MEDICAL JURISPRUDENCE

PATIENT’S RIGHTS
PATIENT’S RIGHTS
OBJECTIVES:
1. Understand the concepts and principles of Patient’s Rights
2. Discuss the basis for patient’s rights
3. Review the Rights of a Patient
4. Review the definition of Disclosure and Informed Consent
5. Discuss the elements of Disclosure and Informed Consent
6. Review the definition of Privacy and Confidentiality
7. Discuss the elements of Privacy and Confidentiality
REFERENCES:
1. Solis, Pedro Jr., 1988, Medical Jurisprudence. Quezon City. Garotech
Publishing
2. Ng, Peter P., Po, Philipp U., Medical Laws and Jurisprudence. Manila.
Philippine College of Medical Researchers Foundation, Inc.
3. B.M. Dickens, R.J. Cook, 2004, Dimensions of informed consent to treatment,
International Journal of Gynecology and Obstetrics
4. Cristina M. Beltran-Aroca, Eloy Girela-Lopez, Eliseo Collazo-Chao, Manuel
Montero-Pérez-Barquero and Maria C. Muñoz-Villanueva, 2016, Confidentiality
breaches in clinical practice: what happens in hospitals?, BMC Medical Ethics
5. Barbara J. Evans, 2011, Much Ado About Data Ownership, Harvard Journal of
Law & Technology.
6. Darwin P. Angeles, 2011, Dissecting Philippine Law and Jurisprudence on
Medical Malpractice. 85 Philippine Law Journal
PATIENT’S RIGHTS

Patients should receive treatment

consistent with the dignity and
respect they are owed as human
beings.
 PATIENT’S RIGHTS

The Nuremberg Code of 1947 –

"the voluntary consent of the
human subject is absolutely
essential."
 PATIENT’S RIGHTS
Universal Declaration of Human Rights
•Basis of patient’s rights
•Formalized in 1948
•Recognizes “the inherent dignity” and
the “equal and unalienable rights of all
members of the human family”.
•Depends upon prevailing cultural and
social norms
 PATIENT’S RIGHTS

The Tuskegee Experiments, 1932-1972

▪ US Public Health Service study

▪ 400 Negro men
▪ Diagnosis was withheld
▪ Not given treatment
 RIGHTS OF PATIENTS
1. Right to choose his physician
2. Right to give consent to diagnostic and treatment
procedures
3. Right to disclosure of information
4. Right of treatment
5. Right to refuse necessary treatments
6. Right to religious belief
7. Right of privacy
8. Right to confidential information
INFORMED
CONSENT
DISCLOSURE & INFORMED CONSENT

Respect for a patient’s right to self-

determination.
A choice can only be valid if it is
based on adequate knowledge.
 INFORMED CONSENT

• The right to receive information from

physicians and to discuss the benefits, risks,
and costs of appropriate treatment alternatives

• The right to make decisions regarding the

health care that is recommended by the
physician
 BASES OF CONSENT

1. The physician-patient relationship is

fiduciary in nature.
2. Patient’s right to self-determination.
3. Contractual relationship.
 PURPOSES
1. To protect the patient from
unnecessary/unwarranted procedure applied
to him without knowledge
2. To protect the physician from any
consequences for failure to comply with legal
requirements
 INSTANCES WHEN CONSENT
IS NOT NECESSARY
1.In cases of emergency, there is an “implied
consent” or the physician is “privileged”
because he is reasonably entitled to assume
consent
2.When the law made it compulsory for
everyone to submit to the procedure
REQUISITES OF A VALID CONSENT

✓Informed or enlightened consent

➢ Awareness and assent
➢ Full disclosure of facts and willingness of
the patient to submit
✓Voluntary
✓Subject matter must be legal
 FORMS OF CONSENT

✓Expressed consent – written or oral

✓ Implied consent may be deduced
from the conduct of the patient
 SCOPE OF THE CONSENT

✓ General or Blanket consent

✓ Limited or conditional consent
✓ Non-liability or exculpatory clause
Quantum of Information Necessary for Valid
Consent
1. Nature of his condition;
2. Natured of proposed treatment or procedure;
3. Possible alternative methods;
4. Risk involved;
5. Chances of success or failure
❖Consent must be given freely
or voluntarily
 INFORMED CONSENT

▪ Provide enough information for choice, but not

so much as to coerce or frighten patients into
compliance.
▪ Strike a proper balance between respecting the
autonomy of patients who are capable of making
informed decisions and protecting those with
cognitive impairment
 INFORMED CONSENT

Valid Informed Consent –

Disclosure of appropriate information to a
competent patient who is permitted to make
a voluntary choice.
 WHO MAY GIVE CONSENT
✓Patient ;
✓If patient is minor - parents;
✓In the absence of the parents - grandparents;
✓In the absence of parents and grandparents, eldest
brother or sister, of legal age and not disqualified
by law;
✓Other person who may have substitute parental
authority.
 INFORMED CONSENT

Consent means that a patient has the option

to decline the suggested treatment.
Even when a patient’s condition presents
only one choice of medical intervention.
 INFORMED CONSENT

Inform patient that not every possible effect of

treatment options is known.

Physicians should abandon any residual

posture of omniscience!
 INFORMED CONSENT

Physicians are not guarantors of the

effectiveness or safety of their
procedures, but may be liable for
appearing to claim that specific effects
will be achieved or, in particular, that
certain feared results cannot occur.
Dr. Rubi Li vs. Sps. Reynaldo &
Lina Soliman
GR No. 165279, June 7, 2011

page 25
Dr. Rubi Li vs. Sps. Reynaldo & Lina Soliman
GR No. 165279, June 7, 2011
FACTS:
7/7/93 – 11 y/o Angelica Soliman underwent biopsy for mass at SLMC
Result: Osteosarcoma, Osteoblastic
Referred to Dr. Rubi Li for chemotherapy
7/23/93 – First consultation with Dr. Li where she explained the need
for chemotherapy and side effects
1.Loss of hair
2.Nausea & vomiting
3.Loss of appetite
4.Low WBC, RBC & platelets
5.Sterility
6.Damage to heart and kidneys
7.Skin darkening
 Dr. Li vs. Sps. Soliman
GR No. 165279; June 7, 2011

8/18/93 – Admitted at SLMC for chemotherapy

8/19/93 – Administration of 1st round of chemo
8/21/93 – D3 of Chemo; DOB noted, O2 given
8/22/93 – Severe pain, black stools & reddish urine(?); carpo-
pedal spasm(?)
8/23/93 – Convulsion vs carpo-pedal spasm
8/26/93 – Bleeding from mouth, transfusions
8/29/93 - Intubated
1/1/94 – Angelica Soliman passed away
2/21/94 – Damage suit for negligence
Dr. Li vs. Sps. Soliman
GR No. 165279; June 7, 2011

Causal Relationship between a physician’s

failure to inform and the injury to the patient and
such connection arises only if it is established
that, had revelation been made, consent to
treatment would not have been given.
Dr. Li vs. Sps. Soliman
GR No. 165279; June 7, 2011

1) The physician had a duty to disclose material

risks;
2) He failed to disclose or inadequately disclosed
those risks;
3) As a direct and proximate result of the failure to
disclose, the patient consented to treatment she
would otherwise would not have consented to;
and
4) Plaintiff was injured by the proposed treatment
 PRIVACY AND
CONFIDENTIALITY
“What I may see or hear in the course
of the treatment or even outside of
the treatment in regard to the life of
men which in no account one must
spread abroad, I will keep to myself,
holding such things shameful to be
spoken about.”
Hippocratic Oath
PRIVACY
▪ Right to be left alone
▪ Freedom from exposure or intrusion by
others
▪ Reasonable expectation of privacy
▪ Physical, Decisional & Informational
PRIVACY
▪ Physical Privacy – freedom from contact
with others or exposure of one’s body
▪ Decisional Privacy – ability to make
personal choices without interference from
others
▪ Informational Privacy – prevention of
disclosure of personal information
PRIVACY

Informational Privacy is closely

related to Confidentiality
CONFIDENTIALITY
➢ Refer to how private information
provided by individuals will be protected by
the healthcare provider .

➢ “Contractual” duty of the healthcare

provider.
CONFIDENTIALITY

❖ Duty to protect information from

disclosure to others who have no right
to the information
 Moral and Ethical Basis
for Confidentiality
❖ Hippocratic Oath
❖ WMA Declaration of Geneva
➢ “I will respect the secrets which are
confided in me, even after the patient has
died.”
❖ PMA Code of Ethics
 Moral and Ethical Basis
for Confidentiality

❖PMA Code of Ethics

Sec. 6 – The physician should hold as sacred and
highly confidential whatever may be deiscovered
or learned pertinent to the patient even after
death, except when required in the promotion of
justice, safety and public health.
 Legal Basis of Confidentiality

❖ Rules of Court (Sec. 21 )

A person authorized to practice medicine, surgery or
obstetrics cannot in a civil case, without the consent
of the patient, be examined as to any information
which he may have acquired in a professional
capacity, and which would blacken the character of
the patient.
Who has the right to
the information ?
INCOMPETENTS Surrogate
✓Minors ✓Parents
✓Insane ✓Legal
✓Mentally-challenged Guardians
Is the right to confidentiality
absolute?
Physicians have duties which
override a patient’s right to
confidentiality.
✓Duty to protect the patient.
✓Duty to protect others.
✓Duty to obey the law.
 Privacy and confidentiality must be
honored unless there exists a stronger
conflicting duty.