Unite 04. Culture Health society Health And Human Rights. 17 th November 2015 New Life College of Nursing Karachi

 DEFINE HEALTH AND HUMAN RIGHTS.  ELABORATE THE IMPORTANCE OF BASIC HUMAN RIGHTS.  RECOGNISE BASIC HUMAN RIGHTS.  CONCEPTULIZE A RIGHT BASED APPROACH TO HEALTH.  IDENTIFY NURSES ROLE IN CLIENT CENTERED HEALTH.

HUMAN RIGHT:  The human right to health guarantees a system of health protection for all.  Everyone has the right to the health care they need, and to living conditions that enable us to be healthy, such as adequate food, housing, and a healthy environment.  Health care must be provided as a public good for all, financed publicly and equitably.

Cont:  The human right to health care means that hospitals, clinics, medicines, and doctors’ services must be accessible, available, acceptable, and of good quality for everyone, on an equitable basis, where and when needed. The design of a health care system must be guided by the following key human rights standards:

What are Human Rights Principles?  Universality  Inviolable  Inalienable  Indivisible  Interdependent  Inter-related  Equality  Non-discriminatory

TYPES OF RIGHTS: Negative and Positive Rights:  1. Negative Rights : is the right to be left alone. Negative rights are an absolute right whose slightest violation breaks this right. Right not be tortured. Duty bearer has to refrain.  2. Positive Rights: Right to health Right to education etc Duty bearer has to act.

Categories of Rights  Civil and Political Rights  Economic Social and Cultural Rights  Individual and Community Rights  Democratic Rights

WHO: Patient rights understood as one aspect of basic human rights World Health Organisation:  Formalized in 1948, the Universal Declaration of Human Rights recognizes “ the inherent dignity ” and the “ equal and unalienable rights of all members of the human family ”. And it is on the basis of this concept of the person, and the fundamental dignity and equality of all human beings, that the notion of patient rights was developed.  In other words, what is owed to the patient as a human being, by physicians and by the state, took shape in large part thanks to this understanding of the basic rights of the person.

Hong Kong Medical Association's Patients' Rights and Responsibilities Responsibilities:  To play an active and responsible role in the healthcare process, you should  be frank to your doctors in revealing your medical conditions.  endeavor to co-operate with any agreed form of management.  be well informed by your insurers of the detailed scope of coverage of your medical insurance policies.  not request doctors to issue incorrect receipts, certificates or document, or to make incorrect entry into the medical records.  be responsible to meet the required fees and charges for the medical services provided to you.

The importance of person-centred approaches to nursing care  Hide summary Professor Jan Draper and Dr Josie Tetley explain why getting to know the person behind the patient is the raison d'être of person-centred nursing care. Hide summary

HA Patients ’ Charter – Patients ’ rights  Right to Medical Treatment  Right to Information  Right to Choices  Right to Privacy  Right to Complaint

HA Patients ’ Charter – Patients ’ Responsibilities  Give your heath care providers as much information as you can about your present health, past illnesses, any allergies …  Follow the prescribed and agreed treatment plan, and conscientiously comply with the instructions given.  Show consideration for the rights of other patients and health care providers, by following the hospital rules concerning patient conduct.  Keep any appointments that you make, or notify the hospital or clinic as early as possible ….  Should not ask health care providers to provide incorrect information, receipts or certificates.  Should not waste medical resources unnecessarily.

Hong Kong Medical Association's Patients' Rights and Responsibilities Responsibilities: To play an active and responsible role in the healthcare process, you should  be frank to your doctors in revealing your medical conditions.  endeavor to co-operate with any agreed form of management.  be well informed by your insurers of the detailed scope of coverage of your medical insurance policies.  not request doctors to issue incorrect receipts, certificates or document, or to make incorrect entry into the medical records.  be responsible to meet the required fees and charges for the medical services provided to you.

HKMA Patients ’ rights  Right of information. - Charges - Drugs.  Right of refusal  Right of confidentiality  Medical Reports - Public medical institutions. - Private hospitals and practitioners  Complaints - Public medical institutions. - Private hospitals and practitioners  Operations - Public and Private Medical Institutions

HKMA: Right of Information  A patient should have a reasonable and balanced understanding of the sickness he is suffering from.  You may enquire about what disease you have, if you need any further examination, and how to cure the disease. You should also know what treatment you will receive, whether with drugs or operation, any side effects after treatment, and the chances of recurrence.  In other words, in order to know more relevant facts about your sickness, you should consult your attending doctor.

 A nurse academic writing for the Nursing Standard in 2006, ‘the term person-centred care is used…to indicate a strong interest in the patient’s own experience of health, illness, injury or need. It infers that the nurse works with the person’s definition of the situation, as well as that presented through a medical or other diagnosis’.

 There are a number of different frameworks that have been developed by nurse academics to help practicing nurses implement person-centred care. While these frameworks are all slightly different, they all share some key components: knowing the patient as an individual being responsive

 Providing care that is meaningful respecting the individual’s values, preferences and needs fostering trusting caregiving relationships emphasising freedom of choice promoting physical and emotional comfort involving the person’s family and friends, as appropriate.

 This model of nursing care contrasts with a more frequent approach called ‘patient- centred’ nursing. This focuses on the person as a patient, emphasizing medical diagnosis and the identification of nursing problems.  Personal needs may be acknowledged but only in as much as they relate to overall medical and nursing needs. In practice,

 This means that medical and nursing care needs take priority over other personal and, perhaps undeclared, needs of the person receiving care.

 The importance of life stories In order to achieve care that is person-centred, nurses need to understand the biographies of their patients and their relatives. Paying attention to the life stories and experiences of patients is the only way nurses will get to know their patients and their aspirations for the future. Achieving this can be challenging, as it requires time to listen and talk. Furthermore,

 The organization of care, particularly in hospital settings, sometimes means that the focus is on ‘getting the job done’ rather than focusing on the importance of the individual’s needs and wants.

 We care Moving forward, adopting truly person- centred care is a key objective for the nursing profession. To achieve this nurses need the right level of knowledge, skills and experience. At The Open University, we have argued that the move to an all graduate profession is a step in the right direction,

 As this will better equip nurses to respond to the increasingly complex care situations in which they practice. While there have been some recent examples of the way in which nursing has struggled to meet some of the essential care needs of patients, the reasons for this are often quite complex and are not just simply because nurses don’t care. So in addition to graduate education, supportive working environments, with appropriate nurse/patient ratios and good leadership are all important factors in ensuring person-centred nursing practice.

What is an ‘ethical issue’?  When you have to judge what is right or wrong  Choosing between options  Deciding whether to do something or do nothing  Should I or shouldn’t I?  Weighing up the potential impact of your decisions or actions  A dilemma – making a difficult choice

Ethical issues in health care  We usually think of the ‘big’ issues e.g. definition of life, what is a person, quality of life, prolonging life, ending life, human rights.  But day to day ethical issues can involve:  Respecting people  Treating people with dignity  Treating people fairly  Supporting patient’s choices  These ‘principles’ are encompassed in the NMC code  The code is a useful source of ethical principles in health care

4 Key Ethical Principles  autonomy  beneficence  non-maleficence  justice

Autonomy  Respect a person’s right to make their own decisions  Teach people to be able to make their own choices  Support people in their individual choices  Do not force or coerce people to do things  ‘Informed Consent’ is an important outcome of this principle

Beneficence (to do good)  Our actions must aim to ‘benefit’ people – health, welfare, comfort, well-being, improve a person’s potential, improve quality of life  ‘Benefit’ should be defined by the person themselves. It’s not what we think that is important.  Act on behalf of ‘vulnerable’ people to protect their rights  Prevent harm  Create a safe and supportive environment  Help people in crises

Non – maleficence (to do no harm)  do not to inflict harm on people  do not cause pain or suffering  do not incapacitate  do not cause offence  do not deprive people  do not kill  Both Beneficence and Non-maleficence underpin EBP

Justice  Treating people fairly  Not favouring some individuals/groups over others  Acting in a non–discriminatory / non- prejudicial way  Respect for peoples rights  Respect for the law

Justice Distributive Justice – sharing the scarce resources in society in a fair and just manner (e.g. health services, professional time)  How should we share out healthcare resources?  How do we share out our time with patients?  Deciding how to do this raises some difficult questions Patients should get…..  an equal share ?  just enough to meet their needs ?  what they deserve ?  what they can pay for ?

4 ethical rules  Veracity – truth telling, informed consent, respect for autonomy  Privacy – a persons right to remain private, to not disclose information  Confidentiality – only sharing private information on a ‘need to know basis’  Fidelity – loyalty, maintaining the duty to care for all no matter who they are or what they may have done

Ethics 2 broad philosophical theories  1) consequentialism – taking the consequences of our actions into consideration  2) deontology – basing our actions on a set of principles or duties

Consequentialism  Actions are right or wrong according to the balance of their good and bad consequences  the right act is the one that produces the best overall result  Utilitarianism (what action has the greatest utility - use/benefit/positive outcome) is a type of consequentialism

Utilitarianism  most prominent consequence-based theory  based on the principle of utility  actions ought to produce the maximal balance of positive value (e.g. happiness) over disvalue (e.g. harm)

Deontology  Duty or principle based theory  An act is right if it conforms to an overriding moral duty For example – do not tell lies, do not kill.  E.g. Christian ethics – The Ten Commandments But Christian ethics are not important for some people in the world so moral duties vary between cultures and societies  A moral duty or principle is one that is:  laid down by god / supremely rational being  or is in accordance with reason / rationality  or would be agreed by all rational beings  The NMC Code of Conduct is a product of Deontological ethics – it guides action based on a set of principles/duties.

References:  Constitution of the World Health Organization. Geneva: World Health Organization Grad, Frank P. (Jan 2002). "The Preamble of the Constitution of the World Health Organization". Bulletin of the World Health Organization 80 (12): 981. Universal Declaration of Human Rights, United Nations, 1948 Pillai, Navanethem (Dec 2008). "Right to Health and the Universal Declaration of Human Rights". The Lancet 372 (9655): 2005–2006. doi: /S (08) Retrieved 14 Oct Gruskin, Sofia; Edward J. Mills; Daniel Tarantola (August 2007). "History, Principles, and Practice of Health and Human Rights". The Lancet 370 (9585): 449–455. doi: /S (07) Constitution of the World Health Organization"The Preamble of the Constitution of the World Health Organization" Universal Declaration of Human Rights"Right to Health and the Universal Declaration of Human Rights"doi /S (08) doi /S (07)