The Filipino Patient's Rights

All of us at one time in our lives will experience some sort of illness and become patients. But, does every patient know their rights?  Beginning in 2010 hospitals in the country were required by the Department of Health (DoH) and Philippine Health Insurance Corporation (PHIC) to post these rights prominently around their premises, particularly in the emergency room, clinics and wards.  However, there is no uniform standard on patient rights and each hospital can come out with it's own or adopt the existing standard set by the DoH.

In 2001, The Philippine Medical Association (PMA) came out with a declaration on The Rights of The Patient.  This was prepared by the Philippine College of Surgeons with the different Specialty Societies and adapted by the PMA. In its introduction, it states that the physician should always act according to his conscience, for best interest of the patient, and must exert equal effort to guarantee patient autonomy, justice and participation in the decision making. It further declares that what is written is only "some" of the principal rights of the patient which the medical profession should endorse and promote.  It goes even further by saying that physicians and other persons or bodies involved in the provision of health care have a joint responsibility to recognize and uphold these rights and that whenever legislation, government action or any other administration or institution denies patients these rights, physicians should pursue appropriate means to assure or to restore them. But they draw the line on legislation. According to the declaration, "legislating these rights will erode the basic foundation that welds the patients and the physicians together - trust and respect, running counter to the best interests of the patients".  In other words, the physician-patient relationship will change from a fiduciary one to a business contract. 

Here are the principles as stated in the PMA declaration.

Principle 1. Right to good quality health care and humane treatment. 

a. Every person has a right to good quality health care without any discrimination and within the limits of the resources available for health and medical care.

b. In the course of such care, his human dignity, culture, convictions and integrity shall be respected.

c. If the patient has to wait for care, he shall be informed by the health professionals of the reason for the delay.

d. The patient shall always be treated in accordance with his best interests. The treatment applied shall be in accordance with generally accepted medical principles.

e. The patient has the right of continuity of health care.

f. An emergency patient who is immediate threat of dying or losing life or limb shall be extended immediate medical care and treatment without any pecuniary consideration until the emergency situation is over.


Principle 2. Right to dignity

a. The patient’s dignity, culture and value shall be respected at all times in medical care and teaching.

b. Terminal ill patients are entitled to humane terminal care to make dying as dignified and comfortable as possible.


Principle 3. Right to be informed of His Rights and Obligations as a Patient 

Every person has the right to be informed of his rights and obligations as a patient. The Philippine Medical Association (PMA) in coordination with health care providers, professionals and civic groups, the medical people’s organizations, local government units, and other government agencies and non-governmental organizations shall conduct a nationwide information and education to make known to people their rights as patients as provided in this Declaration. The health care institutions shall inform patients of their rights as well as of the institution’s rules and regulations that apply to the conduct of the patient while in the care of such institution.

Principle 4. Right to Choose his Physician

a. The patient is free to avail of the services of a physician of his choice except when he chooses to be confined in a service ward. In this case, his attending physician shall be the one who was on duty and who made the admitting orders at the time of admission as appearing in the Doctor’s Order Sheet of the Medical Record.

b. The patient has the right to seek a second opinion.

c. The patient has the right to change his physician or other health care provider.


Principle 5. Right to Informed consent 

a. The patient has the right to self-determination, to make free decisions regarding himself. The physician shall inform the patient of the consequences of his decisions.

b. Patient who is mentally competent and of legal age or in his incapacity or age of minority his legal representative, has a right to a clear explanation, in layperson’s terms, of all proposed or contemplated procedures whether diagnostic or therapeutic, including the identity and professional circumstances of the person or persons who will perform the said procedure or procedures.

The explanation shall include that amount of information necessary and indispensable for him to intelligently give his consent which may include, but may not be limited to the benefits, risk and side effects, and the probability of success or failure, as a possible consequence of said proposed procedure or procedures, including the implications of withholding consent. In the explanation of the proposed procedure or procedures, the comprehensive ability of the patient shall also be considered taking into account his level of education, the dialect or language that he speaks and understands and if possible, the use of anatomic sketch, or otherwise the use of those materials or visual aids that may aid the patient or his legal representative, in fully understanding the proposed procedure or procedures. The right to informed consent shall likewise consider the voluntariness in which the patient or his legal representative has given his consent seeing to it that the patient or his legal representative was allowed to ask questions, or that he is given the chance to consult his kins, or to seek another expert opinion.

c. The unconscious patient

1. If the patient is unconscious or unable to express his will, informed consent must be obtained whenever possible from a legal representative.
2. When medical intervention is urgently needed, consent of the patient may be presumed.
3. Physicians should always try to save the life of a patient unconscious due to a suicide attempt.

d. The legally incompetent patient

1. If a patient is a minor or legally incompetent the consent of a legally representative is required. Nevertheless the patient must be involved in the decision making to the fullest extent allowed by his mental capacity.

       A patient, who is eighteen years of age and above, shall be considered,
       for purposes of this declaration, to be of legal age.

1. If the legally incompetent patient can make rational decisions, his decisions must be respected, and he has the right to forbid the d
2. If the patient’s legal representative, forbids treatment but, in the opinion of the physician contrary to the patient’s best interest, the physician may challenge this decision in court. In case of emergency, the physician will act in the patient’s best interest.

e. In case of emergency, when there is no one who can give consent in his behalf, the physician can perform any emergency diagnostic or treatment procedure in the best interests of the patient.


Principle 6. Right to REFUSE DIAGNOSTIC AND MEDICAL TREATMENT

a. The patient has the right to refuse diagnostic and medical treatment procedures, provided that the following conditions are satisfied:

1. He is of age twenty one and above, and mentally competent;
2. He is informed of the medical consequences of his refusal;
3. He releases those involved in his care from any obligation relative to the consequences of his decision; and
4. His refusal will not jeopardize public health and safety.

b. An adult with a sound mind may execute an advance directive for physicians not to put him on prolonged life support if, in the future, his condition is such that there is little or no hope of reasonable recovery and the physician shall therefore allow the natural course to happen. The qualifications listed as 1, 2, 3, and 4, of the preceding provision 6,a., shall be considered as satisfied if a patient whose condition makes him unable to express his will, has executed an advance directive.



Principle 7. Right to Refuse Participation in Medical Research 

The patient has the right to be advised of plans to involve him in medical research that may affect the care or treatment of his condition. The proposed research shall be performed only upon the written informed consent of the patient.

Principle 8. Right to religious belief and assistance. 

The patient has the right to receive spiritual and moral comfort including the help of a minister of his chosen religion.

Principle 9. Right to Privacy and Confidentiality

The patient has the right to privacy and protection from unwarranted publicity. This right to privacy shall include the patient’s right not to be subjected to exposure, private or public, either by photography, publications, video-taping, discussion, medical teaching or by any other means that would otherwise tend to reveal his person and identity and the circumstances under which he was, he is, or he will be, under medical or surgical care or treatment.

a. All identifiable information about a patient’s health status, medical condition, diagnosis, prognosis and treatment and all other information of a personal kind, must be kept confidential, even after death. Except, in cases when descendants may have a right of access to information that would inform them of their health risks.

b. All identifiable patient data must be protected. The protection of the data must be appropriate as to the manner of its storage. Human substance from which identifiable data can be derived must be likewise protected.

c. Confidential information can be disclosed in the following cases :

1. when his mental or physical condition is in controversy in a court litigation and the court in its discretion orders him to submit to physical or mental examination by a physician;
2. when the public health and safety so demand ;
3. when the patient or, in his incapacity, his legal representative expressly gives the consent ;
4. when his medical or surgical condition, without revealing his identity, is discussed in a medical or scientific forum for expert discussion for his benefit or for the advancement of science and medicine.
5. when it is otherwise required by law.

Principle 10. Right to Disclosure of, and Access to Information

a. In the course of his treatment and hospital care, the patient has the right to be informed of the result of the evaluation of the nature and extent of his disease. Any other additional or further contemplated medical treatment and surgical procedure or procedures.

b. Disclosure of information maybe withheld if the information to the patient will cause mental suffering or further impair his health. Such disclosure may be withheld or deferred at some future opportune time upon due consultation with the patient’s immediate family.

c. Information must be given in a way appropriate to the local culture and in waiver the patient can understand.

d. The patient has the right not to be informed on his explicit request, unless required for the protection of another person’s life.

e. The patient has the right to choose who, if anyone, should be informed on his behalf.

f. The patient has the right to examine and be given an itemized bill of the hospital and medical services rendered.

g. The patient or his legal representative, has the right to be informed by the physician or his delegate of his continuing health care requirements following discharge, including instructions about home medications, diet, physical activity and all other pertinent information.


Principle 11. Right to Correspondence and to Receive Visitors

The patient has the right to communicate with relatives and other persons and to receive visitors subject to reasonable limits prescribed by the rules and regulations of the health care institution.

Principle 12. Right to Medical Records

The health care institution and the physician shall ensure and safeguard the integrity and authenticity of the medical records.

a. Upon the request of patient, the physician shall issue a medical certificate, a clinical abstract. to the patient upon discharge from the institution. Any relevant document that the patient may require for insurance claims shall also be made available to him within a reasonable period of time.

b. He has the right to view the contents of his medical records with the attending physician explaining contents thereof and at his expense.

c. The patient may obtain from the health care institution a reproduction of his medical record at his expense.


Principle 13. Right to Health Education

Every person has the right to health education that will assist him in making informed choices about personal health and about the available health services. The education should include information about healthy lifestyles and about methods of prevention and early detection of illnesses. The personal responsibility of everybody for his own health should be stressed. Physicians should have an obligation to participate actively in educational efforts.


Principle 14. Right to Express Grievances 

The patient has the right to express only valid complaints and grievances about the care and services received. Patients may express their complaints and grievances with the Medical Director, the Ethics Committee or the Medical Staff Organization of the health care institution, or the Ethics Committee of the Philippine Medical Association (PMA) which shall afford all parties concerned with the opportunity to settle amicably all grievances.