LEGAL RIGHTS AND

RESPONSIBILITIES OF CLIENTS

Patient’s Charter under the

Ghana Health Service
 The Patient’s Rights

1. The patient has the right to quality basic

health care irrespective of his/her
geographical location
2. The patient is entitled to full information
on his/her condition and management and
the possible risks involved except in
emergency situations when the patient is
unable to make a decision and need for
treatment is urgent.
3. The patient is entitled to know of
alternative treatment(s) and other health
care providers within the Service if these
may contribute to improved outcomes.
4. The patient has the right to know the
identity of all his/her caregivers and other
persons who may handle him/her
including students, trainees and ancillary
workers.
5. The patient has the right to consent or
decline to participate in a proposed
research study involving him or her after a
full explanation has been given.
The patient may withdraw at any stage of
the research project.
6. A patient who declines to participate in or
withdraw from a research project is
entitled to the most effective care
available
7. The patient has the right to privacy
during consultation, examination and
treatment.

In cases where it is necessary to use the

patient or his/her case notes for teaching
and conferences, the consent of the
patient must be sought.
8. The patient is entitled to confidentiality of
information obtained about him or her and
such information shall not be disclosed to
a third party without his/her consent or
the person entitled to act on his/her
behalf except where such information is
required by law or is in the public interest
9. The patient is entitled to all relevant
information regarding policies and
regulation of the health facilities that
he/she attends.
10. Procedures for complaints, disputes
and conflict resolution shall be explained
to patients or their accredited
representatives

11. Hospital charges, mode of payments

and all forms of anticipated expenditure
shall be explained to the patient prior to
treatment.
12. Exemption facilities, if any, shall be
made known to the patient

13. The patient is entitled to personal safety

and reasonable security of property within
the confines of the Institution.
14. The patient has the right to second
medical opinion if he/she so desires.
 THE PATIENT’S RESPONSIBILITES

The patient should understand that he/she is

responsible for his/her own health and
should therefore co‐operate fully with
healthcare providers.
The patient is responsible for:

1. Providing full and accurate medical history for

his/her diagnosis, treatment, counseling and
rehabilitation purposes.
2. Requesting additional explanation on
his/her health or treatment, which may
not have been well understood.

3. Complying with prescribed treatment,

reporting adverse effects and adhering to
follow up request.
4. Informing his/her healthcare providers of
any anticipated problems in following
prescribed treatment or advice.

5. Obtaining all necessary information,

which have a bearing on his/her
management and treatment including all
financial implications.
6. Acquiring knowledge on preventive,
promotive and simple curative practices
and where necessary seeking early
professional help.

7. Maintaining safe and hygienic

environment in order to promote good
health.
8. Respecting the right of other
patients/clients and Health Service
personnel.

9. Protecting the property of the Health

facility.
NB: These rights and responsibilities shall be
exercised by accredited and recognized
representatives on behalf of minors and
patients who are unable for whatever
reasons to make informed decisions by
them.

In all healthcare activities the patient’s dignity

and interest must be paramount
Consent to treatment
 Definition

• Consent to treatment is the principle that a

person must give permission before they receive
any type of medical treatment, test or
examination.

• This must be done on the basis of an

explanation by a clinician.
• Consent from a patient is needed regardless
of the procedure, whether it's a physical
examination, organ donation or something else.

• The principle of consent is an important part of

medical ethics and the international human
rights law.
 Valid Consent
• For consent to be valid, it must be voluntary
and informed, and the person consenting must
have the capacity to make the decision.

• These terms are explained below:

• voluntary – the decision to either consent or not

to consent to treatment must be made by the
persons themselves, and must not be influenced
by pressure from medical staff, friends or family
• informed – the person must be given all of the
information in terms of what the treatment
involves, including the benefits and risks,
whether there are reasonable alternative
treatments, and what will happen if treatment
doesn't go ahead

• capacity – the person must be capable of

giving consent, which means they understand
the information given to them and they can use
it to make an informed decision
 How consent is given

• Consent can be given:

• verbally – for example, by saying they're happy

to have an X-ray

• in writing – for example, by signing a consent

form for surgery
 Informed Consent

• Informed consent means that:

• A doctor or nurse must make every effort to be
sure the patient understands the purpose,
benefits, risks, and other options of the test or
treatment.

• Then the doctor or nurse must get the patient’s

consent before starting.

• In some cases, even a simple blood test or an

injection (“shot”) requires written consent from the
patient.
• As long as adult patients are mentally able to
make their own decisions, medical care cannot
begin unless they give informed consent.

• If the patient is a minor (under age), has a

serious mental disability, or cannot give consent,
then the parent, legal guardian, or a person
authorized by the court must give consent
before treatment can start.
• Informed consent is a process that
includes all of these steps:
• You are told (or get information in some way)
about the possible risks and benefits of the
treatment.

• You are told about the risks and benefits of

other options, including not getting treatment.

• You have the chance to ask questions and get

them answered to your satisfaction.
• You have had time (if needed) to discuss the
plan with family or advisors.

• You are able to use the information to make a

decision that you think is in your own best
interest.

• You share your decision with your doctor or

treatment team.
• If you have gone through these steps and decide
to get the treatment or procedure, you are usually
asked to sign a paper called a consent form.

• The completed and signed consent form is a legal

document that lets your doctor go ahead with the
treatment plan.

• The consent form names the procedure or

treatment to be done.
 Informed Consent Form

• Informed consent is the process and actions that

take place as you learn about and think about a
treatment before you agree to it.

• Your signature on the form is taken to be

evidence that this took place.

• If you decide that you don’t want the procedure

or treatment, you should not sign the consent
form.
 Informed Refusal Form

• In this case, you may be asked to sign

an informed refusal form or a form that states
you are choosing not to follow medical advice.

• Your signature on this form implies that you

know the risks of refusing, so be sure that you
understand these risks and know your other
options before you sign.
Confidentiality
• Something told in confidence (a secret)

• It is also an underlying part of professional

practice that protects human rights
• People have the right to control access to their
own personal health information, which means
healthcare professionals cannot discuss matters
relating to patients outside the clinical setting,
nor discuss a case in public where they could be
overheard, nor leave records unattended where
they may be read by others.
• Martine Tune, professional adviser (nursing),
who is lead officer on patient confidentiality and
the nurses and midwives’ code of conduct, says:
‘A patient wants to walk into a healthcare setting
and know that any information they give to the
person they are dealing with when receiving a
service about their health is for the purposes of
that service being delivered and not for any
other purpose.
• ‘so they can have trust and confidence in the
people who are giving them the service.

• A patient should be certain that, whatever their 

issues are, they won’t be shared with anybody
else unnecessarily.
•
• That’s a basic right of every patient.’
Patient’s Property
 Care of Patients Property

• Improperly safeguarding patient property may be

perceived as careless and lead to the assumption that
staff are equally as careless in their medical care.

• Security departments should make sure their hospitals

have clear policies and procedures that spell out how
to handle valuables during a patient's stay.
• In this discussion we would consider five ways to
safeguard patients property
1. Encourage patients to leave valuables
at home
• When a patient first makes arrangements for his
or her hospital stay, the admitting office and
other involved parties should make it clear that
he or she should leave all valuables at home.

• If he or she still brings items to the hospital,

arrangements should be made for a relative or
friend to take them home.
• "These statements should be right in the
hospital's admission paperwork so the
patient understands the hospital's policy
up front,".

• Staff should also reiterate the policy

verbally to make sure the patient didn't
overlook the language in the paperwork.
 2. Require patients to sign a liability
waiver
• If patients arrive at the hospital with valuables
and are unable, for whatever reason, to send
them home, require them to sign a waiver of
liability as part of the admissions process, to
relieve the hospital from responsibility for any
lost or stolen property.
 3. Offer patients a place to lock away
valuables
• If possible, make a safe or lockbox available for
holding patients' belongings. "[The safe] could
be located in the admitting office or the security
office".

• "Storage and lockup capabilities differ from

institution to institution," but whatever they may
be, make sure the patient understands up front
what your policy is and where [his or her] items
will be kept."
• For example, some hospitals require its
patients to put small valuables (e.g., watches,
money, glasses, etc.) in an envelope, sign a
waiver, and keep the envelope on their
person for the duration of their stay.

• Large or electronic items, such as laptop

computers and personal digital assistants, are
locked in a safe located in the security office.
4. Use an inventory and receipt system
• When patients request the safekeeping of their
belongings, have them place the items into a
tear-resistant envelope and record the inventory
on a form that clearly displays the patient's
name and date and time that inventory was
taken.

• Also have space for the signatures of two

witnesses, preferably hospital staff.
• "Describe the belongings in objective terms,
being careful not to write down simply what a
patient may tell you about an item,".

• For example, a watch may be gold-colored, but

not necessarily made of actual gold. "And don't
simply put down 'watch.' If it's a Seiko, write
down 'Seiko.' "
• If you put money in an envelope, note the bill and
coin denominations. These measures ensure
accurate inventory control.

• Consider using a numbering system to avoid

confusion among patients with similar names.
• Ideally, the inventory forms should be made in
triplicate. That way, the security, admitting, or
business office can keep a copy for its records, the
patient can take one as a receipt, and the third
copy can be placed in the item envelope as backup.
• "Items should be inventoried regularly,".
"Compare the items listed on the form to
what's actually in the envelope.“
• Individuals who take the inventories should
initial and date the form.
• When a patient is discharged, he or she turns
in the receipt in exchange for the envelope.
• If a patient is unable to pick up his or her
items, a designated family member or friend
may do so instead.
• "When patients originally fill out the inventory
form, have [them] write down the names of one
or two individuals who have their permission to
pick up items for them,".

• Hospitals should require all designees to show at

least one form of positive identification (e.g., a
valid voter ID)-in addition to the receipt-when
retrieving belongings for a patient.
• Always make sure the patient or designee
opens and empties the envelope before leaving
the security office (or wherever items are held).
•
• Have him or her double-check all of the items in
the presence of a staff member and sign out.

• If money is in the envelope, have the person

count it out for the staff member.
 5. don’t forget the emergency department (ED)
and outpatients

• Policies and procedures should make provisions for

safeguarding the property of hospital outpatients and ED
visitors.

• "Patients brought to the ED are often alone and are

rarely admitted to the hospital, so we give them special
envelopes to put their belongings in,".

• These envelopes stay in a secured location at the ED

main desk. They also include a form that serves as an
inventory record for the ED staff and a receipt for the
patient.
• In the future, many hospitals will follow the
hospitality industry's example and provide
lockers or safes in patient rooms.

• New hospitals are being designed this way, but

for now, most of us need to stick to clear
policies and procedures."
Signing of legal documents

Witnessing a will
 Wills

Wills are legal declarations by a person

stating how his properties should be disposed
of after death.

A person making a will must be in good

health i.e. mentally, physically and socially.

He must not be influenced by anybody or the

will be invalid.
• It can be changed at any time
• In case you die and you owe, your property
can be sold to defray the debt
• It must be in writing and must bear your
signature
• Must have the signature of the one who
witnesses the stator
• The signature of the stator must be at the
bottom
• A nurse may be asked to be a witness to a will in
court

• Make sure you are not a beneficiary of the will you are
witnessing

• If the nurse witness the will, he must record the state

of the patient’s condition at the time of the will in the
patient’s chart

• The nurse has the right to refuse to witness if in his

opinion there was undue influence
 How to prepare a will
• 1. title
• 2. Revocation
• 3. Executors
• 4. Disposition
• 5. Residual laws
• 6. Signature
Clinical Trials
 Definition
• A clinical trial is defined as an experiment on
humans being carried out in order to evaluate
one or more potential beneficial therapies

• A clinical trial is a prospective biomedical or

behavioral research study of human subjects
that is designed to answer specific questions
about biomedical or behavioral interventions
(vaccines, drugs, treatments, devices, or new
ways of using known drugs, treatments, or
devices).
 Types of Clinical Trials
• There are three types of clinical trials:
• Phase I trials
• Phase II trials
• Phase III trials
 Phase I Trial
• Typically, a Phase I clinical trial refers to a new
treatment that is to be tried on humans for the first
time.

• It is a study intended to estimate the so-called

maximum tolerable dose (MTD) of a new regimen.

• In such studies, toxicity and pharmacologic information

is obtained from dose escalation experiments, whereby
volunteers are subjected to increasing doses of the
regimen according to a predetermined schedule
• Typically, a Phase I study has 20-40 patients.

• Typically, patients entered in Phase I trials

constitute a very advanced disease population.
Thus, they are those who are refractory to
therapies believed to be beneficial.

• As a result, the evaluation of side effects on this

advanced disease population may not necessarily
be the same for patients who ultimately will
receive the therapy for an evaluation of benefit.
 Phase II
• Phase II cancer trials are initiated after the
completion of Phase I trials.

• A Phase II clinical trial is a small scale study

investigating the efficacy and safety of a regimen.

• Efficacy can be measured in terms of response to

therapy (response could be clinical response or a
change in a marker) and/or progression-free
survival.
• Safety is assessed in terms of toxicity.
• A typical Phase II study has 30-50 patients

• Phase II trials can enter newly diagnosed

patients (who have received none or limited
therapy).

• Phase II trials can investigate a single dose

and schedule while others can test
combinations of drugs.
• After a regimen is shown to be reasonably
effective, it is natural to compare it with
the current standard treatment. This leads
to a Phase III clinical trial.
 Phase III
• A Phase III clinical trial is a randomized large scale
comparative study involving two or more treatment
arms.

• Phase III trials could have between 250-5000, some

10,000 patients

• The Phase III trial is the most rigorous and extensive

type of scientific clinical investigation of a new
treatment.

•
This is perhaps the most important of the
three types of clinical trials since it involves
a substantial number of patients and has
the potential for changing physician practice
and having a major impact on patients’
lives.