Patients' rights

4 Patients' rights H. J. J. Leenen Registering for immunization in Viet Nom. Health core is a human right for all. Modern health core con only function when doctors and patients behove as partners. Indeed, experience and research hove shown that patients who ore informed and involved, and whose rights ore respected, recover more quickly and hove shorter stays in hospitals. Awareness of the rights of pa-tients is evolving rapidly. This is partly due to the develop- ment of medical science and technol- ogy, which are intruding more and more on the human body and mind. People demand the right to determine for themselves what medicine they will receive. In addition the health care system is becoming more com- plicated. So patients, already depen- dent on the services because of their illness and the insecurity it produces, feel even more subordinate to the services and seek the support of the law to strengthen their position. The equitable distribution of scarce health care facilities is a problem of a different nature. As WHO has always stressed, every- body is entitled to the health care that he or she needs, but there is some- times a distressing disparity in the apportionment of health care, not only between countries but also within countries. The rising costs of health care and the increasing em- phasis on market forces in health care make even more remote the fair distribution of avai lable health care facilities. Governments and legisla- tors have to intervene in the alloca- tion of health care in order to guarantee the accessibility of that care for every citizen, and equity in its partition . These problems fall within the province of both ethics and health law, and here the two disciplines overlap. As everybody knows, rights are often not maintained, even when people agree that they are required by justice. Then law has to play its role, and its instruments can con- World Health • 49th Year, No.5, September-october 1996 tribute to closing the gap between reality and ideas of justice. Sometimes law is regarded as creating a conflict, but its purpose is to prevent social conflicts and to solve them when they arise. The legislator who draws up rules gov- erning the state of marriage, for instance, is not seeking to hinder the very personal relationship involved in marriage; asserting the rights of chi ldren is not to deny the personal feelings uniting children and parents. A mutual agreement This is no less true for patients' rights in medical treatment. Such rights are invoked with a view to facilitating cooperation between doctors and patients. The relation between patient and doctor involves a mutual agreement to work together to solve the patient's problem. To call that an agreement does not negate its basis of mutual trust. Modern health care can only function when doctors and patients behave as partners. Indeed, this kind of cooper- ation appears to have a positive effect. Experience and research have shown that patients who are informed and involved, and whose rights are respected, recover more quickly and have shorter stays in hospitals. Cooperation requires ski ll s. Therefore regulation in law has to be complemented by education and training of health care providers and of patients. They must be informed about their own and each other's situation, and must learn to commu- nicate and cooperate. Health care providers have a special responsibil- ity here. Patients' rights are receiving more and more attention from the public and from legislators, at both national and international level. Such rights are set out in the World Health • 49th Yeor, No.5, September-October 1996 International Covenant on Civil and Political Rights (1966), in the European Convention of Human Rights and Fundamental Freedoms (1950), in resolutions of the Council of Europe, decisions of the European Commission and the jurisprudence of the European Court of Justice. The Council of Europe is preparing a convention for the protection of human rights and dignity of the human being with regard to the application of biology and medicine, in which patients ' rights are incorpo- rated. Private organizations have also contributed to the development of patients ' rights. The EEC Hospital Committee, for instance, has adopted a charter on the rights of the hospital patient (1979), and in 1995 the World Medical Association revised its Declaration on the Rights of the Patient. A Declaration of Rights WHO itself is active in this field, especially in the European Region. On the basis of two comparative studies which surveyed develop- ments in European countries, the Regional Office for Europe decided to draft a declaration on the rights of patients. The draft was discussed by a group of experts and sent for com- ment to the Member States and to national and international organiza- tions. In March 1994 the final text, entitled "A Declaration on the Promotion of Patients ' Rights in Europe", was adopted by a special WHO European Consultation on the Rights of Patients, held in Amsterdam. As is customary in this type of declaration, the focus is on such individual rights of the patient as information, consent, confidential- ity and privacy, and on their applica- tion. A special paragraph is dedicated to care and treatment, and this covers social rights in health care. These rights are presented as principles. They provide guidelines for the Member States and for other organizations, while the way in which they are implemented remains a national matter. How organizations can make use of this European Declaration is illustrated by the revised Declaration of Lisbon of the World Medical Association of 1995, mentioned above, which to a large extent echoes it. Such use is all the more important because international instruments are often not coordinated with one another. For other regions of WHO and for WHO itself, the European Declaration can serve as a model. Declarations provide an instru- ment for improving health care, which in today 's world calls not only for new medical techniques but also for new human relations. These new 5 human relations need to be supported by the international and national recognition of patients' rights . Other aspects too have to be taken into account, such as rulings on the quali- fications and competence of health care providers, the quality of medical appliances and the guaranteeing of everybody's right to the health care they need. The formulation of pa- tients' rights is just one part- but an important one- of the regulation of the health care system. • Or H.).). Leenen is Emeritus Professor of Social Medicine and Health Law at the University of Amsterdam, Netherlands, and Chairman of the preparatory woup of the Declaration on the Promotion of Patients' Rights in Europe. His address is Oosterpark 46, I 092 AN Amsterdam, Netherlands. Additional reading: Leenen HJJ., Pinel G. , Prims A.V. Trends in health legislation in Europe. Published on behalf of the WHO Regional Office for Europe by Masson, Paris, 1986. Leenen HJJ., Geversj.K.M. , Pinel G . The rights of patients in Europe. Published on behalf of the WHO Regional Office for Europe by Kluwer, Netherlands, 1993. WHO Regional Office for Europe, 1994. The proceed ings of the European Consul tat ion on the Rights of Patients are published in: Promotion of the rights of patients in Europe, Kluwer, Netherlands, 1995. Distribution of essential drugs in Latin America . Governments must play a key role in ensuring fair access to health care. In todoy's world, doctor and patient have to cooperate in order to arrive at the best possible treatment.