Patient Rights Unit 7 Patient Rights 1960s patients

Patient Rights Unit 7

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

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

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

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

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

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

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

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

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

Nurses’ Potential Liability § 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 11

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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