Patient rights

1. Patient Rights

2. 2
Patient Rights
1960’s: patients turned to nurses for information
Protection of patient’s right to refuse treatment
Informed consent
Right to privacy
Avoiding false imprisonment

3. 3
Patient Rights Documents
What People Can Expect of Modern Nursing
Practices, NLN, 1959
Statement on Patient’s Bill of Rights, American
Hospital Association, 1973
Citizens Bill of Hospital Rights, Penn. Insurance
Dept., 1973

4. 4
Patient Rights Documents Continued
Bill of Rights for Hospice Patients, Hospice
Association of America, 1990

5. 5
Congressional Action
Rehabilitation Act, 1973
Community Mental health Amendment, 1975
Education for Handicapped Children Act, 1975
Dev. Disabled Assist. And Bill of Rights Act, 1978
Mental Health Systems Act, 1980
Americans with Disabilities Act, 1990

6. 6
Omnibus Budget
Reconciliation Act, 1987
New requirements for nursing homes and home
health
Standard for minimum RN staff
Immediate access for relatives
Access to federal and state officials who
investigate complaints

7. 7
Legal Status of Patient Rights
Bills of Rights that become laws or state
regulations carry most authority
Hospital may jeopardize funding from
Medicare/Medicaid if found in violation of
regulations
Bills of Rights professionally binding

8. 8
Informed Consent and the Law
Informed Consent: Information given to the
patient regarding treatment and patient
agreement to treatment
Standards for Informed Consent:
Reasonable Doctor Standard
Reasonable Patient Standard

9. 9
Informed Consent: Landmark Ruling
California Supreme Court, 1957
Negligent nondisclosure
Ruling established basic rule: A doctor violates
his duty to his patient and subjects himself to
liability if he withholds any facts that are
necessary to form basis of an intelligent consent

10. 10
Responsibility for Obtaining Informed
Consent
Obtaining informed consent rests with attending
doctor for medical acts
Nurses may be required to sign form as a
witness

11. 11
Nurses’ Potential Liability
Nurses can be held legally responsible if: 1)
Nurse has knowledge the patient has not been
adequately informed and 2) Nurse fails to act on
this knowledge

12. 12
Two Exceptions to Obtaining Informed
Consent
Patient discretion: patient may waive right to be
informed; tells doctor not to disclose details;
directs doctor to provide info to next of kin
Emergencies: Unconscious patient or minor
where family can’t be reached

13. 13
Right to Consent: Birth to Adulthood
Birth rights: confidentiality, privacy during
treatments, legal protection from malpractice
Minors: Anyone under 18 or 21 has right to
consent to treatment for STDs, serious
communicable diseases, drug/alcohol abuse

14. 14
Rights Continued
Mature Minors: sufficiently developed awareness
and mental capacity to make decisions about
medical care
Adults: Right to consent or refuse medical
treatment for self or minor children

15. 15
Legal Right to Refuse Treatment
Quinlan case, 1976, New Jersey
Cruzan v. Director, Mo. Dept. of Health, 1990
Freedom of Religion: Jehovah’s Witness, 1972,
Christian Scientist, 1971

16. 16
Right to Die
Natural Death Laws
Living Will Laws
Durable Power of Attorney: can make medical
decisions regarding life and death treatment if
patient becomes incapacitated

17. 17
Recent Legislation
Patient Self-Determination Act, 1990
Must be given written information re rights under
state law
Patient decision regarding advance directive
must be documented in record

18. 18
Act, 1990 Continued
Health care providers cannot discriminate in any
way regardless of advance directive
Facility must provide education for staff and
community on advance directive issues

19. 19
Challenging the Right to Refuse
Treatment
Patient incompetence: lacks mental ability to
make reasonable decision
Delirium
Compelling circumstances: refusal endangers
another’s life, child’s life, public interest
outweighs patient rights, etc.

20. 20
Nurses’ Response to Patient’s Request
to Stop Treatment
Stop preparations for any further treatment
Immediately notify doctor
Report patient’s decision to supervisor

21. 21
Patient’s Right to Privacy
Constitution does not explicitly sanction a right to
privacy
Supreme Court has cited several amendments
that imply right
Right to make personal choices without outside
interference

22. 22
State Law and Right to Privacy
Some states have written privacy provisions into
their constitutions
Nearly all recognize the right through statutory or
common law

23. 23
Privilege Doctrine
Patient cannot be forced to reveal confidential
communication
Few states recognize the nurse-patient
relationship as protected

24. 24
When Confidential Information Must Be
Disclosed
Child abuse cases
Criminal cases
Government request: IRS, EPA, Dept of Labor,
HHS
Public’s right to know - President’s annual
physical exam

25. 25
When Confidential Information May Be
Disclosed
Welfare of a person or group is at stake
When disclosure is necessary for continued care
If patient consents to disclosure
To protect public or individuals from harm

26. 26
When Patients Demand Records
Right to Access: some states guarantee direct
access, may have to subpoena records in other
states
Cannell v. S.C. Clinic, 1974: patient has a right to
know treatment details and right to info because
of payment

27. 27
Patient Discharge Against Medical
Advice
Patient has legal right to leave
Patient should be adequately informed
Contact patient’s family - optional
Explain AMA procedure
Give patient AMA form to sign
Provide discharge care

28. 28
Lawful Detention
Restraint, when necessary, is lawful with
psychiatric patients, prisoners, and violent
patients
Restrain patient only if medical conditions
warrants or if authorities (police, courts, etc.)
instruct to do so

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