MODULE 08: RENAL, GENITOURINARY, AND OBSTETRIC PATHOLOGIES

Patient Rights
ROBERTO C. TANCHANCO, MD
02/18/2021 (10:30-11:30)
ETHICS

TABLE OF CONTENTS (e) In circumstances where a choice must be made between potential
patients for a particular treatment that is in limited supply, all such patients
I. WMA LISBON PRINCIPLES ....................................................................................... 1 are entitled to a fair selection procedure for that treatment. That choice
A. PRINCIPLE 1 RIGHT TO MEDICAL CARE OF GOOD QUALITY ............................ 1 must be based on medical criteria and made without discrimination.
B. PRINCIPLE 2 RIGHT TO FREEDOM OF CHOICE ................................................ 1
(f) The patient has the right to continuity of health care. The physician has
C. PRINCIPLE 3 RIGHT TO SELF-DETERMINATION ............................................... 2
D. PRINCIPLE 4 THE UNCONSCIOUS PATIENT ..................................................... 2
an obligation to cooperate in the coordination of medically indicated care
E. PRINCIPLE 5 THE LEGALLY INCOMPETENT PATIENT ....................................... 2 with other health care providers treating the patient. The physician may
F. PRINCIPLE 6 .............................. 2 not discontinue treatment of a patient as long as further treatment is
G. PRINCIPLE 7 RIGHT TO INFORMATION ........................................................... 2 medically indicated, without giving the patient reasonable assistance and
H. PRINCIPLE 8 RIGHT TO CONFIDENTIALITY ...................................................... 2 sufficient opportunity to make alternative arrangements for care.
I. PRINCIPLE 9 RIGHT TO HEALTH EDUCATION ................................................... 2
J. PRINCIPLE 10 RIGHT TO DIGNITY .................................................................... 3
K. PRINCIPLE 11 RIGHT TO RELIGIOUS ASSISTANCE............................................ 3 In the Context of the COVID-19 Pandemic
L. SUMMARY......................................................................................................... 3 There are discrepancies and maldistribution of resources
II. CASES ...................................................................................................................... 3 o Better access to care in some parts of the country as compared to
A. THE RURAL DOCTOR ......................................................................................... 3 others
B. THE UNIVERSAL DO-NOT-RESUSCITATE (DNR) ORDER ...................................... 4
C. THE UNAUTHORIZED IDENTITY DISCLOSURE .................................................... 5
In some situations, the capacity of the system to accommodate the
D. ETHICAL ALLOCATION OF FUTURE COVID-19 VACCINES ................................... 5 patients was really tested and breached
QUICK REVIEW ............................................................................................................ 6 In the DOH website, we can see that the tally of the number of hospital
SUMMARY OF CONCEPTS ..................................................................................... 6 beds > number of ICU beds > number of ventilators
REVIEW QUESTIONS ............................................................................................. 7 When the system is overwhelmed, one is forced to ration the resources
REFERENCES ............................................................................................................... 7 o Leads to triaging as a strategy to allocate the scarce resources
REQUIRED ............................................................................................................. 7
FREEDOM SPACE ........................................................................................................ 7 Making the DNR1 policy a policy (mandatory)
APPENDIX ................................................................................................................... 8 o If you have a patient who want the save-at-all-costs approach, then DNR
is not an option anymore
Extreme case end-of-life situation
I. WMA LISBON PRINCIPLES Vaccine is a limited resource
o roblem in allocating the scarce resource
Falls under Principle 1, (e) the fair selection of recipients when
has undergone resource is limited
"While a physician should always act according to his/her conscience, and How do you now arrive at the fair allocation of limited vaccination
always in the best interests of the patient, equal effort must be made to opportunities?
some values will be forsaken, and some will
s or bodies involved in the provision of health be upheld
care have a joint responsibility to recognize and uphold the principal rights What we want to make sure of is that the higher values are the
ones that are upheld
o The basic principle that we want to recognize is that the patient is in the
It reveals to us what the higher values are. In situations of
best position to determine what will be in their own best interest
disaster, we want to make sure that it is the higher values that
are upheld.
information that the patient will need to determine what is best for
them
"Whenever legislation, government action or any other administration or B. PRINCIPLE 2 RIGHT TO FREEDOM OF CHOICE
institution denies patients these rights, physicians should pursue (a) The patient has the right to choose freely and change his/her physician
appropriate means to assure or to restore them." and hospital or health service institution, regardless of whether they are
based in the private or public sector.
In the Context of the COVID-19 Pandemic (b) The patient has the right to ask for the opinion of another physician at
any stage.
We see examples of upholding these rights when we see doctors involved
in the IATF, technical working groups for vaccinations, and educational
efforts about COVID-19 In the Context of the COVID-19 Pandemic
For Case 1
A. PRINCIPLE 1 RIGHT TO MEDICAL CARE OF GOOD QUALITY o Dr Cortez only doctor in the community
o It came out that the committee should be very grateful that the dr chose
(a) Every person is entitled without discrimination to appropriate medical to stay in the community and be the source of information and
care.
healthcare that they would otherwise not have
(b) Every patient has the right to be cared for by a physician whom he/she o
knows to be free to make clinical and ethical judgements without any provider, and there are probably other healthcare providers in the
outside interference. community aside from the doctor
(c) The patient shall always be treated in accordance with his/her best Midwives, nurses, barangay health workers
interests. The treatment applied shall be in accordance with generally Allies that can also provide care
approved medical principles.
(d) Quality assurance should always be a part of health care. Physicians, in
particular, should accept responsibility for being guardians of the quality of
medical services.

1 DNR: Do-Not-Resuscitate

Transcribed by TG 8: Acha, Bertiz, Divinagracia, Heraldo, Laurito, Orfanel, Pojol, Villanueva

YL6: 08.31
Checked by TG 20: Caballero, Clemente, Dee, Garrido, Liu, Molen, Punzalan 1 of 8
 C. PRINCIPLE 3 RIGHT TO SELF-DETERMINATION
(a) The patient has the right to self-determination, to make free decisions
regarding himself/herself. The physician will inform the patient of the
consequences of his/her decisions.
(b) A mentally competent adult patient has the right to give or withhold
consent to any diagnostic procedure or therapy. The patient has the right
to the information necessary to make his/her decisions. The patient should
understand clearly what is the purpose of any test or treatment, what the
results would imply, and what would be the implications of withholding
consent.
(c) The patient has the right to refuse to participate in research or the
teaching of medicine.
In the Context of the COVID-19 Pandemic
Forsaken in the quarantine policy
o Lockdown, limitation in movement
There is a hierarchy of values
o There is still the value of self-determination, but there is also the value
of upholding the welfare of the public
A conflict between the two qualifies as an exceptional case
Value of self-determination should give way to ensure public
safety
Upheld in trials involving novel treatments for the COVID-19 virus
o Informed consent process is still followed
o Patients still have the freedom to refuse to participate in such trials,
even in this crisis
D. PRINCIPLE 4 THE UNCONSCIOUS PATIENT
(a) If the patient is unconscious or otherwise unable to express his/her will,
informed consent must be obtained whenever possible, from a legally
entitled representative.
(b) If a legally entitled representative is not available, but a medical
intervention is urgently needed, consent of the patient may be presumed,
previous firm expression or conviction that he/she would refuse consent to
the intervention in that situation.
(c) However, physicians should always try to save the life of a patient
unconscious due to a suicide attempt.
E. PRINCIPLE 5 THE LEGALLY INCOMPETENT PATIENT
(a) If a patient is a minor or otherwise legally incompetent, the consent of
a legally entitled representative is required in some jurisdictions.
Nevertheless, the patient must be involved in the decision-making to the
fullest extent allowed by his/her capacity.
(b) If the legally incompetent patient can make rational decisions, his/her
decisions must be respected, and he/she has the right to forbid the
disclosure of information to his/her legally entitled representative.
(c)
the patient, forbids treatment which is, in the opinion of the physician, in
the patie
the relevant legal or other institution. In case of emergency, the physician
F. PRINCIPLE 6
Diagnostic pro
out only in exceptional cases, if specifically permitted by law and
conforming to the principles of medical ethics.
In the Context of the COVID-19 Pandemic
Similar to the Right to Freedom of Choice, the pandemic is an exceptional
case
Other rights give way for the higher good of ensuring public safety
G. PRINCIPLE 7 RIGHT TO INFORMATION
(a) The patient has the right to receive information about himself/herself
recorded in any of his/her medical records, and to be fully informed about
his/her health status including the medical facts about his/her condition.
party should not be given to the patient without the consent of that third
party
(b) Exceptionally, information may be withheld from the patient when
there is good reason to believe that this information would create a serious
hazard to his/her life or health.
YL6: 08.31 RENAL, GENITOURINARY, AND OBSTETRIC PATHOLOGIES: Patient Rights
(c) Information should be given in a way appropriate to th
culture and in such a way that the patient can understand
(d) The patient has the right not to be informed on his/her explicit request,
(e) The patient has the right to choose who, if anyone, should be informed
on his/her behalf
In the Context of the COVID-19 Pandemic
herself, and whether they want to know or not know
Can be applied to the COVID test results and if people want to know if they
are positive or not
o We have to weigh it against public safety and public welfare
misinformation
o There is an added burden of helping people filter between accurate and
inaccurate information
H. PRINCIPLE 8 RIGHT TO CONFIDENTIALITY
condition, diagnosis, prognosis and treatment and all other information of
a personal kind must be kept confidential, even after death. Exceptionally,
descendants may have a right of access to information that would inform
them of their health risks
(b) Confidential information can only be disclosed if the patient gives
explicit consent or if expressly provided for in the law. Information can be
basis unless the patient has given explicit consent.
(c) All identifiable patient data must be protected. The protection of the
data must be appropriate to the manner of its storage. Human substances
from which identifiable data can be derived must be likewise protected.
In the Context of the COVID-19 Pandemic
At the start of the pandemic, the DOH and other reporting bodies were
very careful about the information they shared regarding the first few cases
o They used case numbers
o They also did their best to avoid any identifiers that would allow others
to identify the patients
Confidentiality can be waived
o You see this in people who want to become advocates and share their
experiences
Help educate others
Increase support for research or legislation
I. PRINCIPLE 9 RIGHT TO HEALTH EDUCATION
Every person has the right to health education that will assist him/her in
making informed choices about personal health and about the available
health services.
The education should include information about healthy lifestyles and
about methods of prevention and early detection of illnesses.
The personal responsibility of everybody for his/her own health should be
stressed
Physicians have an obligation to participate actively in educational efforts.
In the Context of the COVID-19 Pandemic
Currently, we have to deal with vaccination hesitancy
We also went through a phase when hydroxychloroquine was a must give
medication but after some time research showed that it did not have an
impact on COVID and there were other risks to using this medication
s also a lot of misinformation present
o Bleach being injected into the veins as a treatment
Highlights the role of physicians as sources of good, reliable information
o Only sharing information that passes our own strict standards
o Information must be validated and evidence-based
o Patients will have confidence in the information provided to them by
their doctors
o It is an ethical obligation for physicians to offer good and reliable
information.
2 of 8
 J. PRINCIPLE 10 RIGHT TO DIGNITY
(a) The
in medical care and teaching, as shall his/her culture and values.
(b)The patient is entitled to relief of his/her suffering according to the
current state of knowledge.
(c) The patient is entitled to humane terminal care and to be provided with
all available assistance in making dying as dignified and comfortable as
possible
K. PRINCIPLE 11 RIGHT TO RELIGIOUS ASSISTANCE
The patient has the right to receive or to decline spiritual and moral
comfort including the help of a minister of his/her chosen religion.
Discussion
L. SUMMARY
These rights are all predicated on the premise that the patient, as a
rational being, is in the best position to determine what is in his/her own
best interest
The duty of the physician is to enable and empower his/her patients to
attain this end with his/her expert assistance.
Rights Upheld
II. CASES
A. THE RURAL DOCTOR
Summary
Dr. Anthony Cortez has been the sole community doctor catering to the
56,000 inhabitants of Bambang for 21 years
o He sees 80-100 patients a day and thus, has limited time for
consultation
o His clinic is nowhere near large enough for the number of people it
serves
With the pandemic, he and Mayor Balgos (a former community doctor)
implemented measures to prevent transmission
o As of 9 July 2020, the town has zero cases and the isolation center set
up in the mountains is empty
The Pan-Philippine Highway runs through the middle of the town, making
virus transmission highly likely
Contact tracing system
o Dr. Cortez operated on the assumption that every new arrival was
asymptomatic
town. (Dr. Anthony Cortez)
o Everyone who had traveled to other countries, especially China, since
December were placed under strict 14-day quarantine
o Anyone entering Bambang must agree to quarantine for 14 days or
return to where they came from
o
tabs on new arrivals to the village
o These are reported to Dr. Cortez who sends nurses to follow up
o He is careful to verify reports and to quash unfounded rumors of
positive cases
My dad warned me not to break quarantine even briefly because the
neighbors would know and blame me if there was an outbreak. (Xyza
Cruz Bacani)
There has been resistance to measures implemented
o Some people curse the medical team or refuse to cooperate
o Others try to reason their way out
o But with news of deaths in developed countries, the pandemic was
taken more seriously
Under enhanced community quarantine, nurses would go to homes
directly to deliver medications and immunize children
o Patients needing medical intervention amounted to thousands
overrun. (Xyza Cruz Bacani)
YL6: 08.31 RENAL, GENITOURINARY, AND OBSTETRIC PATHOLOGIES: Patient Rights
Francisco Fernandez, a beloved jeepney barker, died after falling off a
motorbike
o With a public-facing job and a spot on his lung, he was considered a
suspected COVID-19 carrier
o Following protocols, he was buried quickly against Philippine tradition
Funerals in the Philippines are a huge affair lasting a week with many
people in attendance
Fernandez was known throughout Bambang as the guy who attended
get one of his own. When his coronavirus test came back 10 days later, it
was negative.
NOTE: The following discussion points are derived from the group outputs.
Issues may be framed differently depending on the group. Rather than
cherry-picking, the trans group opted to include all arguments raised.
Right to Medical Care of Good Quality
o
o Continuity of healthcare was upheld
Medical team continued to deliver needed health interventions (e.g.
immunization, hypertension medication) in the midst of the
pandemic
Care given despite scarcity of resources
Daily visits to those quarantined
o Nurses stationed strategically across town to cater to
o Science-based protocols curbed the spread of the virus
o Impartiality exercised
Everyone was quarantined regardless of status
Right to Health Governance
o Dr. Cortez worked alongside the Mayor
Right to Information
o Being the sole doctor, Dr. Cortez was the source of information that the
community would otherwise not have
o Information was given to the community in order to justify the
protocols
o Reports were verified and unfounded rumors were quashed
o ons of spreading the
virus if Francisco Fernandez was not buried immediately.
Right to Life
o There were measures to protect the community from virus transmission
Right to Health Education
o Healthcare workers were informed regarding updates on the pandemic
in order to give correct and accurate information to patients
o Healthcare workers tried to reach out to residents, which may be a form
of health education
o Measures were communicated, and implemented with general public
understanding the reason/s for utilizing mask-wearing, face shield use,
etc.
Right to Confidentiality
o Lists of names of those needing interventions were kept within the
clinics
o The gossip brigade was not a violation of confidentiality since these
were not facts, merely speculation, and the information was not taken
through the physician-patient relationship.
Right to Dignity
o Overall, health measures were put in place for the overall safety and
protection of the residents from further harm and suffering
Right to Self-Determination
o Have the choice to quarantine or leave the town when coming from
outside
o
sister) was obtained in order to conduct the immediate burial.
3 of 8
Rights Forsaken
Right to Confidentiality
o Arrivals were tracked through gossip and their identities can be
pinpointed
Gossip as a means of contact tracing may be prone to error or abuse
Identifying information were passed around without consent
o e public
Right to Self-Determination
o
as he was the sole physician available
No choice but to quarantine
Everyone was regarded as a suspect
Preferences regarding isolation were overruled
Family did not have an opportunity to decide on the burial
Right to Medical Care of Good Quality
o With the multitude of people he serves, Dr. Cortez has limited time for
consultation, compromising quality
o Clinic is disproportionate in size and manpower to the number of
people in need
Right to Dignity
o Immediate burial goes against Philippine tradition
Right to Health Education
o o There are limited resources of PPEs, machines, and health workers
neighbors would know
Gives false perception of the importance of quarantine
o Resistance to protocols may point to fragmented understanding
Subsequent compliance may be borne out of fear, rather than
understanding
Right to Freedom of Choice
o While other healthcare workers are present (nurses, midwives etc.), the
town is heavily reliant on a single doctor
A patient seeking free healthcare has no opportunity to freely
choose his/her physician or ask the opinion of another physician.
Isolation and the risk of contracting COVID-19 prevented patients
from seeking care outside town
o Due to government protocol of quarantining possible COVID suspects
upheld
Right to Religious Assistance
o No sign of any religious intervention (e.g. priest, pastor, chieftain) was
explicitly noted to conduct the burial
o Grieving family not given proper avenue to talk to spiritual adviser and
say goodbye properly
Right to Information
o The negative COVID result was released days after the burial of
Francisco Fernandez
B. THE UNIVERSAL DO-NOT-RESUSCITATE (DNR) ORDER
Summary
record of a patient
o This orders the health workers to withhold resuscitation when the
patient undergoes cardiac or respiratory distress
o Cardiopulmonary resuscitation includes:
Mouth to mouth resuscitation
Chest compressions
Other complementary procedures (e.g. intubation)
With the COVID-19 pandemic, resuscitation provides two dangers to health
workers:
o Increased exposure to the virus via contact and/or air droplets
Around 8-30 health workers are involved in resuscitating a patient
o Increased utilization of Personal Protective Equipment (PPEs2)
There are limited, if not insufficient, quantities of safety helmets,
gloves, eye protection, high-visibility clothing, safety footwear, and
safety harnesses
It is protocol to dispose of the PPEs after resuscitating a patient,
making these of one-time use
2 PPE: Personal Protective Equipment
YL6: 08.31 RENAL, GENITOURINARY, AND OBSTETRIC PATHOLOGIES: Patient Rights
Increasing number of doctors are becoming more inclined to the Universal
DNR in order to protect and save resources
There is no certainty on whether or not the resuscitation would save
the patient
Life saved or not, PPEs have already been used and disposed of
Without health workers, quality of care will decline, and more lives
will be lost
Health workers may expose the virus to other patients, who were
initially not infected by the virus
Discussion
NOTE: The focus of the discussion is the ethical issues regarding the
universal DNR. As such, points raised against the specific hospitals are
excluded.
Rights Upheld
Right to Medical Care of Good Quality
o In circumstances where a choice must be made between potential
patients for a particular treatment that is in limited supply, all such
patients are entitled to a fair selection procedure for that treatment
o Proceeding with the Universal DNR order would save resources and
properly allocate these to patients who have higher chances of survival
o The allocation of resources are justified by the medical criteria
o
probability of transmission to other patients
The Unconscious Patient and the Right to Information
o If the patient is unconscious or otherwise unable to express his/her will,
informed consent must be obtained whenever possible, from a legally
entitled representative
o Most critically ill patients in the 12 days since their first coronavirus case
have experienced steady declines rather than a sudden crash
o This provides the health workers sufficient time to talk with the families
of the patients about:
Risk to health workers
How having to put on protective gear delays a response and
decreases the chance of saving a life
Deferring initiation of CPR for 10 minutes may decrease survival
rate to far below 10% for all patients irrespective of COVID-19
status
o Such conversation influences the decision of the families to sign the
DNR order
Rights Forsaken
Right to Medical Care of Good Quality
o The patient shall always be treated in accordance with his/her best
interests
o While resuscitation may not be clinically indicated in some, the DNR
order is universal
Applying the DNR order as a blanket approach is not consistent with
an individualized, evidence-based, clinical assessment
Therefore, to completely withhold resuscitation to infected patients
may mean to withhold a possible procedure that would allow them
to live
Taking away their chance to live may not be in the best interests of
the patient, especially if resuscitation is clinically indicated
Right to Self-Determination
o Patients have the right to self-determination, to make decisions
regarding him/herself
o The order disregards the wishes of the patients or their representatives
Right to Dignity
o The patient is entitled to relief of his/her suffering according to the
current state of knowledge
o If the current state of knowledge is to resuscitate the COVID-19 patient
as clinically indicated, the right is forsaken
The patient may be saved, but the possibility is foregone by the
universal DNR order
4 of 8
 C. THE UNAUTHORIZED IDENTITY DISCLOSURE Right to Freedom of Choice
o Some patients felt forced to disclose their information
Summary o Patients were not informed their identities would be disclosed
The entire article was a recount of various cases throughout the pandemic
where there was unauthorized disclosure of COVID- D. ETHICAL ALLOCATION OF FUTURE COVID-19 VACCINES
The National Privacy Commission (NPC) had been investigating 22
complaints of privacy breaches involving more than 150 COVID-19 patients Summary
o A leaked manifest of a medical evacuation plane that crashed in NAIA The study aimed to:
revealing the names of passengers and crew o Identify the ethical goals that vaccine distribution should aim to
o A hospital staff took a photo of the death certificate of a suspected promote
COVID-19 patient and posted it in their department group chat o Assess the likely impact of different prioritization strategies on
achieving these goals
o Identify key empirical questions that will shape the likely outcomes
tact- associated with different national vaccine prioritization strategies
Three (3) central goals for future COVID-19 vaccination campaigns
o disclosure of the proposed in the study were:
names of the coronavirus positive residents on its official FB page o Reduction of morbidity and mortality
Consistent with position of the CDC
It was not clear if consent was obtained before disclosing names Primary purpose of vaccine campaigns is to reduce the impact of
policy dilemma disease on health
o
o The Inter-Agency Task Force on the Management of Emerging economy
Infectious Diseases (IATF-MEID) had to put together a Data Sharing o Narrow unjust health inequalities
Agreement (DSA3) to which all contact tracers must adhere Uphold that the moral foundation of public health is social justice
The DSA allows contact tracers from different agencies to access, Resonant in the COVID-19 context
with strict confidentiality, the information provided by confirmed Evidence of disproportionate health and economic burdens of
and probable cases of COVID-19 the pandemic borne by racial and ethnic minorities as well as
Uniquely in Baguio City, COVID-19 patients were voluntarily revealing their those of low socioeconomic status
identity in order to inform people about the disease Five (5) strategies were proposed by the study:
o The DOH itself has been sharing stories of health workers who survived o S1: Prioritize most vulnerable and those with comorbidities, which
Survivors Speak includes:
that all photos and statements were taken with consent Above 65 years of age
Hypertension
Diabetes
Pertinent Discussion Points
Cancer
Rights Upheld Cardiovascular disease
Right to Health Education Cerebrovascular disease
o Contact tracing is crucial for the interest of public safety o S2: Prioritizing by life cycle
It allows health services and authorities to track the virus spread To ensure greatest number of individuals have the opportunity to
o People have an obligation to know incidents and cases in their pass through all stages of life
community in order to spread proper awareness of disease detection Those below 65 years of age
o The "Survivors Speak" program which shared stories about survivors o S3:
who voluntarily disclosed their information helped educate citizens on Includes: essential healthcare workers, individuals who provide life-
the effects of COVID-19 saving services, and workers who provide services that are
Right to Information necessary for society to function as normally as possible
o Contact tracing upholds the right of the public to be informed on o S4: Ensuring equal access
matters pertaining to public health and safety
o Though, while contact tracing may have benefits for the general public, o S5: Prioritizing the reduction of spread of COVID-19 infections
the rights of COVID-19 patients, in this case, were forsaken Uses several approaches:
Reduce infection spread within confined communities (ex.
Rights Forsaken nursing homes and prisons)
Right to Confidentiality Reduce spread through the community as a whole
o Early in the pandemic, the privacy of patients diagnosed as COVID-19 No single prioritization approach can effectively advance all three goals
positive was breached (by health workers, DOH, and the Cagayan LGU) o A multipronged approach that considers risk of serious COVID-19
Identifying information was posted on social media, or by illness, instrumental value and risk of transmission should be
authorities themselves implemented
o This right extends beyond death and explicit consent is required to
disclose personal information Pertinent Discussion Points
In initial cases described, patients were not asked for their consent
prior to sharing their medical statuses
Right to Dignity and Privacy NOTE: This section will tackle each of the 5 proposed strategies (S1-S5),
o In their efforts to initiate contact-tracing, various governments failed to under which, rights upheld, rights forsaken, and which of the 3 central goals
account for the individual rights as well as the privacy of the patients for future vaccination campaigns were met will be discussed.
o When their right to privacy is violated, patients are stripped of their
dignity by being treated as merely data Table 1. 5 Proposed Prioritization Strategies for Ethical Allocation of COVID-19
o Unauthorized disclosure exposed patients to acts of discrimination, Vaccines [Refer to Appendix A]
maltreatment and stigma driven harassment
Right to Information
o

The patients were not given a choice on whether they agree to

share their personal information
o Patients were not given the right to choose who would be informed of
their COVID-19 status

3 DSA: Data Sharing Agreement

YL6: 08.31 RENAL, GENITOURINARY, AND OBSTETRIC PATHOLOGIES: Patient Rights 5 of 8

Rights Upheld Right to Information:
o The patient has the right to receive information about himself/herself
Right to Medical Care of Good Quality
recorded in any of his/her medical records, and to be fully informed
o S1-S5
about his/her health status including the medical facts about his/her
o Each strategy presents with a particular target population
o According to the WMA Declaration of Lisbon: In circumstances where a
about a third party should not be given to the patient without the
choice must be made between potential patients for a particular
consent of that third party
treatment that is in limited supply, all such patients are entitled to a fair
o The patient has the right not to be informed on his/her explicit request,
selection procedure for that treatment. That choice must be based on
medical criteria and made without discrimination.
Right to Confidentiality:
Right to Information and Right to Health Education
o
o S1-S5
condition, diagnosis, prognosis and treatment and all other information
o Patients are informed of their qualification for vaccination as well as
of a personal kind must be kept confidential, even after death.
the efficacy, side effects, and unknowns of the vaccine.
Exceptionally, descendants may have a right of access to information
The Legally Incompetent Patient
that would inform them of their health risks
o S1, S2
Right to Health Education:
o Target population of the strategies may present to be legally
o Every person has the right to health education that will assist him/her
incompetent, such as minors or those who are not mentally capable of
in making informed choices about personal health and about the
making decisions
available health services
Right to Freedom of Choice and Right to Self-Determination
Right to Dignity:
o S4, S5
o
o First come, first served policy entails the freedom of patients to choose
in medical care and teaching, as shall his/her culture and values
a physician and an institution of their choice to administer the vaccine
Right to Religious Assistance:
o The patient has the right to receive or to decline spiritual and moral
Rights Forsaken comfort including the help of a minister of his/her chosen religion
Right to Freedom of Choice and Right to Self-Determination
o S1, S2, S3 CASES
o Initial outcome of vaccination is dependent on a specific population, The Rural Doctor:
and therefore causes strain on an individual to opt out o Summary:
o Also requires providing adequate information and education to the Dr. Anthony Cortez has been the sole community doctor catering to
patients the 56,000 inhabitants of Bambang for 21 years
Right to Medical Care of Good Quality
o S4 There was resistance to changes implemented
o First come, first served policy lessens the assurance of good quality Francisco Fernandez, a beloved jeepney barker, died after falling off
medical care for the less privileged a motorbike and had to be buried quickly according to COVID
Right to Unconscious Patient and The Legally Incompetent Patient protocols
o S4 o Discussion:
o First come, first served policy may predispose the unconscious and the Rights Upheld:
legally incompetent patients from availing the vaccine Right to Medical Care of Good Quality
-
resistance
Right to Health Governance
Feedback Form: https://tinyurl.com/2024YL6gHMT
Right to Information
Errata Tracker: https://tinyurl.com/2024YL6ET08
- Information was given to the community in order to justify
the protocols
QUICK REVIEW Right to Life
SUMMARY OF CONCEPTS Right to Health Education
WMA LISBON PRINCIPLES - Healthcare workers were informed regarding updates on the
Right to Medical Care of Good Quality: pandemic in order to give correct and accurate information
o Every person is entitled without discrimination to appropriate medical to patients
care Right to Confidentiality
Right to Freedom of Choice: - Lists of names of those needing interventions were kept
o The patient has the right to choose freely and change his/her physician within the clinics
and hospital or health service institution, regardless of whether they are
based in the private or public sector Right to Dignity
o Right to ask the opinion of another physician - Overall, health measures were put in place for the overall
Right to Self-Determination: safety and protection of the residents from further harm and
o The patient has the right to self-determination, to make free decisions suffering
regarding himself/herself. The physician will inform the patient of the Right to Self-Determination
consequences of his/her decisions - Have a choice to quarantine or leave town if coming from
The Unconscious Patient: outside
o If the patient is unconscious or otherwise unable to express his/her will, Rights Forsaken:
informed consent must be obtained whenever possible, from a legally Right to Confidentiality
entitled representative -
The Legally Incompetent Patient: Right to Self-Determination
o If a patient is a minor or otherwise legally incompetent, the consent of - Dr. Cortez made the decisions for the patients
a legally entitled representative is required in some jurisdictions. Right to Medical Care of Good Quality
Nevertheless, the patient must be involved in the decision-making to - Dr. Cortez has limited time for consultation, compromising
the fullest extent allowed by his/her capacity quality
Procedures Against t : Right to Dignity
o - Immediate burial goes against Philippine tradition
carried out only in exceptional cases, if specifically permitted by law and Right to Health Education
conforming to the principles of medical ethics - Resistance to protocols may point to fragmented
understanding
Right to Freedom of Choice
Right to Religious Assistance

YL6: 08.31 RENAL, GENITOURINARY, AND OBSTETRIC PATHOLOGIES: Patient Rights 6 of 8

 Right to Information Rights Forsaken:
- The negative covid result was released days after the burial of Right to Freedom of Choice and Right to Self-Determination
Francisco Fernandez Right to Medical Care of Good Quality
The Universal DNR Order: - First come, first served policy lessens the assurance of good
o Summary: quality medical care for the less privileged
Right to Unconscious Patient and The Legally Incompetent
medical record of a patient Patient
With the COVID-19 pandemic, resuscitation provides two dangers to - First come, first serve policy may predispose the unconscious
health workers: and the legally incompetent patients from availing the
Increased exposure to the virus via contact vaccine
Increased utilization of PPEs which are limited in quantity
Increasing number of doctors are becoming more inclined to the REVIEW QUESTIONS
Universal DNR order to protect and save resources 1. If a patient is forced to participate in a research study related to his disease,
o Discussion: which of his rights are being compromised?
Rights Upheld: a) Right to freedom of choice
Right to Medical Care of Good Quality b) Right to self-determination
- Save resources and properly allocate these to patients who c) Right to medical care of good quality
have higher chances of survival d) None of the above
- Reduce health worker exposure
The Unconscious Patient 2. If a patient is prohibited from asking the opinion of another physician,
The Right to Information which of his rights are being compromised?
Rights Forsaken: a) Right to freedom of choice
Right to Medical Care of Good Quality b) Right to self-determination
- Takes away the patients chance to live whether they are c) Right to medical care of good quality
infected or not d) None of the above
Right to Self-Determination
Right to Dignity 3. T/F. The patient shall always be treated in accordance with the medical
The Unauthorized Identity Disclosure:
o Summary:
The entire article was a recount of various cases throughout the 4. T/F. A physician should always try to save the life of a patient unconscious
pandemic where there was unauthorized disclosure of COVID-19 due to a suicide attempt.

The National Privacy Commission (NPC) had been investigating 22 5. T/F. If a patient is a minor, only the consent of his legal guardian is
complaints of privacy breaches involving more than 150 COVID-19 necessary.
patients
o Discussion: ANSWERS:
Rights Upheld: 1B, 2A, 3F, 4T, 5F
Right to Health Education
Right to Information REFERENCES
- Contact tracing upholds the right of the public to be informed REQUIRED
on matters pertaining to public health and safety
(1) Roberto C. Tanchanco, MD. February 18, 2021. Patient Rights [Lecture
Rights Forsaken:
slides].
Right to Confidentiality
Right to Dignity and Privacy
Right to Information FREEDOM SPACE
- The patients were not given a choice on whether they agree
to share their personal information
Right to Freedom of Choice
Ethical Allocation ff Future Covid-19 Vaccines:
o Summary:
Three central goals proposed were:
Reduction of morbidity and mortality

the economy
Narrow unjust health inequalities
Five strategies proposed were:
S1: Prioritize most vulnerable and those with comorbidities
S2: Prioritizing by life cycle
S3:
S4: Ensuring equal access
S5: Prioritizing the reduction of spread of COVID-19 infections
o Discussion:
Rights Upheld:
Right to Medical Care of Good Quality
- Each strategy presents with a particular target population
Right to Information and Right to Health Education
The Legally Incompetent Patient
- Target population of the strategies of S1 and S2 may present
to be legally incompetent
Right to Freedom of Choice and Right to Self-Determination
- First come, first served policy entails the freedom of patients
to choose a physician and an institution of their choice to
administer the vaccine

YL6: 08.31 RENAL, GENITOURINARY, AND OBSTETRIC PATHOLOGIES: Patient Rights 7 of 8

 APPENDIX

APPENDIX A: Table 1. 5 Proposed Prioritization Strategies for Ethical Allocation of COVID-19 Vaccines
STRATEGIES
Prioritize most vulnerable
and with comorbidities
Prioritize by life cycle
Prioritize individuals with
RIGHTS UPHELD RIGHTS FORSAKEN ACHIEVED CENTRAL GOAL
Right to Medical Care of Good Quality Right to Freedom of Choice All
Right to Information Right to Self-Determination
The Legally Incompetent Patient
Right to Medical Care of Good Quality Right to Freedom of Choice
The Legally Incompetent Patient Right to Self-Determination effects on societal
infrastructure and the
economy
Right to Medical Care of Good Quality Right to Self-Determination All

Ensuring equal access Right to Medical Care of Good Quality Right to Medical Care of Good Quality None
Right to Freedom of Choice Rights of the Unconscious Patient
Right to Self-Determination The Legally Incompetent Patient
Right to Information
Prioritize reduction of Right to Medical Care of Good Quality
spread of infections Right to Freedom of Choice effects on societal
Right to Self-Determination infrastructure and the
Right to Information economy
Narrow unjust health
inequalities

YL6: 08.31 RENAL, GENITOURINARY, AND OBSTETRIC PATHOLOGIES: Patient Rights 8 of 8