Transcript Slide 1

HUMAN RIGHTS IN PATIENT
CARE
Assoc. Prof. Dr. Silviya Aleksandrova-Yankulovska, MD, PhD, MAS
Documents

Universal Declaration of Human Rights (1948)

Binding treaties
International Covenant
on Civil and Political
Rights

Non-binding
instruments
WMA Declaration of
Lisbon
Patients’ rights
Liberty and security of person
2. Privacy
3. Access to information
4. Bodily integrity
5. Life
6. Highest attainable standard of mental and physical
health
7. Freedom from torture and other cruel, inhuman or
degrading treatment or punishment
8. Participation in public policy
9. Equality and freedom from discrimination
10. Effective remedy
1.
1. Liberty
Content – protection of individuals from
arbitrary or unjustified confinement
 Deprivation of liberty must be necessary and
proportionate

1.
and security of person
Content – safeguards individuals’ freedom from
bodily injury
 Government must take measures to protect
individual from threats to bodily integrity

1. Liberty and security of person
MH* – protection from detention based solely on
mental health without judicial review (special provisions in
Bulgarian Health Act)
ID** – restrictive measures should respect individuals’ rights
and guarantee judicial review
RH*** – recognition of individual’s reproductive choices
*MH – Mental Health
**ID – Infectious Diseases
*** RH – Reproductive Health
11. Privacy
Content – protects the individual from unlawful
and arbitrary interference with his/her privacy
 Meaning - any interference must be based on
law and be proportionate to the end sought

11. Privacy
MH – In patient care, medical treatment or examination of a
patient’s mental and physical state the law can constitute a
violation of patient’s right to privacy
ID
RH
- legal protection of information
- disclosure with patient’s consent
- guiding principles and recommendations
- laws on privacy and confidentiality
- report of cases of criminal abortion
- women applying for a job can’t be asked for
contraceptive usage and can’t be subject of pregnancy tests
- confidentiality of adolescents
111. Access to information
Content – guarantee of individual access
to information (including medical
information) concerning her/him, except
when this information can be harmful to
her/his life or health
 Right not to be informed, unless the
disclosure is need to protect another
person’s life

111. Access to information
MH – information about mental state, treatment, criminal
proceedings and charges against the patient should be
accessible to him/her; in case of children – accessible to the
parents
ID – public information campaigns to enable individuals to
take informed decisions
RH
- allows family planning
- adolescents – information without parental
consent based on adolescent’s maturity level
1V. Bodily integrity
Content – protection from bodily injury
 Relevant in cases of involuntary medical
treatment and experimentation

1V. Bodily integrity
MH
- protection from the use of coercive force and
restraint unless following “a thorough and professional
medical assessment”
- monitoring and reporting system of mental-health
institutions
ID – quarantine – protection of PH should be balanced with
the individual’s right and he/she is treated humanely
RH – forced sterilization, genital mutilation
V. Life
Content – protection from the imposition of
death sentence when the process on which the
judgement is based does not meet the
requirements under international human rights
law
 Wide interpretation – measures to increase life
expectancy – provision of minimum level of
health services and essential medication that
ensures patient’s good health

V. Life
MH – health care measures for the protection of patients’
lives (example: depression)
ID
- measures to eliminate epidemics
- preventive measures
- access to medicines
RH
- protection of women’s life via adoption of
comprehensive abortion laws, especially in cases of rape,
incest and therapeutic reasons (decriminalizing abortions)
- access to reproductive health services
- availability of contraceptives
V1. Highest attainable standard of
mental and physical health
Content – the right of everyone to enjoy the
highest attainable standard of both mental and
physical health
 State have the obligation to make available health
care facilities, goods and services in sufficient
quantity and accessible to everyone physically,
economically and without discrimination.
 Extends to determinants of health, such as access
to safe and portable drinking water, and adequate
supply of safe food, nutrition and housing.

V1. Highest attainable standard of
mental and physical health
MH
- training of personnel to care for patients with
mental disabilities
- public campaigns against stigma and discrimination
- downsizing psychiatric hospitals and extend
community care
ID
- access affordable treatment and health services
- establishment of effective PH surveillance and
reporting systems
RH – UN Himan Rights Council declared maternal mortality
as human rights violation and called states to take measures
V11. Freedom from torture and
other cruel, inhuman or degrading
treatment or punishment
Content – the State should prevent and protect
people from, and punish acts of, cruel, inhuman
or degrading treatment and torture.
 “Untouchable” right even in exceptional
circumstances, such as war
 Applicable also to detainees and individuals
under custody.
 Concerns also denying pain relief, if it
causes severe pain and suffering.

V11. Freedom from torture and other cruel,
inhuman or degrading treatment or
punishment
MH
- applicable to every person incl. those in
psychiatric hospitals
- improvement of hygienic conditions
- provision of regular exercise and adequate
treatment
- solitary confinement and food deprivation are
right’s violation
ID
- intentional transmission of infectious diseases is
prohibited
- denying access to HIV-related information,
voluntary testing, counselling etc.
RH
- forces sterilization is a breach of this right
- state’s failure to provide access to abortion
services when it is necessary, is a violation of this right
V111. Participation in public policy
Content – right of every person to
participate in political processes and
policy decisions affecting their health.
 Extended to participation in decisions
about planning and implementation of
health care services.

V111. Participation in public policy
MH – participation in public life on equal basis with others,
directly or with chosen representative
ID – participation in designing and implementing policies that
affect them
RH – participation to ensure that needs related to family
planning and access to contraceptives are met
IX. Equality and freedom from
discrimination
Content – health services and treatment
must be accessible and provided without
discrimination.
 Poorer households should not be
disproportionally burdened with health
expenses as compared to richer
households.

IX. Equality and freedom from
discrimination
MH – protection from stigma, unnecessary
institutionalization
ID – protection from stigmatization in fields of education,
employment, housing and health care (awareness raising
campaigns on HIV/AIDS)
RH – removal of legal and other obstacles that prevent
women from accessing health care on the basis of gender
X. Effective remedy
Content – remedies for human rights
violations should be accessible and
effective.
 States to establish mechanisms to ensure
that human rights violations are effectively
addressed at domestic level.
 Appropriate compensations (example:
public apology for Tuskegee study)

X. Effective remedy
MH – ability to access courts
ID – effective addressing of claims; states to address
deleterious prison conditions
RH – redress in cases of involuntary sterilizaton
WORLD MEDICAL
ASSOCIATION DECLARATION
ON THE RIGHTS OF THE
PATIENT /LISBON DECLARATION/
1.
2.
3.
4.
Informed
consent
related
5.
6.
7.
8.
9.
10.
11.
Right to medical care of good quality
Right to freedom of choice
Right to self-determination
The unconscious patient
The legally incompetent patient
Procedures against the patient’s will
Right to information
Right to confidentiality
Right to health education
Right to dignity
Right to religious assistance
Lisbon Declaration
1. Right to medical care of good quality



without discrimination;
by a physician free to make clinical
and ethical judgements without any
outside interference;
right to continuity of health care.
Lisbon Declaration
2. Right to freedom of choice
right to choose freely and change his/her
physician and hospital or health service
institution, regardless of whether they are
based in the private or public sector;
 right to ask for the opinion of another
physician at any stage.

Lisbon Declaration
3. Right to self-determination
right to make free decisions regarding
himself/herself;
 right to give or withhold consent to any
diagnostic procedure or therapy;
 right to refuse to participate in research or
the teaching of medicine.

Lisbon Declaration
4. The unconscious patient
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informed consent must be obtained
whenever possible, from a legally entitled
representative;
if a legally entitled representative is not
available, but a medical intervention is
urgently needed, consent of the patient
may be presumed.
physicians should always try to save the
life of a patient unconscious due to a
suicide attempt.
Lisbon Declaration
5.The legally incompetent patient
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the patient must be involved in the decisionmaking to the fullest extent allowed by
his/her capacity;
if the patient's legally entitled
representative, or a person authorized by
the patient, forbids treatment which is, in
the opinion of the physician, in the patient's
best interest, the physician should challenge
this decision in the relevant legal or other
institution.
in case of emergency, the physician will act
in the patient's best interest.
Lisbon Declaration
6. Procedures against the patient's will
Can be carried out only in exceptional
cases, if specifically permitted by law
and conforming to the principles of
medical ethics.
Lisbon Declaration
7. Right to information
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Exceptionally, information may be withheld
from the patient when there is good reason
to believe that this information would
create a serious hazard to his/her life or
health.
The patient has the right not to be informed
on his/her explicit request, unless required
for the protection of another person's life.
The patient has the right to choose who, if
anyone, should be informed on his/her
behalf.
Lisbon Declaration
8. Right to confidentiality
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descendants may have a right of access to
information that would inform them of their
health risks;
confidential information can only be
disclosed if the patient gives explicit consent
or if expressly provided for in the law;
All identifiable patient data must be
protected. The protection of the data must
be appropriate to the manner of its storage.
Lisbon Declaration
9. Right to Health Education
The education should include information
about healthy lifestyles and about methods
of prevention and early detection of
illnesses.
 The personal responsibility of everybody for
his/her own health should be stressed.
 Physicians have an obligation to participate
actively in educational efforts.

Lisbon Declaration
10. Right to dignity
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The patient is entitled to relief of his/her
suffering according to the current state of
knowledge.
The patient is entitled to humane terminal
care and to be provided with all available
assistance in making dying as dignified
and comfortable as possible.
Lisbon Declaration
11. Right to religious assistance
The patient has the right to receive or to
decline spiritual and moral comfort
including the help of a minister of
his/her chosen religion.
Movie – watch and answer
Which human and patient’s rights are violated in
the movie?
Movie – watch and answer
Which human and patient’s rights were violated
in the movie?
Right to liberty
Right to life
Right to highest attainable health
Right to freedom of torture
Right to effective remedy
 ………