MedJuris Patient's Rights (2018)

PATIENT’S RIGHTS
ATTY. MALAYA M. CAPULONG, MD, FPAFP

PATIENT’S RIGHTS
Patients should receive
treatment consistent
with the dignity and
respect they are owed as
human beings.
Contoso
Pharmaceuticals
page 2
PATIENT’S RIGHTS
Patients should receive
treatment consistent with the
dignity and respect they are
owed as human beings.
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 Nuremberg Code of 1947 –

"the voluntary consent of the
human subject is absolutely
essential."
PATIENT’S RIGHTS
Nazi Eugenics Program
-Forced sterilization
-Action T4 -systematically killed
between 200,000 to 250,000
people with intellectual or
physical disabilities
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. R i g h t t o g i v e c o n s e n t t o d i a g n o s t i c a n d
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
Contoso
Pharmaceuticals
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. T o p r o t e c t t h e p a t i e n t f r o m
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
üInformed or enlightened consent
Ø Awareness and assent
Ø Full disclosure of facts and willingness of the
patient to submit
üVoluntary
üSubject matter must be legal
FORMS OF CONSENT
üExpressed consent – written or oral

üImplied consent may be deduce
from the conduct of the patient
SCOPE OF THE CONSENT
ü General or Blanket consent

ü Limited or conditional consent
ü 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
vConsent must be given freely
or voluntarily
INFORMED CONSENT
ü Elements of disclosure
ü The prognosis if the patient remains untreated.
ü Alternative treatment goals, and accessible
means of treatment to serve such goals.
ü Success and failure rates of treatment options.
ü Known effects and material risks of treatment
options, and their likelihood to occur.
ü The limits of relevant knowledge.
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.
üPatient ;
üIf patient is minor - parents;
üIn the absence of the parents - grandparents;
üIn the absence of parents and grandparents,
eldest brother or sister, of legal age and not
disqualified by law;
üO t h e r p e r s o n w h o m a y h a v e s u b s t i t u t e
parental authority.
Subject matter is legal
 The subject matter or procedure

applied to the patient and which the
patient consented must not be that
which the law penalizes or against
public policy.
üConsent of minor is not valid if the
procedure will not benefit him
üExpressed refusal of a minor to surgery
shall not prevail over the existing
emergency
üDoctrine of parens patriae , the court
may grant consent for the minor.
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
Contoso
Pharmaceuticals
page 28
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
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
1/1/93 – Angelica Soliman passed away
2/21/94 – Damage suit for negligence
GR No. 165279; June 7, 2011
Causal Relationshi p 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.
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
INFORMED CONSENT
IN RESEARCH
Consent is not an event or
signed form, but an on-going
process or quality.
Contoso
Pharmaceuticals
page 33
INFORMED CONSENT
Clinical Trial - A controlled study
involving human subjects
- designed to evaluate
prospectively the safety and
effectiveness of new drugs or
devices or of behavioral
interventions.
INFORMED CONSENT
P h a s e 1 , 2 , 3 , 4 D r u g Tr i a l s :
Different stages of testing drugs in
human, from first application in
humans (Phase 1) through limited
and broad clinical tests (Phase 3),
to postmarketing studies (Phase 4).
INFORMED CONSENT
§A statement that the study involves
research
§An explanation of the purposes of the
research and the expected duration of
the subject’s participation
§A description of the procedures to be
followed
§Identification of any procedures
which are experimental
Produced with a Trial Version of PDF Annotator - www.PDFAnnotator.com
INFORMED CONSENT
• A description of any reasonably
foreseeable risks or discomforts
to the subject;
• A description of any benefits to
the subject or to others
• A disclosure of appropriate
alternative procedures or courses
of treatment
INFORMED CONSENT
• A statement describing the extent,
if any, to which confidentiality of
records identifying the subject will
be maintained;
• For research involving more than
minimal risk, an explanation as to
whether any compensation and any
medical treatments are available if
injury occurs
INFORMED CONSENT
• Whom to contact for answers to
pertinent questions about the
research and research subjects’
rights, and in the event of a
research-related injury to the
subject
• Statement that participation is
voluntary and the subject may
discontinue participation at any
time
PRIVACY AND
CONFIDENTIALITY
Contoso
Pharmaceuticals
“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
v Right to be left alone

v Freedom from exposure or
intrusion by others
vReasonable expectation of privacy
v Physical, Decisional &
Informational
PRIVACY
v Physical Privacy – freedom from

contact with others or exposure of
one’s body
v Decisional Privacy – ability to make
personal choices without
interference from others
v Informational Privacy – prevention of
disclosure of personal information
PRIVACY
Informational Privacy is closely

related to Confidentiality
CONFIDENTIALITY
Ø Refer to how private information
provided by individuals will be
protected by the healthcare provider .
Ø “Contractual” duty of the healthcare

provider.
CONFIDENTIALITY
v Duty to protect information

from disclosure to others who
have no right to the
information
CONFIDENTIALITY
v Duty to protect
information from
disclosure to others who
have no right to the
information
Moral and Ethical Basis
for Confidentiality
v Hippocratic Oath
v WMA Declaration of Geneva
Ø “I will respect the secrets which are
confided in me, even after the patient
has died.”
v PMA Code of Ethics
Moral and Ethical Basis
for Confidentiality
vPMA 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
v 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 ?
INCOMPETENT
Surrogate
S
üMinors
üParents
üInsane
üLegal
üMentally- Guardians
challenged
Is the right to
confidentiality
absolute?
Physicians have duties which
override a patient’s right to
confidentiality.
üDuty to protect the patient.
üDuty to protect others.
üDuty to obey the law.
Duty to protect the patient.

ØIs the patient incapacitated?
ØIs violating confidentiality in
the best interest of the
patient?
Duty to protect others

ØHas the patients verbalized
harming others?
ØDoes the patient pose a
danger to others?
Duty to obey the law

ØIsthere a law mandating
reporting?
ü Child abuse
ü Firearm associated injuries
ü Induced Abortion
Privacy and confidentiality must be
honored unless there exists a
stronger conflicting duty.
ADVANCE
DIRECTIVES
Contoso
Pharmaceuticals
Unique First to Market
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DIRECTIVES
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Contoso
Pharmaceuticals
ADVANCE DIRECTIVES
Written instruction recognized

under state law relating to the
provision of health care when the
individual is incapacitated.
Contoso
Pharmaceuticals
ADVANCE DIRECTIVES
Living Will - a written, legal document
that describes the kind of medical
treatments or life-sustaining
treatments a person would want if he
were seriously or terminally ill.
• A living will doesn't appoint someone
to make decisions for the patient. Contoso
Pharmaceuticals
ADVANCE DIRECTIVES
A durable power of attorney for health
care (DPAHC)- A patient designates an
agent to make health-care decisions
for them if they become men tally
incapacitated.
- It becomes active any time the patient
is unconscious or unable to make
medical decisions. Contoso
Pharmaceuticals
ADVANCE DIRECTIVES
D PA H C - t h e a g e n t i s n o t
empowered to make decisions on
behalf of the patient unless the
patient is deemed, usually by his or
her physicians, to be incapable of
informed consent or refusal
Contoso
Pharmaceuticals
ADVANCE DIRECTIVES
DPAHC - Physicians are legally bound
to respect an agent's wishes.
- The agent must act consistently with
the terms of the DPAHC, as well as
with the patient's known wishes.
- The agent must act in the patient's
best interests. Contoso
Pharmaceuticals
ADVANCE DIRECTIVES
A do not resuscitate (DNR) order - is a
request not to have cardiopulmonary
resuscitation (CPR) if the patient’s
heart stops or if he stops breathing.
Contoso
Pharmaceuticals

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PATIENT’S RIGHTS

ATTY. MALAYA M. CAPULONG, MD, FPAFP

The Nuremberg Code of 1947 –

Respect for a patient’s right

• The right to make decisions regarding the

1. The physician-patient relationship is

1.In cases of emergency, there is an “implied

üExpressed consent – written or oral

ü General or Blanket consent

§ Provide enough information for choice, but not

Valid Informed Consent –

 The subject matter or procedure

Inform patient that not every

Physicians should abandon any

Physicians are not guarantors of the

8/18/93 – Admitted at SLMC for chemotherapy

Causal Relationshi p between a

1) The physician had a duty to disclose

v Right to be left alone

v Physical Privacy – freedom from

Informational Privacy is closely

Ø “Contractual” duty of the healthcare

v Duty to protect information

Duty to protect the patient.

Duty to protect others

Duty to obey the law

Written instruction recognized

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