty and security of person Liberty and security of person 2. Privacy Privacy 3. Access to information Access to information 4. Bodily integrity Bodily integrity 5. Life Life 6. Highest attainable standard of mental and physical health Highest attainable standard of mental and physical health 7. Freedom from torture and other cruel, inhuman or degrading treatment or punishment Freedom from torture and other cruel, inhuman or degrading treatment or punishment 8. Participation in public policy Participation in public policy 9. Equality and freedom from discrimination Equality and freedom from discrimination 10. Effective remedy Effective remedy
1. Liberty Content – protection of individuals from arbitrary or unjustified confinement Deprivation of liberty must be necessary and proportionate 1. and security of person Content – safeguards individuals’ freedom from bodily injury Government must take measures to protect individual from threats to bodily integrity
1. Liberty and security of person MH* – protection from detention based solely on mental health without judicial review (special provisions in Bulgarian Health Act) ID** – restrictive measures should respect individuals’ rights and guarantee judicial review RH*** – recognition of individual’s reproductive choices *MH – Mental Health **ID – Infectious Diseases *** RH – Reproductive Health
11. Privacy Content – protects the individual from unlawful and arbitrary interference with his/her privacy Meaning - any interference must be based on law and be proportionate to the end sought
11. Privacy MH – In patient care, medical treatment or examination of a patient’s mental and physical state the law can constitute a violation of patient’s right to privacy ID- legal protection of information - disclosure with patient’s consent - guiding principles and recommendations - laws on privacy and confidentiality RH- report of cases of criminal abortion - women applying for a job can’t be asked for contraceptive usage and can’t be subject of pregnancy tests - confidentiality of adolescents
111. Access to information Content – guarantee of individual access to information (including medical information) concerning her/him, except when this information can be harmful to her/his life or healthexcept when this information can be harmful to her/his life or health Right not to be informed, unless the disclosure is need to protect another person’s life Right not to be informed, unless the disclosure is need to protect another person’s life
111. Access to information MH – information about mental state, treatment, criminal proceedings and charges against the patient should be accessible to him/her; in case of children – accessible to the parents ID – public information campaigns to enable individuals to take informed decisions RH- allows family planning - adolescents – information without parental consent based on adolescent’s maturity level
1V. Bodily integrity Content – protection from bodily injury Relevant in cases of involuntary medical treatment and experimentation Relevant in cases of involuntary medical treatment and experimentation
1V. Bodily integrity MH- protection from the use of coercive force and restraint unless following “a thorough and professional medical assessment” - monitoring and reporting system of mental-health institutions ID – quarantine – protection of PH should be balanced with the individual’s right and he/she is treated humanely RH – forced sterilization, genital mutilation
V. Life Content – protection from the imposition of death sentence when the process on which the judgement is based does not meet the requirements under international human rights law Wide interpretation – measures to increase life expectancy – provision of minimum level of health services and essential medication that ensures patient’s good health
V. Life MH – health care measures for the protection of patients’ lives (example: depression) ID- measures to eliminate epidemics - preventive measures - access to medicines RH- protection of women’s life via adoption of comprehensive abortion laws, especially in cases of rape, incest and therapeutic reasons (decriminalizing abortions) - access to reproductive health services - availability of contraceptives
V1. Highest attainable standard of mental and physical health Content – the right of everyone to enjoy the highest attainable standard of both mental and physical health State have the obligation to make available health care facilities, goods and services in sufficient quantity and accessible to everyone physically, economically and without discrimination.without discrimination Extends to determinants of health, such as access to safe and portable drinking water, and adequate supply of safe food, nutrition and housing.
V1. Highest attainable standard of mental and physical health MH- training of personnel to care for patients with mental disabilities - public campaigns against stigma and discrimination - downsizing psychiatric hospitals and extend community care ID- access affordable treatment and health services - establishment of effective PH surveillance and reporting systems RH – UN Himan Rights Council declared maternal mortality as human rights violation and called states to take measures
V11. Freedom from torture and other cruel, inhuman or degrading treatment or punishment Content – the State should prevent and protect people from, and punish acts of, cruel, inhuman or degrading treatment and torture. “Untouchable” right even in exceptional circumstances, such as war Applicable also to detainees and individuals under custody. Concerns also denying pain relief, if it causes severe pain and suffering.
V11. Freedom from torture and other cruel, inhuman or degrading treatment or punishment MH - applicable to every person incl. those in psychiatric hospitals - improvement of hygienic conditions - provision of regular exercise and adequate treatment - solitary confinement and food deprivation are right’s violation ID- intentional transmission of infectious diseases is prohibited - denying access to HIV-related information, voluntary testing, counselling etc. RH- forces sterilization is a breach of this right - state’s failure to provide access to abortion services when it is necessary, is a violation of this right
V111. Participation in public policy Content – right of every person to participate in political processes and policy decisions affecting their health. Extended to participation in decisions about planning and implementation of health care services.
V111. Participation in public policy MH – participation in public life on equal basis with others, directly or with chosen representative ID – participation in designing and implementing policies that affect them RH – participation to ensure that needs related to family planning and access to contraceptives are met
IX. Equality and freedom from discrimination Content – health services and treatment must be accessible and provided without discrimination. Poorer households should not be disproportionally burdened with health expenses as compared to richer households.
IX. Equality and freedom from discrimination MH – protection from stigma, unnecessary institutionalization ID – protection from stigmatization in fields of education, employment, housing and health care (awareness raising campaigns on HIV/AIDS) RH – removal of legal and other obstacles that prevent women from accessing health care on the basis of gender
X. Effective remedy Content – remedies for human rights violations should be accessible and effective. States to establish mechanisms to ensure that human rights violations are effectively addressed at domestic level. Appropriate compensations (example: public apology for Tuskegee study)
X. Effective remedy MH – ability to access courts ID – effective addressing of claims; states to address deleterious prison conditions RH – redress in cases of involuntary sterilizaton
WORLD MEDICAL ASSOCIATION DECLARATION ON THE RIGHTS OF THE PATIENT /LISBON DECLARATION/
1. Right to medical care of good quality 2. Right to freedom of choice 3. Right to self-determination 4. The unconscious patient 5. The legally incompetent patient 6. Procedures against the patient’s will 7. Right to information 8. Right to confidentiality 9. Right to health education 10. Right to dignity 11. Right to religious assistance Informed consent related
1. Right to medical care of good quality without discrimination; by a physician free to make clinical and ethical judgements without any outside interference; right to continuity of health care. Lisbon Declaration
2. Right to freedom of choice right to choose freely and change his/her physician and hospital or health service institution, regardless of whether they are based in the private or public sector; right to ask for the opinion of another physician at any stage. Lisbon Declaration
3. Right to self-determination right to make free decisions regarding himself/herself; right to give or withhold consent to any diagnostic procedure or therapy; right to refuse to participate in research or the teaching of medicine. Lisbon Declaration
4. The unconscious patient informed consent must be obtained whenever possible, from a legally entitled representative; if a legally entitled representative is not available, but a medical intervention is urgently needed, consent of the patient may be presumed. physicians should always try to save the life of a patient unconscious due to a suicide attempt. Lisbon Declaration
5.The legally incompetent patient the patient must be involved in the decision- making to the fullest extent allowed by his/her capacity; if the patient's legally entitled representative, or a person authorized by the patient, forbids treatment which is, in the opinion of the physician, in the patient's best interest, the physician should challenge this decision in the relevant legal or other institution. in case of emergency, the physician will act in the patient's best interest. Lisbon Declaration
6. Procedures against the patient's will Can be carried out only in exceptional cases, if specifically permitted by law and conforming to the principles of medical ethics. Lisbon Declaration
7. Right to information Exceptionally, information may be withheld from the patient when there is good reason to believe that this information would create a serious hazard to his/her life or health. The patient has the right not to be informed on his/her explicit request, unless required for the protection of another person's life. The patient has the right to choose who, if anyone, should be informed on his/her behalf. Lisbon Declaration
8. Right to confidentiality descendants may have a right of access to information that would inform them of their health risks; confidential information can only be disclosed if the patient gives explicit consent or if expressly provided for in the law; All identifiable patient data must be protected. The protection of the data must be appropriate to the manner of its storage. Lisbon Declaration
9. Right to Health Education The education should include information about healthy lifestyles and about methods of prevention and early detection of illnesses. The personal responsibility of everybody for his/her own health should be stressed. Physicians have an obligation to participate actively in educational efforts. Lisbon Declaration
10. Right to dignity The patient is entitled to relief of his/her suffering according to the current state of knowledge. The patient is entitled to humane terminal care and to be provided with all available assistance in making dying as dignified and comfortable as possible. Lisbon Declaration
11. Right to religious assistance The patient has the right to receive or to decline spiritual and moral comfort including the help of a minister of his/her chosen religion. Lisbon Declaration
Movie – watch and answer Which human and patient’s rights are violated in the movie?
Movie – watch and answer Which human and patient’s rights were violated in the movie? Right to liberty Right to life Right to highest attainable health Right to freedom of torture Right to effective remedy ………