Otmar Kloiber – Patients Rights’ – A World View
Dr. Kloiber thanked the Israeli Medical Association for their invitation to present at this important meeting and for their hospitality in Israel.
Dr Kloiber began with an anecdote of an 11 year-old girl, who he named Anna, who presented to her physician with an ulceration on her foot. The treatment failed and the surgeon wanted to amputate her foot. The girl’s father objected to the amputation, as he did not want his daughter to be viewed as disabled. The surgeon tried to remove the ulceration without the amputation, but in the end the foot was amputated against the father's wishes.
Dr. Kloiber explained that in many international conventions the right to health is mentioned. In the World Health Organization's Constitution enshrines “…the highest attainable standard of health as a fundamental right of every human being.” The United Nations International Covenant on Economic, Social and Cultural Rights states: “recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”
Note that the wording is weak here as it states the highest ATTAINABLE, and in many parts of the world this would equate to nearly nothing.
The United Nations Committee on Economic, Social and Cultural Rights issued a legally binding interpretation of the human right to health, in a document generally referred to as Comment 14. This document is the key source for advocates seeking to develop and apply human rights principles and standards to their own national, state or local context. It makes the right to health a human right and an entitlement. This is more in place with countries where there is health insurance system. In health care systems which are state-run – it make health a collective right, which is then conditioned on rationing rather than an individual right.
The World Medical Association (WMA) is more involved in the physician’s role with regards to patients’ rights. The WMA has produced several statements and declarations on this issue. The WMA Declaration of Geneva, which was first adopted in 1948, states: “THE HEALTH OF MY PATIENT will be my first consideration”.
In 1964 the WMA Declaration of Helsinki raises the need for of patient autonomy, which is relevant to the issue of force feeding hunger strikers.
In addition the WMA Declaration of Lisbon on the rights of the Patient was first adopted in 1981. Over the years this has become more detailed and now includes patients' rights to information and the right not to know and restricting treatment against patients will.
In the 1990’s patients were seen to be customers – pay for service. However, in the relationship between the patient and the physician there is an imbalance of information – they are not equal partners in this relationship.
In addition, in many circumstances patients are suffering from something, which may incapacitate them, in some way. This way of thinking may not be politically correct, but it is true.
Respecting patients’ autonomy, does not necessitate that the patient be seen as a customer, but rather as a partner.
While, patients are healthcare consumers, the relationship between the patient and the doctor is a special one. For those that see the patient-doctor relationship as the same as any other commercial realtor, reducing the relationship to money – is wrong.
Doctor-patient relationship should be display respect. Requires the doctor to both protect and assist their patients. It is essential that patients’ rights come first, which is not the same in the consumer market. If doctors were to follow economic dictate, i.e. make choices regarding money/costs rather than patient's needs, we would then to safeguard patients’ rights. Dr Kloiber pointed out that governments’ moves to invade or change physician autonomy are not taken on enough by patients associations.
Patients’ rights have limits; there are limited resources, both natural and artificial. Distributing resources in medicine by medical need, are often dependent on proximity. Patients’ rights can also be in competition with physician rights. Patients may choose a specific physician, the physician has the right to refuse treatment when not an emergency. Physicians have the right to conscientious objection – physicians do not surrender their human rights when becoming a physician.
When the right to strike exists in a country, they are not then able to withhold this right from physicians. In the past, when patients understand that they will still receive the necessary treatment when needed, such as in emergencies, and rather routine non-emergency procedures are postponed, they often support physicians.
Summary of Rights:
Right to religious assistance
Patients' rights should not be confused with consumer rights
Autonomy of both patient and physician
Solid self-governing structure
Patients’ Rights have limits
Dr Kloiber returned to the case of Anna, suffered from bone tuberculosis and the amputation of her foot, most likely saved her life. However, her father sued the surgeon and the court ruled in favour of the father. This took place in 1894, we are 120 years on and we are still learning.