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Chapter I

INTRODUCTION

Rights are fundamental to living. Awareness on these rights makes

it happen.

Human rights according to the Universal Declaration of Human

Rights formalized in 1948 are the inherent dignity and the equal

unalienable rights of all members of the human family. It is a universal

phenomenon the years have imbibed on humanity. Through rights, man

is able to decide what’s best for his life without worrying that his privacy

will be subjected to endless queries.

It is therefore on the basis of understanding the concept of the

fundamental dignity and equality of all human people that the notion of

patients’ rights was first established.

In the Philippines, the 1987 constitution substantiate for

provisions of the patient’s rights which states that the State values the

dignity of every human person and guarantees full respect of human

rights. The patient’s rights; however, became more distinct in Article II

section 15 of the same constitution. It says that the State shall protect

and promote the right to health of the people and instill consciousness

among them. It embraces the rights of patients, in which every individual

enjoys certain rights which cannot be modified or taken away by the

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lawmaking body. These rights are recognized and guaranteed because it

is inherent dignity of every person (Hector De Leon, 2002).

The patient’s rights are supported by the Article XIII, section 11

which states that the State shall adopt an integrated and comprehensive

approach to health development which shall endeavor to make essential

goods, health and other social services available to all the people at

affordable cost. It is in the basis of protecting and promoting the right to

health of every Filipino by ensuring quality and adequate health care

available and accessible to everybody, especially to the poor and the

disadvantaged. For the realization of patients’ rights, the State must

exert efforts to unify the national health care delivery system and to

make medical services available throughout the country.

Situation Analysis

Patient’s rights vary in different countries and in different

jurisdictions. Application of the concept of the “right” varies according to

social and cultural norms. It has, nevertheless, a practical function,

namely to describe, in a concise and straightforward manner, an existing

legal position, which would otherwise have to be described using a great

variety of circumstances, something in its complexity becomes difficult to

grasp.
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Patient’s rights seen in every patient-physician relationships are

also similar to citizen-state relationships that patients are informed to

what particular rights they are entitled to.

In some countries like the United States, the paternalistic trend,

set by Hippocrates, is prevalent wherein the best interest of the patient,

as judged by the clinical expert and are valued above the provision of

comprehensive medical information and decision-making power of the

patient. Health care providers usually decide what’s best for the patient

without being constrained by financial difficulties.

Paternalism holds that an authority figure such as “the physician

knows best” and that each individual is obligated to comply with the

authority. This thinking has been quite abused by many physicians and

is often given the post of directorship or leadership in health teams.

However, paternalism is good if it takes a parenteral model of benevolent

intervention, one that likens the state to a protective parent caring for

one incompetent minor. In some instances, paternalism is good if acts

are done for those with limited or no autonomy. Paternalism, according

to Beauchamp and Childress (1994), always involves some form of

interference with the refusal to conform to another person’s preferences

regarding his own good.

In the Philippine context, what is prevalent is the informative trend

wherein patients are seen mainly as a consumer, who is in the best

person to judge what is best for them. The patient is in the best position
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to choose between the options which are provided by the physicians. In

here, the physicians are chiefly viewed as merely a provider of

information.

Patients are then given the autonomy. With autonomy, patients

now have the choice and freedom to seek other opinions to validate what

health care management the physician has advised them. Autonomy has

given the patient the freedom to grow, to be responsible and to be

mature.

Conceptual Framework

Hector de Leon (2005) defines bill of rights as the declaration and

documentation of person’s right and privileges on which the constitution

is designed to protect against violations by the government or by an

individual. It is a charter of liberties for the individual and a limitation

upon the power of the State.

Patient’s rights on the other hand refer to the charter which

regulates the relationship between clients and health care professionals.

Patient’s rights promote the interest and well-being of the patients and

the health care providers. It does not only protect the individual, but it

also protects the health care providers from committing negligence or

malpractice. These are achieved through better communication.

(Dworkin, 1972)
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The movement for patient’s rights in health care arose in the late

1960s. At this time, the movement is aiming towards improving the

quality of health care and making the health care system more

responsive to patient’s needs. Today, patients are also seeking more self-

determination and control for themselves. Informed consent,

confidentiality and the right of the patient to refuse treatment are all

aspects of his self-determination. The need for patient’s rights is largely

the result of two circumstances: the vulnerability of the patient because

of illness and the complexity of the relationships in the health care

setting. (Code of Medical Ethics, 1997)

When people are ill, they are frequently unable to assert their

rights as they would likely do if they are healthy. Asserting rights

requires energy and for one to be able to assert his rights in a certain

situation, he must be aware of it.

Today, the goals of health include the return of autonomy and

independence to the patient, and the acceptance of good health as a

responsibility of the patient, the health care providers and the society.

These goals cannot be met unless patients are ready to accept their

responsibility for their health and unless patients and care providers

have mutual respect for each other. (Kuan, 2006)

In 1973, the American Hospital Association (AHA) published “A

Patient’s Bill of Rights” to promote the rights of hospitalized clients.

These were revised in 1992. Included in this bill are the rights of patient
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to considerate and respectful care; to information about diagnosis,

treatment and prognosis; to informed consent; to refuse treatment; to

privacy; to confidentiality; to services and to transfer; to know the

relationship with other health care and educational institutions; not to

be the subjects of research or experimentation; to expect reasonable

continuity of care; to examine and receive an explanation of the hospital

bill; and to know what hospital rules and regulations apply to his

conduct as patient. (Kozier, 2004)

Health literacy skills are increasingly important for both health and

health care. Unfortunately, many patients with the most extensive and

complicated health care problems are at greatest risk for

misunderstanding their diagnoses, medications and instructions on how

to be responsible for their medical problems. Much health promotion and

patient education information has traditionally used printed materials

written at reading levels. Such material is not accessible to the millions

of Filipinos with inadequate literacy.

In the Philippine context, awareness of patients on their rights has

gone very far. In instances like negligence and malpractice of health care

professionals. Patients just have to stand for their rights for them to get

justice. Malpractice is rampant and documented reports exist as proofs.

One account deals about the negligence done by a resident doctor while

resuscitating a patient who is experiencing a cardiac arrest. The report

says that the resident doctor missed the order of the attending physician
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that worsened the health status of the patient. Efforts have been done by

the immediate family to file a formal complaint against the resident

doctor and the hospital regarding the negligence incurred. Everyone

whom they sought consultation discouraged them from pursuing the

case considering that there is no law on medical malpractice in the

Philippines. (David, 2003)

The most critical stage in the health care setting is the need for

greater vigilance on the part of patients, hospital administrators and

even the rest of the medical community when it comes to these rights.

People place a great deal of faith to medical professionals and health

facilities where they sought health care. Together, they also place their

trust and confidence in their diagnoses and courses of treatment.

However, it is very important to remember that these medical

professionals are not beyond questioning because mistakes that are

made sometimes cause patients to suffer from dangerous side effects,

significant injury and even death. (David, 2003)

Another significant account which deals with awareness transpired

when former President Joseph Ejercito Estrada has filed his motion for

him to undergo a knee-replacement operation in the United States

through Noel Malaya, his court-appointed lawyer. With regards to this

issue, the vice president for medical affairs of the Asian Hospital, Rodrigo

B. Floro, stated and admitted that their hospital had the full capability to

perform the knee surgery that Estrada needs. But Floro said he
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respected Estrada's decision to undergo the operation by a doctor of his

choice and he will absolutely honor the patient's Bill of Rights because

the patient is the king. (David, 2003)

The prevalence of medication errors committed by doctors, nurses

and other health care professionals paved way for many lawsuits. A

report issued by the National Academy of Science’s Institute of Medicine

said that medical errors comprise one of the nation’s leading causes of

death and injury. This was brought about by prescribing the wrong type

of drug, ordering an improper dose, giving a patient a drug that he or she

is allergic to, or any other medications that are incompatible that can

lead to deadly consequences. This alarmed the people and prompted

them to be more aware of their rights because they don’t want to be a

victim of doctor’s ignorance, negligence and malpractice. (David, 2003)

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Conceptual Paradigm

The model below guided the researchers in the pursuance of this

study.

Independent Variable Dependent Variable

1. Patient’s Profile

• Age
Awareness
• Sex

• Highest Educational
of Patients

Attainment on their
• Occupation
Rights
2. Level of awareness of

patients on their Rights

Figure I. The Research Paradigm

Paradigm showing the Level of Awareness of Patients on their Rights.
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Statement of the Problem

This study aims to determine the level of awareness of patients in

Ilocos Training and Regional Medical Center (ITRMC) with regards to

their rights. It also seeks to answer the following specific problems.

1. What is the profile of the patients in Ilocos Training and Regional

Medical Center (ITRMC) in terms of:

a. age

b. sex

c. highest educational attainment

d. occupation

2. What is the level of awareness of patients in Ilocos Training and

Regional Medical Center (ITRMC) regarding the patient’s rights?

3. Is there a significant relationship between the profile and the level of

awareness of patients in Ilocos training and Regional Medical Center

(ITRMC) on their rights?

Hypothesis

1. There is no significant relationship between the profile and the

level of awareness of patients in Ilocos training and Regional Medical

Center and Bethany Hospital regarding their rights.

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Scope and Delimitation

This study was geared in determining the awareness of the rights

of the patients. Specifically, the researchers look into the level of

awareness of patients in Ilocos Training and Regional Medical Center

(ITRMC) on their rights. It also aims to find out the relationship between

the patient’s profile and the level of awareness of patients on their rights

However, it was delimited to patients in Ilocos Training and

Regional Medical Center (ITRMC). Along with this study are various

factors that may influence the level of awareness of patients on their

rights, but the researchers limit their study to patient’s (a) age –

respondents must be 19 years old and above and below 19 years old are

not included in the study because rights of patients can be exercised on

the patient’s behalf by either a designated surrogate or proxy decision

maker especially if the patient lacks decision-making capacity, is legally

incompetent or is a minor, (b) sex – it is either male or female, (c) highest

educational attainment – patient’s highest educational attainment is

categorized as elementary, secondary or high school, and tertiary or

college graduate, and (d) occupation – patient’s occupation is also

subdivided as professional, technical and others.

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Definition of Terms

The following terms are operationally defined to facilitate easier

understanding of the study.

Age. It refers to the number of years the respondent has lived from

birth to the time this study is conducted.

Awareness. Having the knowledge of something such as one’s rights

as human being and as a patient because one has observed or learned it

or somebody has told to him about it.

Health. The general condition of the body or mind, especially in

terms of the presence or absence of illness, injuries or impairments.

Health Care and Treatment. Measures taken by a health care

provider or that are taken in a health care institution in order to

determine a patient's state of health or to restore or to maintain it.

Health Care Institutions. A site devoted primarily to the

maintenance and operation of facilities for the prevention, diagnosis,

treatment, and care of individuals suffering from illness, disease, injury,

or deformity that needs medical and nursing care.

Health Care Professionals. Any physician, dentist, nurse,

pharmacist or paramedical and other supporting health personnel

trained in health care and/or duly registered and licensed to practice in

the Philippines.
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Highest Educational Attainment. It is the highest level of

education obtained by the respondent. It is either elementary, high

school or college.

Individual Dignity. It refers to a proper sense of pride and self-

respect of an individual.

Information. It refers to a definite knowledge acquired or supplied

about something or somebody.

Informed Consent. The voluntary agreement of a person to undergo

or to be subjected in a procedure or other bodily intervention based on

his understanding of the relevant consequences of receiving a particular

treatment, as clearly, truthfully and reasonably explained by the health

care provider in a manner and language understandable to the patient.

Such permission is always in written form.

Occupation. It refers to a job by which somebody earns a living

Patient. A person who avails himself or herself of health and medical

care services or is otherwise the subject of such services.

Patient’s Rights. It refers to the privileges or fundamental powers

entitled to a patient admitted in a health care facility.

Sex. It refers to being male or female.

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Significance of the Study

This study hopes to establish an understanding on the Level of

Awareness on the rights of patient’s confined in Ilocos Training and

Regional Medical Center. Furthermore, the study could be of importance

to the following.

Future Researchers. The ideas presented may be used as baseline

data in conducting new researches or in testing the validity of other

related findings.

Student Nurses. The situation presented herewith may enable them

to act accordingly on different patient-centered situations in the clinical

setting in a manner that even though conforms to the institution’s policy

still proves to be convenient for the patient.

Clinical Instructors. The result may enable them to make sure that

quality health care is delivered to every rightful patient regardless of

physical and socio-economic status.

Nursing Institutions. The information presented may enable them

to make re-orientation about patient’s bill of rights and obligations before

duties and the proper protocol for its realization for their students to act

accordingly and humanely in different situations.

Various Health Institutions. The ideas presented may enable them

to devise ways to make the patients’ rights known to them by means of

posting a copy of these rights in the institution’s bulletin for them to be

able to air their grievances or to ask for additional help if the need arises.
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The Government. The situation presented may enable the law-

making bodies to enact laws that will protect the dignity and integrity of

every human life.