Patient Rights

Unit 7

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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

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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

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

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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

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   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

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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

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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

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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

 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

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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

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 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

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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

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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

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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

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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

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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

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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

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  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.

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

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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

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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

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

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   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

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   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

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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

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     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

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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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