1. Patient Rights Unit 5

2. 2 Patient Rights l 1960’s: patients turned to nurses for information l Protection of patient’s right to refuse treatment l Informed consent l Right to privacy l Avoiding false imprisonment

3. 3 Patient Rights Documents l What People Can Expect of Modern Nursing Practices, NLN, 1959 l Statement on Patient’s Bill of Rights, American Hospital Association, 1973 l Citizens Bill of Hospital Rights, Penn. Insurance Dept., 1973

4. 4 Patient Rights Documents Continued l Bill of Rights for Hospice Patients, Hospice Association of America, 1990

5. 5 Congressional Action l Rehabilitation Act, 1973 l Community Mental health Amendment, 1975 l Education for Handicapped Children Act, 1975 l Dev. Disabled Assist. And Bill of Rights Act, 1978 l Mental Health Systems Act, 1980 l Americans with Disabilities Act, 1990

6. 6 Omnibus Budget Reconciliation Act, 1987 l New requirements for nursing homes and home health l Standard for minimum RN staff l Immediate access for relatives l Access to federal and state officials who investigate complaints

7. 7 Legal Status of Patient Rights l Bills of Rights that become laws or state regulations carry most authority l Hospital may jeopardize funding from Medicare/Medicaid if found in violation of regulations l Bills of Rights professionally binding

8. 8 Informed Consent and the Law l Informed Consent: Information given to the patient regarding treatment and patient agreement to treatment l Standards for Informed Consent: Reasonable Doctor Standard Reasonable Patient Standard

9. 9 Informed Consent: Landmark Ruling l California Supreme Court, 1957 l Negligent nondisclosure l 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

10. 10 Responsibility for Obtaining Informed Consent l Obtaining informed consent rests with attending doctor for medical acts l Nurses may be required to sign form as a witness

11. 11 Nurses’ Potential Liability l 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

12. 12 Two Exceptions to Obtaining Informed Consent l Patient discretion: patient may waive right to be informed; tells doctor not to disclose details; directs doctor to provide info to next of kin l Emergencies: Unconscious patient or minor where family can’t be reached

13. 13 Right to Consent: Birth to Adulthood l Birth rights: confidentiality, privacy during treatments, legal protection from malpractice l Minors: Anyone under 18 or 21 has right to consent to treatment for STDs, serious communicable diseases, drug/alcohol abuse

14. 14 Rights Continued l Mature Minors: sufficiently developed awareness and mental capacity to make decisions about medical care l Adults: Right to consent or refuse medical treatment for self or minor children

15. 15 Legal Right to Refuse Treatment l Quinlan case, 1976, New Jersey l Cruzan v. Director, Mo. Dept. of Health, 1990 l Freedom of Religion: Jehovah’s Witness, 1972, Christian Scientist, 1971

16. 16 Right to Die l Natural Death Laws l Living Will Laws l Durable Power of Attorney: can make medical decisions regarding life and death treatment if patient becomes incapacitated

17. 17 Recent Legislation l Patient Self-Determination Act, 1990 l Must be given written information re rights under state law l Patient decision regarding advance directive must be documented in record

18. 18 Act, 1990 Continued l Health care providers cannot discriminate in any way regardless of advance directive l Facility must provide education for staff and community on advance directive issues

19. 19 Challenging the Right to Refuse Treatment l Patient incompetence: lacks mental ability to make reasonable decision l Delirium l Compelling circumstances: refusal endangers another’s life, child’s life, public interest outweighs patient rights, etc.

20. 20 Nurses’ Response to Patient’s Request to Stop Treatment l Stop preparations for any further treatment l Immediately notify doctor l Report patient’s decision to supervisor

21. 21 Patient’s Right to Privacy l Constitution does not explicitly sanction a right to privacy l Supreme Court has cited several amendments that imply right l Right to make personal choices without outside interference

22. 22 State Law and Right to Privacy l Some states have written privacy provisions into their constitutions l Nearly all recognize the right through statutory or common law

23. 23 Privilege Doctrine l Patient cannot be forced to reveal confidential communication l Few states recognize the nurse-patient relationship as protected

24. 24 When Confidential Information Must Be Disclosed l Child abuse cases l Criminal cases l Government request: IRS, EPA, Dept of Labor, HHS l Public’s right to know - President’s annual physical exam

25. 25 When Confidential Information May Be Disclosed l Welfare of a person or group is at stake l When disclosure is necessary for continued care l If patient consents to disclosure l To protect public or individuals from harm

26. 26 When Patients Demand Records l Right to Access: some states guarantee direct access, may have to subpoena records in other states l Cannell v. S.C. Clinic, 1974: patient has a right to know treatment details and right to info because of payment

27. 27 Patient Discharge Against Medical Advice l Patient has legal right to leave l Patient should be adequately informed l Contact patient’s family - optional l Explain AMA procedure l Give patient AMA form to sign l Provide discharge care

28. 28 Lawful Detention l Restraint, when necessary, is lawful with psychiatric patients, prisoners, and violent patients l Restrain patient only if medical conditions warrants or if authorities (police, courts, etc.) instruct to do so