Patient Rights

Patient Rights
Chapter 10
Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

What Is a Right?
• A right
• is a claim or privilege to which one is either legally or morally
entitled ie. if someone has a right to access care, the Government is
obligated to provide that care
• Legal rights
• are enforced through the courts
• Moral rights
• are acknowledged as societal norms – laws regulate the behavior of
citizens
• may be enforced should the breach bring harm to the patient
2

Patient or Client Responsibilities
• Patients have the responsibility to

• treat others with respect
• disclose
• information important for safe care
• concerns when they disagree with a plan of care
• notify health care providers if unable to keep appointments
• arrive on time, having followed instructions prior to procedures
• respect the needs of other persons
3

Obligations
• An obligation is anything a person must do or refrain from

doing in order to permit the full exercise of the rights of
another
• Ie. Your obligation is to provide safe nursing care and the
employers obligation is to pay you a fair salary
Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 4

Informed Consent
• To exercise the right to informed consent, patients must be fully
informed about
• their health condition
• their prognosis
• treatment options, along with consequences and risks
• Incorrect or incomplete information deprives patients of their right to
informed consent
• Provision of treatment without informed consent can lead to liability
for negligence
• Informed consent is a legal and moral right based on ethical
principle of autonomy. 5

Right to Health Information and
Teaching
• Nurses are required to provide discharged patients (or
substitute decision makers) with knowledge and skills
• to allow them to care for themselves given the
knowledge and skill
• to gain access to the health care system

Communicating a Diagnosis
• Communicating a diagnosis is a controlled act in Ontario

• A nurse would only be permitted to do so as the holder of an
extended certificate (NP)
• When a diagnosis has not been communicated, the nurse
should advocate for the patient’s right to be informed

Right to Confidentiality
• May create conflict with the obligation to provide care and

prevent harm
• Health care providers have a duty to disclose knowledge of
• communicable or sexually transmitted diseases
• suspected child abuse
• intent to harm or kill another person or self

Workers’ Compensation Matters
• Information regarding employers and workers is strictly

confidential
• In some provinces (ON and BC), workers have full access to
their files
• Employers only have access to restricted information related
to workers’ injuries and treatments (handled by Occupational
Health department of the organization)
• Workers’ Compensation Boards have the right to any health
information relevant to an injury or claim

Court Testimony
• Provincial nursing statutes permit disclosure in the case of

legal proceedings such as
• medical malpractice actions
• coroner’s inquests
• The nurse should, however, only disclose details relevant to
the case
10

The Treatment Setting
• Nurses should take care

• to prevent being overheard by others when discussing
care with a colleague
• to ensure privacy when discussing problems with a client
• not to disclose confidential information to colleagues,
friends, or relatives who have no valid right to such
details
• provide privacy while giving care – respect of the patient
11

Personal Health Information
(PHI)
• All provinces and territories have enacted legislation which
protects PHI by:
• establishing rules for the collection, use, and disclosure
of health records
• providing individuals with a right of access
• providing for independent review of complaints
12

Ontario’s Personal Health
Information Protection Act (2004)
• Protected health information includes
• physical or mental heath information (including patient and
family histories)
• identifying a provider (MD) for health care to the individual
• insurance, eligibility, or payment information
• identifying an individual as a donor of any body part
(recipient is not aware of who the donor is)
• identifying an individual’s substitute decision maker
13

Computer Records
• Access to computerized health care information is password

protected
• It is important never to share passwords or document under
another person’s password
• Improper access to patient files may result in disciplinary
action
14

Right to Privacy
• Nurses are obliged to ensure:

• patient privacy during bathing, examinations, or
procedures
• that unauthorized persons do not view the patient or the
patient records
• that pictures are not taken without permission, even if
done for educational purposes
15

Right to Respect
• Health professionals have an obligation to treat all clients

with respect and dignity
• Nurses who disregard clients’ privacy or fail to involve

clients in decisions relevant to them are in violation of their
ethical responsibilities
16

Right to Be Kept Safe
• Errors occur frequently in health care settings
• Many reasons account for human error, including
• communication breakdowns
• fatigue
• workload
• complexity of processes
• reliance on memory over checklists
• There is a growing movement to change the systems that result in
error, rather than focusing on personal blame
17

A Culture of Patient Safety
• Leadership is an essential part of ensuring a culture of safety,

whereby:
• adverse events are openly reported and communicated
• people are made accountable
• the focus is on learning from mistakes
• there is recognition that failed processes contribute to
errors
18

Disclosure of Error
• The process by which health care professionals communicate

adverse events to patients or families
• Disclosure of errors
• acknowledges the right of patients and families to be
informed
• facilitates the healing process of all concerned
• needs to be open and transparent
• information provided to the next steps from the error
19

Right to Be Discharged From a
Health Care Facility
• Hospitals have an obligation to ensure that patients arrive
home safely.
• In cases of same-day surgery, patients must not be sent home
until the sedative has worn off.
• They may have to be sent home in a taxi unless they have
arranged for a ride home.
• In most cases, patients must wait a certain period of time and
be accompanied.
• Special considerations for discharge of newborns
20

Right to Be Discharged From a
Health Care Facility
• Patients have a right to leave a facility against medical
advice (AMA)
• They are asked to sign a waiver acknowledging that they
have been advised against leaving
• Ultimately, it is the patient’s decision, not the health care
team’s
21

Discharge From a Mental Health
Facility
• Two categories exist for admission to a mental health facility
• Involuntary: when the person
• poses a threat to self or others
• must be committed for treatment by order of the
examining physician
• may be detained without consent
• Voluntary: when the person
• poses no threat, but is choosing admission for treatment
• may not be detained without consent
22

What are the rights of a patient?
• As a patient or health care consumer in Ontario, patients have

both rights and responsibilities.
• If a health care professional violates a patient’s rights, they

can make a formal complaint.
Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 23
Patient Rights
• In general, a patient, has the right to:

• Receive safe and proper care
• Give or refuse consent for any procedure, and for any reason
• Have a medical professional clearly explain health problems
and treatments
• Participate in health care decisions
• Ask questions and express concerns
• Legal right to refuse treatment
Patient Rights
• Request a second opinion; within reason.

• Be assured that personal information is confidential.
• Request to access their health information records.
• Request the transfer of their health records to another medical professional; they
may be charged a fee.
• Request delivery of care from another nurse or doctor.
• Right to die
• Right to challenge care
Make a Complaint
• If a health care professional violates a patients rights, they can complain
to the appropriate regulatory organization. For example, if a doctor
refuses to give a patients medical records, they can complain to the
Information and Privacy Commissioner.
• If a patient believes their doctor acted unprofessionally, they can

complain to the College of Physicians and Surgeons of Ontario (CPSO).
Or to the CNO if a nurse violates the act of professionalism
• A complaint can lead to an investigation of the professional's conduct.
Home Care Bill of Rights
• Home Care Bill of Rights - explains patients rights

if they require home care, such as nursing, social
work, home-making or other help in the home.
From CLEO (Community Legal Education
Ontario)
• The Bill of Rights applies to a patient if they are
getting or applying for home care services through
a CCAC.
The Home Care Bill of Rights
• The home care Bill of Rights says you have the right to:
• be treated with respect and to be free from abuse
• have your privacy and dignity honoured
• have your needs and preferences respected
• receive information about the services you get
• take part in decisions about your services
• consent to or refuse services
• comment or criticize without anyone taking action against you
• receive information about home care laws and policies and how to make a complaint
• have your home care records kept confidential
Community Care Access
Centres (CCAC)
• Home care services provided through CCACs and other programs
include:
• nursing, physiotherapy, occupational therapy, social work, speech
therapy, diet advice, and other professional services
• help with activities of daily living, such as bathing, eating, dressing,
and other personal support services
• house-cleaning, laundry, banking, shopping, preparing meals, and
other home-making services
Rights of a Psychiatric Patient
• What are Your Rights as a Psychiatric Patient? -

This webpage has information about the rights of
mental health patients. From the Psychiatric Patient
Advocate Office.
Medical Records Rights
• Medical Records - The official policy that

physicians must follow with regards to patients'
health records. It states that physicians are
obligated to show patients their medical records
and transfer them to another health care
professional if the patients request so. From the
College of Physicians and Surgeons of Ontario.
Slid
Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. e
31
Complaints Process
• The Complaints Process - Explains how to make a

complaint about a doctor and outlines the process
that follows. From the College of Physicians and
Surgeons of Ontario.
Slid
32
Health Services
• Health Services in Your Community - A list of

health-related organizations in Ontario. From the
Ministry of Health and Long-Term Care.
Slid
33

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Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

• Patients have the responsibility to

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

• An obligation is anything a person must do or refrain from

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 4

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

• Communicating a diagnosis is a controlled act in Ontario

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

• May create conflict with the obligation to provide care and

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

• Information regarding employers and workers is strictly

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

• Provincial nursing statutes permit disclosure in the case of

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

• Nurses should take care

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

• Access to computerized health care information is password

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

• Nurses are obliged to ensure:

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

• Health professionals have an obligation to treat all clients

• Nurses who disregard clients’ privacy or fail to involve

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

• Leadership is an essential part of ensuring a culture of safety,

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

• The process by which health care professionals communicate

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

• As a patient or health care consumer in Ontario, patients have

• If a health care professional violates a patient’s rights, they

• In general, a patient, has the right to:

• Request a second opinion; within reason.

• If a patient believes their doctor acted unprofessionally, they can

• Home Care Bill of Rights - explains patients rights

• What are Your Rights as a Psychiatric Patient? -

• Medical Records - The official policy that

• The Complaints Process - Explains how to make a

• Health Services in Your Community - A list of

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