Overview on the Patients' rights given to the medical students at Al-Farabi Medical College on 26-10-2016.

1. Asst. Prof., Dept. of Medical Ethics
Alfarabi Medical college, Riyadh
Dr. Ghaiath M. A. Hussein
Professionalism and Ethics Education for Residents (PEER)
Patients’ Rights

2. Ethical basis for patients’ rights
Definition and classification of patient rights
Patient’s Right related to
 Treatment
 Access to care
 Choice of care
 Participation in decision making
 Privacy and Confidentiality
 Seek for 2nd opinion or referral
 Compassionate Palliative and EOL care
Outline

3. What will we try to learn in this
section of the course?
• Roles & duties of doctors (towards self &
colleagues, patients & community)
• Patients' rights
• Privacy, confidentiality and medical records
• Informed consent to treatment
• Discussions and cases

4. Before we start…where are we?
Patient
Doctor
Lab./X-
ray
Social
worker
Nurse
Manager
Educator
Doctors Are NOT the focus of the healthcare

5. The ethics behind care...
Is there a moral obligation to provide healthcare to our patients?
• The duty to respect patient’s ability to
decideAutonomy
• The duty to do good to patientsBeneficence
• The duty not to do harm to patientsNon-Malificence
• The duty to be fair to our patients
• Fairness is not equity!Justice

6. Islamic Guidance behind care...
1. Relieved patients from some religious commitments ‫خففت‬‫التكاليف‬ ‫عنهم‬
‫الدينية‬:
•( *َ‫ل‬َ‫ف‬ ‫اء‬َ‫س‬ِ‫الن‬ ُ‫م‬ُ‫ت‬ْ‫س‬َ‫م‬َ‫ال‬ ْ‫و‬َ‫أ‬ ِ‫ط‬ِ‫ئ‬‫آ‬َ‫غ‬ْ‫ل‬‫ا‬ ‫ن‬ِ‫م‬ ‫ُم‬‫ك‬‫ن‬ِ‫م‬ ٌ‫د‬َ‫ح‬َ‫أ‬ ‫َاء‬‫ج‬ ْ‫و‬َ‫أ‬ ٍ‫ر‬َ‫ف‬َ‫س‬ ‫ى‬َ‫ل‬َ‫ع‬ ْ‫و‬َ‫أ‬ ‫َى‬‫ض‬ْ‫ر‬َّ‫م‬ ‫ُم‬‫ت‬‫ُن‬‫ك‬ ‫ن‬ِ‫إ‬ َ‫و‬‫ا‬َ‫م‬ ْ‫ا‬‫ُو‬‫د‬ ِ‫ج‬َ‫ت‬ ْ‫م‬ً‫ا‬‫ب‬ِ‫ي‬َ‫ط‬ ً‫ا‬‫يد‬ِ‫ع‬َ‫ص‬ ْ‫ا‬‫و‬ُ‫م‬َّ‫م‬َ‫ي‬َ‫ت‬َ‫ف‬ ‫ء‬)
•( *‫َى‬‫ض‬ْ‫ر‬َّ‫م‬ ‫ُم‬‫ك‬‫ن‬ِ‫م‬ ُ‫ُون‬‫ك‬َ‫ي‬َ‫س‬ ‫ن‬َ‫أ‬ َ‫م‬ِ‫ل‬َ‫ع‬ ِ‫آن‬ْ‫ر‬ُ‫ق‬ْ‫ل‬‫ا‬ َ‫ن‬ِ‫م‬ َ‫ر‬َّ‫س‬َ‫ي‬َ‫ت‬ ‫ا‬َ‫م‬ ‫ُوا‬‫ؤ‬َ‫ر‬ْ‫ق‬‫ا‬َ‫ف‬)‫سورةالمزمل‬20
•( *ٍ‫ام‬َّ‫ي‬َ‫أ‬ ْ‫ن‬ِ‫م‬ ٌ‫ة‬َّ‫د‬ِ‫ع‬َ‫ف‬ ٍ‫ر‬َ‫ف‬َ‫س‬ ‫ى‬َ‫ل‬َ‫ع‬ ْ‫و‬َ‫أ‬ ً‫ا‬‫يض‬ ِ‫ر‬َ‫م‬ َ‫َان‬‫ك‬ ‫ن‬َ‫م‬ َ‫و‬ ُ‫ه‬ْ‫م‬ُ‫ص‬َ‫ي‬ْ‫ل‬َ‫ف‬ َ‫ْر‬‫ه‬َّ‫ش‬‫ال‬ ُ‫م‬ُ‫ك‬‫ن‬ِ‫م‬ َ‫د‬ِ‫َه‬‫ش‬ ‫ن‬َ‫م‬َ‫ف‬َ‫ر‬َ‫خ‬ُ‫أ‬)‫البقرة‬ ‫سورة‬185
•( *ٍٍَُ‫س‬ُ‫ن‬ ْ‫و‬َ‫أ‬ ٌٍَ‫ق‬َ‫د‬َ‫ص‬ ْ‫و‬َ‫أ‬ ٍ‫ام‬َ‫ي‬ ِ‫ص‬ ‫ن‬ِ‫م‬ ٌٌَ‫ي‬ْ‫د‬ِ‫ف‬َ‫ف‬ ِ‫ه‬ِ‫س‬ْ‫أ‬َّ‫ر‬ ‫ن‬ِ‫م‬ ًًَ‫أ‬ ِ‫ه‬ِ‫ب‬ ْ‫و‬َ‫أ‬ ً‫ا‬‫يض‬ ِ‫ر‬َّ‫م‬ ‫ُم‬‫ك‬‫ن‬ِ‫م‬ َ‫َان‬‫ك‬ ‫ن‬َ‫م‬‫ف‬)‫البقرة‬ ‫سورة‬196.
•*{ٌ‫ج‬َ‫َر‬‫ح‬ َ‫ون‬ُ‫ق‬ِ‫ف‬‫ن‬ُ‫ي‬ ‫ا‬َ‫م‬ َ‫ون‬ُ‫د‬ ِ‫ج‬َ‫ي‬ َ‫ال‬ َ‫ين‬ًَِّ‫ل‬‫ا‬ ‫ى‬َ‫ل‬َ‫ع‬ َ‫ال‬ َ‫و‬ ‫َى‬‫ض‬ْ‫ر‬َ‫م‬ْ‫ل‬‫ا‬ ‫ى‬َ‫ل‬َ‫ع‬ َ‫ال‬ َ‫و‬ ‫اء‬َ‫ف‬َ‫ع‬ُّ‫ض‬‫ال‬ ‫ى‬َ‫ل‬َ‫ع‬ َ‫ْس‬‫ي‬َّ‫ل‬)‫س‬ٌ‫التوب‬ ‫ورة‬91
2. Visiting them is a duty (on everybody, not only doctors) ‫جعلت‬
ً‫ا‬‫اجب‬‫و‬ ً‫ا‬‫حق‬ ‫عيادتهم‬.
3. Referred to their health, mental, and social requirements ‫نبهت‬‫على‬
‫يحتاجونها‬ ‫مسائل‬:ً‫ا‬‫اجتماعي‬‫و‬ ً‫ا‬‫ونفسي‬ ً‫ا‬‫صحي‬.

7. Patients’ Rights on who?
State (MOH)
Providers
Family Community

8. ROLES & DUTIES OF DOCTORS
TOWARDS THEIR PATIENTS
Patients’ rights

9. Muslim Doctors’ Duties Towards
Patients
• Respect for Patient ‫المريض‬ ‫احترام‬
• Respect for Privacy ‫المريض‬ ٌ‫خصوصي‬ ‫ضمان‬
• Comprehensive care ‫للمريض‬ ٌ‫الشامل‬ ٌ‫الرعاي‬
• Respect for patient’s autonomy ‫المريض‬ ٌ‫استقاللي‬ ‫احترام‬
• Inform the patient about his/her condition ‫تبصير‬
‫مرضه‬ ٌ‫بطبيع‬ ‫المريض‬
• Protect patient's interests ‫المريض‬ ٌ‫مصلح‬ ٌ‫حماي‬
• Keep the patients’ secrets ‫المريض‬ ‫سر‬ ‫كتمان‬
Source: Islamic Code of Medical & Health Ethics

10. DUTIES OF PHYSICIANS TO PATIENTS
A physician shall
• Always bear in mind the obligation to respect human
life.
• Act in the patient's best interest when providing
medical care.
• Owe his/her patients complete loyalty and all the
scientific resources available to him/her.
• Whenever an examination or treatment is beyond the
physician's capacity, he/she should consult with or
refer to another physician who has the necessary
ability.
• Respect a patient's right to confidentiality.

11. DUTIES OF PHYSICIANS TO PATIENTS
A physician shall
• Give emergency care as a humanitarian duty unless
he/she is assured that others are willing and able to
give such care.
• In situations when he/she is acting for a third party,
ensure that the patient has full knowledge of that
situation.
• Not enter into a inappropriate relationship with
his/her current patient or into any other abusive or
exploitative relationship.

12. The duties of a doctor (GMC)
To be a doctor that patients are able to trust with their lives
and health, you must:
• Make the care of your patient your first concern
• Protect and promote the health of patients and the public
• Provide a good standard of practice and care
– Keep your professional knowledge and skills up to date
– Recognize and work within the limits of your competence
– Work with colleagues in the ways that best serve patients’
interests
• Treat patients as individuals and respect their dignity
– Treat patients politely and considerately
– Respect patients’ right to confidentiality

13. The duties of a doctor (GMC)
• Work in partnership with patients
–Listen to patients and respond to their
concerns and preferences
–Give patients the information they want or
need in a way they can understand
–Respect patients’ right to reach decisions
with you about their treatment and care
–Support patients in caring for themselves
to improve and maintain their health

14. The duties of a doctor (GMC)
• Be honest and open and act with integrity
– Act without delay if you have good reason to
believe that you or a colleague
– May be putting patients at risk
– Never discriminate unfairly against patients or
colleagues
– Never abuse your patients’ trust in you or the
public’s trust in the profession.
• You are personally accountable for your
professional practice and must always be
prepared to justify your decisions and actions.

15. Patient’s Right
Rights directly related to Treatment
 Receive treatment
 Consent to treatment
( accept or refuse )
 Privacy
 Confidentiality
 Compassionate End of
Life ( EOL ) Care
Right Not directly related to treatment
 Respect
 Safety
 Protection for Physical
assault ( specially vulnerable )
 Spiritual care
 Participation in clinical
trials

16. Treatment-Related Rights
• Access to care
• Choice of Care
• Participation in decision making
• Privacy & Confidentiality
• Seek 2nd Opinion/Referral
• Compassionate Palliative
• And EOL care
• Complaint system

17. 1- Access to Care
Patients have the right to have access to healthcare
that meets their needs at the time they need it at a
cost they can afford.
Patients should not be denied access to care they
need or discriminated against based on their colour,
race, belief, disability, etc.
This includes their right to transport to hospital in
case of emergency (Ambulance).
Saudi Commission for Health Specialties

18. 2- Choice of Care
These include:
 Receiving timely emergency care
 Treatment and rehabilitation
 Be seen of their doctor (of choice)
 Provision for special needs
 Counseling
 Palliative care
 Health information (education)

19. Participation in decision-making
Receive Relevant
Information
Diagnosis
Treatment
Prognosis
Post-Discharge Care
Hospital policies
Consent to
Treatment
Relevant facts
explained
Patients are free
from undue
influence
Patients assign
Substitute decision
maker
Right to Refuse
Treatment
Relevant
alternatives
explained
Risks explained,
and consent taken

20. CAPACITY VOLUNTARINESS DISCLOSURE
•The patients has the
ability to:
• Understand medical
information
• Appreciate the risks
• Memorize the
information
•Freedom from undue
influence:
• Money
• Social pressure
•Physical restraint
•Information:
•Diagnosis
• Possible prognosis
• Benefits and risk of
treatment
• Expected outcome
• In a language
understood by the patient

21. 4- Continued care, Seeking
2nd opinion & Referral
The patients have the right to:
 Receive uninterrupted care from his/her doctor.
 To be referred to other health care providers when
necessary.
 Receive a second opinion when the patient or
his/her doctor
requests one.
 The second opinion must be provided by a
qualified health
care professional within the same organization.
Saudi Commission for Health Specialties

22. 5- Compassionate EOL Care
The patient have the right to:
 Have her physical pain assessed and managed
 Have Advance Directive Plan (Living Will)
 Assign a family member to be the SDM
 Have her/his emotional and spiritual needs
addressed
Ethical quiz: what to draw the line between
“allowing your patient to die” and “helping your
patient to die?”
Saudi Commission for Health Specialties

23. 6- Appeal and Complaint Submission
The patient have the right to:
 Be told on how to process her problems or
complaints
 Voice his/her concerns about the care she/he
receives
 Ask questions and express concerns about
hospital health care and services, without fear of
reprisal
 Have his/her complaint responded to in a timely
and satisfactory manner
Saudi Commission for Health Specialties

24. Key messages
 Make sure you know your patient's rights
 Train your colleagues on patient’s rights
 Knowing and providing these rights protects you ethically and
legally
 Patient rights guide you to achieve your ethical and
professional goals of availing the best service to your patients
 Rights are rights NOT gifts that you may not give!
Saudi Commission for Health Specialties