Chapter 4: Patient Rights
Learning objectives for this chapter
By the end of this chapter you should be able to:
- Identify the key rights of patients in clinical practice.
- Appreciate how the Human Rights Act influences the way nurses can intervene in patient care.
- Understand how to take patient rights into account when delivering care.
What are patient rights?
Rights are clear concepts that are universally applied to all people, or to a specific group of people. These are enshrined in law, ethical practice and professional guidelines, depending on the type of right. Rights essentially guarantee that a patent should be treated in a certain way, or should have access to services, without prejudice or refusal.
Rights are legally enforced, and provide clear standards for how an individual can be treated. Rights may vary across nations, depending on national laws and statutes, and may be influenced by national religious values or cultural beliefs. On an international level, the Human Rights Act provides a framework for universal human rights.
The Human Rights Act
The UK is signatory to the Human Rights Act, and therefore healthcare practice should comply with the articles contained within the act. Article 2 gives every patient the right to life and values the protection of that life under law. Article 3 of the Human Rights Act prohibits the use of torture and inhuman or degrading treatment. This may apply to health in a number of ways, particularly when patients receive a course of treatment that may be perceived as degrading or inhuman. An example of this may be where patients are in a vegetative state and treatment is being withdrawn; provided this withdrawal is consistent with the best interests of the patient and the removal of treatment does not cause harm, this would not violate article 3, as inhuman or degrading treatment would not be present.
Article 8 of the Human Rights Act guarantees respect for private and family life. This can be translated as the patient's right to confidentiality and autonomy, particularly with respect to their personal life and their treatment choices. All patients should be able to make decisions for themselves and have personal and private lives that are free from interference from healthcare professionals, or the excessive use of coercion.
Article 14 provides a basis for non-discriminatory practice, promoting equality in care. The final relevant article of the Human Rights Act in the health setting is article 17, which prohibits the abuse of patient rights under any circumstances.
Overall, the Human Rights Act provides a wide range of rights for all patients, many of which are applicable to the healthcare setting. Nurses must appreciate this when addressing patient care, as violation of any of these articles can have a profoundly negative impact on the patient and nursing profession.
Every patient has the right to be treated fairly and in a manner that does not discriminate against or stigmatise. This is guaranteed to all patients under the Equality Act. Every patient should have access to health and social care, regardless of their background, race, religion, beliefs or condition. Nurses should adhere to this principle, and promote non-discriminatory practice in every aspect of their working life.
Patients who experience stigma are more likely to have psychological and mental health issues compared to those who have not experienced stigma. When patients feel discriminated against or stigmatised, they are less likely to seek services or share information with health professionals, which can increase their risk of adverse outcomes. Similarly, nurses who observe stigmatising behaviour are often distressed, and may feel that patients are being victimised unnecessarily. This can make it harder to bond with patients, reducing the potential to enhance patient care outcomes.
Discriminatory practice is particularly problematic in specific patient groups. These patients are often termed 'vulnerable', as they may be at a greater risk of adverse outcomes or stigmatisation. Vulnerable patients include patients with mental health problems, learning disabilities, or demographic features that are prone to discriminatory practice, including age, sex, sexuality, and religious beliefs. These patients are not always vulnerable, but may have an increased likelihood of discrimination in healthcare settings and society as a whole, suggesting that nurses should take extra care to protect the rights of these patients.
Patients have the right to autonomy in all aspects of clinical practice. Autonomy is defined by patients being able to make their own decisions and guide the outcomes of their treatment. Patients who are autonomous are able to act according to their own level of knowledge and judgment. As a nurse, you should provide care to patients that allows for patient autonomy while maintaining the ethical, professional and organisational standards that nursing care demands.
Another aspect of autonomy in practice is nurse autonomy - a professional concept that recognises that nurses can act and make decisions based on their professional knowledge base and experience. Nurses should be able to act autonomously in practice to deliver individualised patient care and respond to the needs of patients as they arise. Nurses need to have a holistic understanding of patient care, be confident in their knowledge and skills and appreciate the needs of patients in order to delivery effective autonomous practice. By practising autonomously, you can make clear decisions and act in accordance with the wishes of the patient, without the need for constant supervision.
Privacy and confidentiality
Patients have the right to respect for their privacy in the public and professional domains. This affects the way nurses can share patient information and how information should be managed in practice. Furthermore, the privacy needs of patents may vary; therefore a person-centred approach should be maintained.
When discussing patients with colleagues, it is often necessary to provide intimate medical details relevant to the discussion and refer to the patient directly. This is acceptable, as otherwise discussing patients would be impossible. These sorts of discussions are based on the implicit understanding that the two colleagues involved are directly involved in the care of the patient. If other colleagues are not involved in patient care directly, then sharing unnecessary details would violate the rights of the patient.
When exchanging information, privacy should be maintained. You should be aware of your surroundings and should not engage in conversations in public settings. Even on the telephone, or in emails, information exchange should be kept as confidential as possible, as needed by the person with whom you are communicating. In addition, when you examine a patient, discuss anything with a patient, or a patient asks you for advice, you try to avoid exposing that conversation or examination to others. Closing a curtain is essential during an examination, and conversations should be kept quiet - especially on a busy ward.
In research, you should consider how confidentiality may affect the way you share information in presentations and publications. For instance, when giving a presentation to colleagues, patient details should be anonymised. The same is true when patients are used in research intended for publication. All irrelevant information should be removed, and patients should either be given anonymous markers or should be grouped together to avoid individual identification. This avoids sharing patient information by accident and maintains professional practice.
Situations where patients' rights may conflict with nursing opinions
The rights of patients to influence and determine their own health outcomes should not be compromised by nurses. However, nurses also have to respect their professional duties to provide care to patients in a range of circumstances, which may include making difficult decisions. This includes situations where the rights of the patient may be directly in opposition to the professional or legal duties of the nurse.
One example is the patient's right to confidentiality. This right protects the patient's personal and health information. However, this right may directly contradict the need for nurses to provide safe care to the patient and the general population. For example, when a patient may pose a danger to the public, it may be ethical to contact authorities to warn of possible danger. However, when in doubt one should always contact a senior representative from a union before breaking confidentiality, or seek advice from a representative organisation. The decision should always be recorded in the notes and, where necessary, senior colleagues should be involved to ensure the ethical and legal justification for the decision.
In contrast, rights of patients may take precedence over the decisions or opinions of healthcare professionals. Any time that a patient has an option of different treatments, the preference of the patient should be taken into account. Their right to autonomy should be respected, as this may yield better outcomes compared to a preferred medical treatment course. Nursing decisions should be made with the patient's opinions and rights in mind, avoiding potential conflict. The person-centred approach should prevent such situations from occurring, thereby reducing the potential for disagreement.
Another situation where patients' rights may conflict with the obligations of the nurse is when patients refuse a course of treatment. This is discussed in the following section.
Right to refuse treatment
Patients have the right to refuse treatment, even when this is against the advice of healthcare professionals. All patients need to give consent before receiving any type of medical intervention. When patients have capacity and refuse a treatment, their decision must be respected. This applies regardless of the consequences, even where refusal may lead to the death of the patient or their unborn child, for example. However, this refusal needs to be based on the principle that patients have made a fully informed decision and are aware of the repercussions.
When a patient refuses a treatment, it can be a challenging ethical and legal process. Patient rights need to be respected, but other concerns should be taken into account. For instance, nurses have a duty to maintain public health, as well as the health of the individual - if a patient has a potentially lethal infectious disease, refusal of treatment may endanger the lives of others. Therefore, decisions involving treatment refusal can be complex and may involve legal battles.
Patient rights, advance care planning and shared decision-making
Different legislative and professional frameworks may be used to support patient rights, or provide patient rights when the patient lacks capacity. When a patient lacks capacity due to a progressive illness, or when they can anticipate that they may lose capacity, certain provisions may be made. The patient may complete advance care planning documents, which would allow their wishes to be carried out in the event of capacity loss, thereby preserving their rights when they are not able to express them or defend them.
Advance care planning is a complex topic; overall, however, you should take into account any documentation the patient may have, including advanced care directives, which may guide your decision-making when patients cannot give their consent or input. There is a legal precedence for following the opinions and wishes of the patient prior to their illness or deterioration. However, as conditions can change, and not all situations can be accounted for in advance, there are arguments against following advance care planning documentation to the letter. Whenever these decisions have to be made, it is important to keep the rights of the patient at the centre of any discussions, which should involve the multidisciplinary team and relevant professional or ethical bodies.
When a patient expresses their wish to go down a certain treatment path, this should be followed as much as possible. This also applies to family members, caregivers, or friends of the patient, although only when a family member has the power of attorney over a patient lacking capacity. Otherwise, the patient's input is the primary focus of any care decisions.
This chapter provides an outline of the importance of human rights for patients. Patients have a number of rights which should be respected and considered during any care decision. Only in exceptional circumstances can rights be challenged or overturned, and often legal challenges may be needed to pursue this route. Therefore, as a nurse you should be able to identify key rights, uphold those rights and recognise when ethical and legal problems may arise when upholding the rights of patients.
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