Recent times have seen an upsurge in conflicts between healthcare service providers and patients. This has resulted in an increase in litigation as well as unwarranted physical attacks on healthcare professionals and facilities. The overall result is a sad deterioration in the doctor-patient relationship and a fallout in standards of care. Doctors have become overtly defensive in their practice and patients deeply suspicious of the advice given by doctors. The debate over who or what is responsible for this sorry state of affairs merely goes around in circles without any progress. The National Human Rights Commission (NHRC) has now seen fit to draft a “Charter of Patients’ Rights” which was put in public domain by the MoHFW, for comment and suggestions in 2018. The draft is obviously aimed at awareness on part of the patient of what to expect from the healthcare sector. More significantly, it also refers to the duties and responsibilities the patient has, when seeking help from a healthcare facility.
The concept of a Patients’ Rights Charter is not new. The NHS in the UK introduced a charter in 1991, revised in 1995 and 1997. There are various models of such Charters. The WHO document points out that “In North America and Europe, for instance, there are at least four models which depict this relationship: the paternalistic model, the informative model, the interpretive model, and the deliberative model; each with different professional obligations of the physician toward the patient. For instance, in the paternalistic model, the best interests of the patient as judged by the clinical expert are valued higher than the provision of information and decision-making power to the patient. The informative model, by contrast, sees the patient as a consumer who is in the best position to judge what is in his/her own interest, and thus views the doctor as chiefly a provider of information”.
Extensive debate continues over which model is the best; but growing international consensus is that all patients have a fundamental right to privacy and confidentiality of their medical information, to consent to or refuse treatment, and to be informed about relevant risk to them of medical procedures. The MoHFW has followed the informative model whereby the physician advises the patient on all aspects of his ailment as comprehensively as possible leaving the final decision with the patient. It recognizes that “the patient is entitled to a certain amount of protection to be ensured by physicians, healthcare providers and the State”.
In India such protection is covered by a variety of legal documents like the Constitution, Article 21, the MCI regulations, CPA, CEA, various judgments of the SC and the National Consumer Disputes Redressal Commission. But there is no dedicated regulator in India unlike many other countries. The Patients’ Rights Charter attempts to consolidate all available information into one single document. “One of the objectives of this Charter is to generate widespread public awareness and educate citizens regarding what they should expect in terms of healthcare and the kind of treatment they deserve as human beings”. It also enumerates the responsibilities of patients, and outlines grievance redressal mechanisms. In short it is an enabling document to ensure the protection and promotion of Human Rights of the most vulnerable sections of society – ordinary patients and citizens seeking health care across India.”
There are 17 rights enumerated in the document. Briefly summarised, they are the Right to information, records, reports and informed consent; the right to second opinion, choosing alternative methods of treatment if available, and proper referral and transfer; as well as choosing source for medicines and tests. Safety and quality of care are to be as per accepted standards, with confidentiality, human dignity, privacy and transparency in rates. There is a right to protection in clinical trials, biomedical and health research, and to Emergency Medical Care, with the right to take discharge of the patient or receive the body of the deceased. Finally, there is a right to seek redressal.
Patients and caretakers are also expected to follow their responsibilities so that hospitals and doctors can perform their work satisfactorily. Patients should provide all required health related information to their doctor, without concealing any relevant information. Patients should cooperate with the doctor during examination, diagnostic tests and treatment, and should follow the doctor’s advice and instructions regarding appointment time, cooperate with hospital staff and fellow patients, avoid creating disturbance to other patients, and maintain cleanliness in the hospital. Patients should respect the dignity of the doctor. Ultimately the patients should take responsibility for their actions based on choices made regarding treatment options or refusal of treatment.
NHRC recommends to all government agencies, to adopt the Charter of Patients’ Rights to be treated as a reference document in all cases related to human rights violations concerning patients and all users of health care services. The patient may file a complaint either personally or through a representative, individually or as part of a group collectively. The complaint should be placed before an “Internal Grievance Redressal Officer” of the clinical establishment. If the matter is not resolved amicably, the district level registering authority under the CEA is approached. If there is no resolution the State Council under the CEA or the State equivalent can be approached and eventually the State Medical Council. There is to be no conflict with existing regulatory mechanisms.
In the final analysis healthcare must shift from the current paternalistic mode to the partnership mode where the patients’ interests reign supreme. Without that the chaos will continue.
(The writer is a founder member of the VHAG)
