1. Introduction to Healthcare Law & Society

2. Is there a right to healthcare? International law? World Health Organisation WHO definition of health as “a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity”. WHO Declaration on the Promotion of Patient’s Rights in Europe Universal Declaration of Human Rights International Convention on Economic, Social & Cultural Rights 1976 Convention on Human Rights and Biomedicine European Social Charter 1961 European Convention on Human Rights and Fundamental Freedoms European Charter of Fundamental Rights (2000)

3. EU Charter of Fundamental Rights (2000) Article 35 of the Charter provides for a 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”.

4. European Charter of Patients’ Rights European Charter of Fundamental Rights (2000) is the bedrock for the 14 rights contained in the European Charter of Patients’ Rights. European Charter of Patients’ Rights – patients have both rights & duties.

5. European Charter of Patients’ Rights – Access to Healthcare Right to preventative measures “Every individual has the right to a proper service in order to prevent illness.” Example: should obese patients have a right to expect hospitals to provide gastric band surgery? Or do obese patients have a duty to take preventative measures, such as diet/ proper nutrition/exercise? Right of access “Every individual has the right of access to the health services that his or her health needs require.” Should this right include elective enhancement or treatment therapies e.g. cosmetic surgery? What about assisted reproductive technology?

6. European Charter of Patients’ Rights – Access to Healthcare Right to free choice “Every individual has the right to freely choose from among different treatment procedures and providers on the basis of adequate information.” Should patients have the right to decide which diagnostic exams & therapies to undergo, and which primary care doctor, specialist or hospital to use? Should this right exist to everyone irrespective of whether the patient can pay for the treatment?

7. European Charter of Patients’ Rights – Access to Healthcare Right to respect of patients’ time “Every patient has the right to receive necessary treatment within a swift and predetermined period of time. This right applies at each phase of the treatment.” Waiting lists? Right to innovation “Every patient has the right of access to innovative procedures, including diagnostic procedures, according to international standards and independently of economic or financial considerations.” Example: use of stem cells from a ‘saviour sibling’ Right to personalised treatment “Every individual has the right to diagnostic or therapeutic programmes tailored as much as possible to his or her personal needs.”

8. European Charter of Patients’ Rights – informed consent Right to information “Every individual has the right to access all kinds of information regarding their state of health, the health services and how to use them, and all that scientific research and technological innovation makes available.” Freedom of Information Acts 1997-2003 Who has the right to access this information?

9. European Charter of Patients’ Rights – informed consent Right to consent “Every individual has the right of access to all information that might enable him or her to actively participate in the decisions regarding his or her health; this information is a prerequisite for any procedure and treatment, including the participation in scientific research.” Notion of informed consent Can you give consent on behalf of someone else? Elderly patients (parents/ relatives) Children Spouse/ Partner

10. European Charter of Patients’ Rights – safety and quality assurance Right to the observance of quality standards “Every individual has the right of access to high quality health services on the basis or the specification and observance of precise standards.” Does this include waiting times in outpatient departments/ casualty? Should this include basic standards of hygiene in hospital wards? Does it mean improving quality through the implementation of internationally-recognised evidence-based guidelines & protocols? Incorporation of training of healthcare professionals in evidence based standards of care.

11. European Charter of Patients’ Rights – safety and quality assurance Right to safety “Every individual has the right to be free from harm caused by the poor functioning of health services, medical malpractice and errors, and the right of access to health services and treatments that meet high safety standards.” Hospital superbugs? Legal protection for whistleblowers? Right to safety for vulnerable patients e.g. those suffering from mental illness who are detained?

12. European Charter of Patients’ Rights – safety and quality assurance Right to avoid unnecessary pain & suffering “Every individual has the right to avoid as much pain and suffering as possible, in each phase of his or her illness.” Access to medication? Palliative care at the end of life? Respect for patients’ dignity? Improve access of visitors?

13. European Charter of Patients’ Rights Right to privacy and confidentiality “Every individual has the right to the confidentiality of personal information, including the information regarding his or her state of health and potential diagnostic or therapeutic procedures, as well as the protection of his or her privacy during the performance of diagnostic exams, specialist visits, and medical/ surgical treatments in general.” Is this possible in overcrowded hospital wards? What about privacy for patients on trolleys in hospital corridors?

14. European Charter of Patients’ Rights - Redress Right to complain “Every individual has the right to complain whenever he or she has suffered a harm and the right to receive a response or other feedback.” Is this a right for the patient to have his or her voice heard, or a right to be listened to? Does complaining help with quality improvement? Complain to who? Statutory body e.g. Medical Council? Department of Health and Children? Legal action?

15. European Charter of Patients’ Rights - Redress Right to compensation “Every individual has the right to receive sufficient compensation within a reasonably short time whenever he or she has suffered physical or moral and psychological harm caused by a health service treatment.” Would this lead to a compensation culture? What about medical negligence claims? Would this encourage an even more adversarial environment between patients and medical professionals? No-fault compensation? Medical Injuries Compensation Assessment Board?

16. Right to Healthcare in Ireland Irish Constitution Does this include a right to health and a right to healthcare? Article 40.3.1° “…the State guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate the personal rights of the citizen..” Article 40.3.2° guarantees the right to life of every citizen.