P ATIENTS R IGHTS Roberta C. Balbi Campos Paper presented to Prof. Helena M.M. Pereira de Melo as requirement of Discipline of Health Law and Bioetics at Master Course.

Human Rights in Patient Care First of all: why the utilization of the concept “human rights in patient care” instead of “patient right”??? Human rights in patient care: refers to the application of general or universal human rights principles to all stakeholders in the delivery of health care services. Patient right: refers to the specific rights of patients, in their relationship in terms of health care. Another important distinction which need to be made is between "human rights in patient care" and "right to health", wherein the concept of right to health encompasses one vast range of human rights that fall outside the patient care delivery context, but nevertheless have an important role in determining health outcomes.

RELEVANT CONCEPTS  "Patient”- means any individual receiving long- or short-term inpatient care, emergency care, or outpatient care, and residents of long-term care facilities.”  "Facility” - means hospitals, clinics, health maintenance organizations, nursing homes, and other health care facilities licensed, or subject to licensing, by the [state licensing authority].  "Physician” - means any staff, attending, visiting, resident, or intern physician who cares for any patient in a licensed facility.

Human Rights in Patient Care in International Framework - The Universal Declaration of Human Rights of 1948 “Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,(…)”. Main dispositions are: Article 3 - Right to life; Article 5 - Prohibition on torture and cruel, inhuman, or degrading treatment; Article 7 - Protection against discrimination; Article 12 - Right to privacy; Article 19 - Right to seek, receive, and impart information; Article 25 – Right to medical care.

- International Covenant on Civil and Political Rights (ICCPR) Relevant dispositions: Article 2(1) - prohibition on discrimination; Article 6 - right to life; Article 7 - prohibition on torture; Article 9 - right to liberty and security; Article 10 - right to dignity for detainees; Article 17 -right to privacy; Article 19(2) - right to information; Article 26 -equality before the law.

- International Covenant on Economic, Social and Cultural Rights (ICESCR) Main disposition: Article 12 - right to highest attainable standard of health *General Comment nº14 of the Committee on Economic, Social, and Cultural Rights. Other relevant dispositions include: Article 2(1) - prohibition on discrimination; Article 10(3) - protection of children; Article 11 - adequate standard of living.

Other relevant treaties that also contains guarantees related to the protection of human rights in patient care.  Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)  Convention for the Elimination of All Forms of Racial Discrimination (CERD)  Convention Against Torture and Other Forms of Cruel, Inhuman, or Degrading Treatment or Punishment (CAT)  Convention on the Rights of the Child (CRC)  International Convention on the Protection of the Rights of All Migrants Workers and Members of their Families (CMW)  Convention on the Rights of Persons with Disabilities (CRPD)

ADDITIONAL INTERNATIONAL DOCUMENTS T here is no binding force in those documents, they are consider as been consensual, although they have a considerable political and moral force.  WHO Alma-Ata Declaration 1978  Charter on the Right to Health 2005 (International Union of Lawyers)  Declaration on the Rights of the Patients 2005 (revised) (World Medical Association (WMA)  Declaration on Patient-Centred Healthcare 2007, International Alliance of Patients’ Organizations (IAPO)  Jakarta Declaration on Leading Health Promotion into the 21st Century (1997)  Position Statement: Nurses and Human Rights 1998, International Council of Nurses (ICN)

EUROPE SYSTEM OF HUMAN RIGHTS IN PATIENT CARE THE COUNCIL OF EUROPE - The European Convention on the Protection of Human Rights and Fundamental Freedoms Relevant dispositions: Article 2 - Right to life; Article 3 - Protection against torture and cruel, inhuman or degrading treatment; Article 5 - Right to liberty and security of person Article 6 - Access to a fair hearing; Article 8 - Right to privacy; Article 13 - Right to effective remedies; Article 14 - Prohibition of discrimination.

- The European Social Charter Relevant dispositions: Article 11 - Right to protection of health; Article 13 - Right to social and medical assistance; Article 14 - Right to benefit from social welfare services; Article 15 - Right of persons with disabilities to independence, social integration and participation in the life of the community; Article 16 - Right of the family to social, legal and economic protection; Article 17 - Right of children and young persons to appropriate social, legal and economic protection; Article 19 - Right of migrant workers and their families to protection and assistance) Article 23 - Right of elderly persons to social protection.

- The Convention on Human Rights and Biomedicine Relevant dispositions: Equitable access to health care (Article 3) Protection of consent (Chapter II, Articles 5-9) Private life and right to information (Chapter III, Article 10) Other relevant treaties that also contains guarantees related to the protection of human rights in patient care.  European Convention for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment  Convention for the Protection of National Minorities 1995  Recommendation No. R (2000) 5 of the Committee of Ministers to member states on the development of structures for citizen and patient participation in the decision making process affecting health care

EUROPEAN UNION - EU Charter of Fundamental Rights Article 35 - right to health protection as the “right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices,” specifying that the EU must guarantee “a high level of protection of human health”. Other relevant dispositions include: Article 1 - the inviolability of human dignity; Article 2 - the right to life; Article 3 - the right to the integrity of the person; Article 6 - the right to security; Article 8 - the right to the protection of personal data; Article 21 - the right to non-discrimination; Article 24 - the rights of the child; Article 25 - the rights of the elderly; Article 34 - the right to social security and social assistance; Article 37 - the right to environmental protection; Article 38 - the right to consumer protection. - EU Directive on Patients’ Rights in Cross Border Health Care

NON BINDING DOCUMENTS IN THE EUROPEAN SISTEM - The European Charter of Patients’ Rights 1) Right to Preventive Measures 2) Right of Access 3) Right to Information 4) Right to Consent 5) Right to Free Choice 6) Right to Privacy and Confidentiality 7) Right to Respect of Patients’ Time 8) Right to the Observance of Quality Standards 9) Right to Safety 10) Right to Innovation 11) Right to Avoid Unnecessary Suffering and Pain 12) Right to Personalized Treatment 13) Right to Complain 14) Right to Compensation

- WHO: Declaration on the Promotion of Patients’ Rights in Europe 1) Human Rights and values in health care 2) Information 3) Consent 4) Confidentiality and privacy 5) Care and treatment 6) Application 7) Definitions - The WHO Ljubljana Charter on Reforming Health Care ) Driven by values 2) Targeted on health 3) Centred on people 4) Focused on quality 5) Based on sound financing 6) Oriented towards primary health care

EUROPEAN CHARTER OF PATIENT´S RIGHTS HUMAN RIGHTS OF GENERAL APPLICATION Right to Preventive MeasuresRight to Health Right to AccessRight to Non-discrimination and Equality Right to Information Right to Consent Right to Body Integrity; liberty and Security of person; freedom from torture, and cruel, inhuman degrading treatment; Privacy; Health Right to Free Choice Right to Privacy and confidentialityRight to privacy Right to Respect for Patient´s TimeRight to Health Right to Observance of Quality StandardsRight to Health; life Right to SafetyRight to Health; life Right to InnovationRight to Health; Benefits Of Scientific Progress Right to Avoid Unnecessary Pain and Suffering Right to Health; freedom from torture, and cruel, inhuman degrading treatment Right to Personalized Treatment Right to Health; Non-discrimination and Equality Right to Complain; CompensationRight to a Remedy How relate the European Charter of Patient´s Rights with the Human Rights of General Application

Possible violation of human rights in patient care? A detention of a female drug user in a hospital without her consent, and after giving birth of her child is denied her custody, is a violation of her Right to Liberty and Security of the Person?

Baby is found dead in the trash inside of a box. Baby found in the trash inside of a shoes box, but alive.

Possible violation of human rights? When physicians imposes a drug user pregnant woman to undergo with an abortion, would it be a violation of human right to body integrity?

Baby of a woman who used crack during the pregnancy…

Possible violation of human rights? Detain people without their consent, as they are assumed to lack the capacity to make decisions about their treatment and care, aiming to provide medical treatment for drug use… would it a violation of human right to liberty and body integrity???

Most of the time people do not accept treatment