Patient Rights and Ethics

Excerpt

"Rights aren't rights if someone can take them away. They're privileges." (Carlin C. It's Bad for Ya. Eardrum Records; 2008).

Minimum enforceable standards for the ways persons can expect to be treated by others are human rights. Customary standards for the ways persons in a given society are expected to treat others are ethics. As such, every patient right is derived from 1 or more medical or social ethical principles. See StatPearls' companion reference, "Medical Ethics," for more information.

The concept of healthcare quality contains 2 primary facets as follows:

1. Providing a service that meets the expectations of the primary customer/stakeholder (the patient) in the service transaction

2. Standardizing the service so that the same level of service is provided across patients

Since each patient/customer has different preferences and all services have associated costs (related to time and equipment), individuals establishing rights must balance the costs with an objective quality level that can be maintained across all patients/customers across different healthcare fields and facilities. Furthermore, nearly all rights have associated responsibilities. Legislators hesitate to establish and protect rights unless they believe people can act in a way that shows responsibility or has 'earned' them.

Healthcare in the United States is unique among developed countries as follows:

1. It is by far the most expensive per national capita (Organisation for Economic Co-operation and Development; 2023. https://stats.oecd.org/Index.aspx?DataSetCode=SHA. Accessed Apri 4, 2024).

2. Most types of services are not granted as a right irrelevant of cost.

3. There is no single location where Americans can find a list of their healthcare rights.

In response to the last point, various American healthcare organizations (HCOs) have created their own non-enforceable healthcare bills of rights. This process began in the 1970s with the American Cancer Society and American Hospital Association. The American Cancer Society published the opinion that bills of patient rights "empower people to take an active role in improving their health... strengthen the relationships people have with their health care providers... [and help patients] in dealing with insurance companies and other specific situations related to health coverage" (American Cancer Society. 2019. The Patient Bill of Rights. https://qa.cancer.org/content/dam/CRC/PDF/Public/6706.00.pdf. Accessed April 17, 2024). The American Medical Association (AMA) is the largest American physician organization (although only about 15% of American physicians belong) and keeps the longest-standing ethics code of any healthcare professional (HCP) organization in the world. For the first time in 2017, it created a list of patient rights (https://code-medical-ethics.ama-assn.org/ethics-opinions/patient-rights. Accessed April 17, 2024).

Prevailing American political and philosophical perspectives generally use language that preserves individual preferences while avoiding promises that would allow such preferences to harm others or prevent the government from protecting society. In other words, the function of rights in any 1 society is to find a middle ground between the wellness of individuals with the wellness of the collective society. A recent example of this includes measures that government administrators took to restrict the spread of the SARS-CoV-2 virus (COVID-19), such as the use of vaccines, tissue testing, respiratory tract masking, and barring of entry to public places by unvaccinated and unmasked persons.

Commonly developed patient rights derive from a limited set of ethical principles guiding patient treatment. These include the following:

1. Placing a high value on the patient's dignity as a person

2. Acting with goodwill toward the patient, in particular, seeking to preserve the patient's life and autonomy

3. Avoiding actions or inactions known to expose the patient to potential harm

4. Distributing resources equitably across patients

HCPS need to know how to prioritize ethical principles because usually, an enforceable standard for how to prioritize principles (eg, based on positions of a government vs a national healthcare society, local institution, or religious organization) does not exist. This article reviews some historical precedents for prioritizing the principles. See StatPearls' companion reference, "Medical Ethics," for more information.