core issue: a formal set of patient rights applicable in all health care settings has never been instituted at the federal or state level. Federal legislative attempts in the 1990s to pass a comprehensive patient bill of rights that would apply to health care services did not succeed, with the exception of consumers’ right to sue their insurance payer for denial of benefits.

Health care provider and accreditation organizations have, however, been leaders in promulgating statements of patient rights. For example, the American Hospital Association recently recrafted its 1992 Patient’s Bill of Rights to include principles of the patient care partnership, a model that represents a shift to patient-centered care. Those principles state what patients can expect during a hospital stay in terms of the hospital environment, participation in their care, protection of privacy, discharge preparation, and help with billing. JCAHO evaluates compliance with standards for ethics, rights, and responsibilities in hospital and ambulatory care settings. The purpose of these standards is to ensure that care, treatment, and services are provided in a way that respects and fosters patient dignity, autonomy, positive self-regard, civil rights, and involvement (JCAHO, 2005). Consideration is given to patients’ abilities and resources; their cultural, psychosocial, and spiritual values; the relevant demands of their environment; and their wishes regarding the involvement of family members in their care. Other efforts to raise awareness of patient rights include those of the Tavistock Group—a group of experts representing health care stakeholders that developed a set of shared ethical principles to guide decision making in an integrated health care delivery system (Smith et al., 1999). Certain states have instituted a patient bill of rights, but provisions are not comprehensive, nor do they cover all health care settings (see Table 4-1 for examples).

While these efforts are steps in the direction of patient-centered care and patient rights, they do not go far enough. The committee believes that establishment of a basic set of patient rights—presented in Box 4-3—is essential to achieve patient-centered care, consumer activation and partnership, and improvements in safety and quality. Many but not all of these rights are established broadly in the U.S. Constitution (Amendments I and XIV1) and have been articulated by the courts through common law. Nonetheless, they remain difficult to enforce for patients and providers alike, especially for sick individuals (Annas, 2004). One important point listed in Box 4-3 that is not specifically provided for in the law is the right to be told

1

Freedom of religion under the First Amendment allows citizens to make decisions according to their religious beliefs, including medical decisions regarding treatment. Due process under the Fourteenth Amendment as applied to health care ensures that citizens retain their right to life, liberty, and equal protection; meaning self determination and civil rights (patient rights).



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