PHILIPPINE MEDICAL ASSOCIATION DECLARATION ON THE RIGHTS AND OBLIGATIONS OF THE PATIENT INTRODUCTION

The time honored relationship between Filipino physicians, their patients and the community has undergone significant changes in recent times. The physician should always act according to his conscience, for the best interest of the patient, and must exert equal effort to guarantee patient autonomy, justice and participation in the decision making. The following Declaration represents some of the principal rights and obligations of the patient which the medical profession endorses and promotes, Physicians and other persons or bodies in ol ed in the pro ision of health care ha e a joint responsibility to recogni!e and uphold these rights. "hene er legislation, go ernment action or any other administration or institution denies patients these rights, physicians should pursue appropriate means to assure or to restore them. #n the other hand, 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.

RIGHTS 1. Right to Good Qualit H!alth Ca"! a#d Hu$a#! T"!at$!#t

a. b. c. d. e. f. % ery person has a right to good quality health care without any discrimination and within the limits of the resources a ailable for health and medical care. &n the course of such care, his human dignity, culture, con ictions and integrity shall be respected. &f the patient has to wait for care, he shall be informed by the health professionals of the reason for the delay. The patient shall always be treated in accordance with his best interests. The treatment applied shall be in accordance with generally accepted medical principles. The patient has the right of continuity of health care. 'n 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 o er.

%. Right to Dig#it
a. b. The patient(s dignity, culture and alue shall be respected at all times in medical care and teaching. Terminal ill patients are entitled to humane terminal care to make dying as dignified and comfortable as possible.

&. Right to B! I#'o"$!d o' Hi( Right( a#d O)ligatio#( a( a Pati!#t

% ery person has the right to be informed of his rights and obligations as a patient. The Philippine )edical 'ssociation *P)'+ in coordination with health care pro iders, professionals and ci ic groups, the medical people(s organi!ations, local go ernment units, and other go ernment agencies and non,go ernmental organi!ations shall conduct a nationwide information and education to make known to people their rights as patients as pro ided 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.

*. Right to Choo(! Hi( Ph (i+ia#

a. The patient is free to a ail of the ser ices of a physician or health institution of his choice except when he chooses to be confined in a ser ice ward. &n 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 #rder -heet of the )edical .ecord. The patient has the right to seek a second opinion. The patient has the right to change his physician or other health care pro ider.

b. c.

,. Right to I#'o"$!d Co#(!#t

a. b.

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. Patient who is mentally competent and of legal age or in his incapacity or age of minority his legal representati e, 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 gi e 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. &n the explanation of the proposed procedure or procedures, the comprehensi e ability of the patient shall also be considered taking into account his le el 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 isual aids that may aid the patient or his legal representati e, in fully understanding the proposed procedure or procedures. The right to informed consent shall likewise consider the oluntariness in which the patient or his legal representati e has gi en his consent seeing to it that the patient or his legal representati e was allowed to ask questions, or that he is gi en the chance to consult his kins, or to seek another expert opinion. c. The unconscious patient /+ &f the patient is unconscious or unable to express his will, informed consent must be obtained whene er possible from a legal representati e. 0+ "hen medical inter ention is urgently needed, consent of the patient may be presumed. 1+ Physicians should always try to sa e the life of a patient unconscious due to a suicide attempt.

d.

The legally incompetent patient /+ &f a patient is a minor or legally incompetent the consent of a legally representati e is required. 2e ertheless the patient must be in ol ed in the decision making to the fullest extent allowed by his mental capacity. ' patient, who is eighteen years of age and abo e, shall be considered, for purposes of this declaration, to be of legal age. 0+ &f the legally incompetent patient can make rational decisions, his decisions must be respected, and he has the right to forbid the disclosure of information to his legally representati e. 1+ &f the patient(s legal representati e, forbids treatment but, in the opinion of the physician contrary to the patient(s best interest, the physician may challenge this decision in court. &n case of emergency, the physician will act in the patient(s best interest. &n case of emergency, when there is no one who can gi e consent in his behalf, the physician can perform any emergency diagnostic or treatment procedure in the best interests of the patient.

e.

-. Right to REFUSE DIAGNOSTIC AND MEDICAL TREATMENT

a. The patient has the right to refuse diagnostic and medical treatment procedures, pro ided that the following conditions are satisfied3 /+ 4e is of age twenty one and abo e, and mentally competent5 0+ 4e is informed of the medical consequences of his refusal5 1+ 4e releases those in ol ed in his care from any obligation relati e to the consequences of his decision5 and 6+ 4is refusal will not jeopardi!e public health and safety. b. 'n adult with a sound mind may execute an ad ance directi e 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 reco ery and the physician shall therefore allow the natural course to happen. The qualifications listed as /, 0, 1, and 6, of the preceding pro ision 7,a., shall be considered as satisfied if a patient whose condition makes him unable to express his will, has executed an ad ance directi e.

.. Right to R!'u(! Pa"ti+i/atio# i# M!di+al R!(!a"+h

The patient has the right to be ad ised of plans to in ol e 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.

0. Right to R!ligiou( B!li!' a#d A((i(ta#+!

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

1. Right to P"i2a+ a#d Co#'id!#tialit

The patient has the right to pri acy and protection from unwarranted publicity. This right to pri acy shall include the patient(s right not to be subjected to exposure, pri ate or public, either by photography, publications, ideo,taping, discussion, medical teaching or by any other means that would otherwise tend to re eal 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.

'll 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, e en after death. %xcept, in cases when descendants may ha e a right of access to information that would inform them of their health risks. 'll identifiable patient data must be protected. The protection of the data must be appropriate as to the manner of its storage. 4uman substance from which identifiable data can be deri ed must be likewise protected. 8onfidential information can be disclosed in the following cases3 */+ when his mental or physical condition is in contro ersy in a court litigation and the court in its discretion orders him to submit to physical or mental examination by a physician5 *0+ when the public health and safety so demand5 *1+ when the patient or, in his incapacity, his legal representati e expressly gi es the consent5 *6+ when his medical or surgical condition, without re ealing his identity, is discussed in a medical or scientific forum for expert discussion for his benefit or for the ad ancement of science and medicine. *9+ when it is otherwise required by law.

b. c.

13. Right to Di(+lo(u"! o'4 a#d A++!(( to I#'o"$atio#

a. &n the course of his treatment and hospital care, the patient has the right to be informed of the result of the e aluation of the nature and extent of his disease. 'ny other additional or further contemplated medical treatment and surgical procedure or procedures. Disclosure of information maybe withheld if the information to the patient will cause mental suffering or further impair his health. -uch disclosure may be withheld or deferred at some future opportune time upon due consultation with the patient(s immediate family. &nformation must be gi en in a way appropriate to the local culture and in wai er the patient can understand. The patient has the right not to be informed on his explicit request, unless required for the protection of another person(s life. The patient has the right to choose who, if anyone, should be informed on his behalf. The patient has the right to examine and be gi en an itemi!ed bill of the hospital and medical ser ices rendered. The patient or his legal representati e, 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 acti ity and all other pertinent information.

b.

c. d. e. f. g.

11. Right to Co""!(/o#d!#+! a#d to R!+!i2! 5i(ito"(

The patient has the right to communicate with relati es and other persons and to recei e isitors subject to reasonable limits prescribed by the rules and regulations of the health care institution.

1%. Right to M!di+al R!+o"d(

The health care institution and the physician shall ensure and safeguard the integrity and authenticity of the medical records. a. :pon the request of patient, the physician shall issue a medical certificate, a clinical abstract to the patient upon discharge from the institution. 'ny rele ant document that the patient may require for insurance claims shall also be made a ailable to him within a reasonable period of time. 4e has the right to iew the contents of his medical records with the attending physician explaining contents thereof and at his expense. The patient may obtain from the health care institution a reproduction of his medical record at his expense.

b. c.

1&. Right to H!alth Edu+atio#

% ery person has the right to health education that will assist him in making informed choices about personal health and about the a ailable health ser ices. The education should include information about healthy lifestyles and about methods of pre ention and early detection of illnesses. The personal responsibility of e erybody for his own health should be stressed. Physicians should ha e an obligation to participate acti ely in educational efforts.

1*. Right to E6/"!(( G"i!2a#+!(

The patient has the right to express only alid complaints and grie ances about the care and ser ices recei ed. Patients may express their complaints and grie ances with the %thics 8ommittee of the Philippine )edical 'ssociation through its component societies which shall afford all parties concerned with the opportunity to settle amicably all grie ances.

So+i!tal Right( o' Pati!#t(

&n addition to the indi idual rights of patients, patients ha e societal rights which are as follows3

1. Right to H!alth $ The patient has the right to access quality health care and to physicians who are
free to render clinical and ethical judgment without interference or outside pressure. The patient has the right to regain and;or acquire the highest attainable standard of health, in a non, discriminatory, gender sensiti e, and equal manner, which health authorities and health practitioner must progressi ely contribute to reali!e.

%. Right to A++!(( to Qualit Pu)li+ H!alth Ca"! $ The patient has a right from the
national and local go ernment a comprehensi e and integrated health care deli ery system, pro iding the necessary manpower and facility resources. The patient has the right to functioning public health and health care facilities, goods and ser ices and programs needed and sufficient quantity. They shall likewise be pro ided with health facilities and ser ices with adequate pro ision of essential drugs, regular screening program, appropriate treatment of pre alent diseases, illnesses, injuries and disabilities, including pro ision of public health insurance. Towards this end, the go ernment shall approximate the international standard allocation for the health sector as set by the "orld 4ealth #rgani!ation.

&. Right to H!alth a#d Sa'! 7o"8/la+! $ The patient has the right to a healthy natural
workplace en ironment with adequate supply of safe and potable water and basic sanitation, industrial hygiene, pre ention and reduction of exposure to harmful substances, pre enti e measures for occupational accidents and diseases, and an en ironment that discourages abuse of alcohol, tobacco use, drug use and other harmful substances.

*. Right to M!di+al a#d Edu+atio# I#'o"$atio# a#d P"og"a$( $ the patient has the
right to pre ention, medical information and education programs on immuni!ation, pre ention, treatment and control of diseases, beha ior,related concerns, and disaster relief and emergency situations during epidemics and similar health ha!ards. The go ernment shall endea or to pro ide these information through lectures, symposia, tri,media, posters and the like.

,. Right to Pa"ti+i/at! i# Poli+ D!+i(io#( $ the patient has the right to participate in policy
decisions relating to patient(s right to health at the community and national le els.

-. Right to A++!(( to H!alth Fa+iliti!(

The patient has the right to be admitted to any primary, secondary, tertiary and other specialty hospitals when appropriate and necessary.

.. Right to E9uita)l! a#d E+o#o$i+ U(! o' R!(ou"+!(

The patient has the right to demand that go ernment health facility resources must be equitably distributed in all regions of the country.

0. Right to Co#ti#ui#g H!alth Ca"!

The patient has the right from the national and local go ernment programs to ensure continuity of care in the form of hospice care, rehabilitation, chemotherapy, and radiotherapy and similar modalities.

1. Right to B! P"o2id!d Qualit H!alth Ca"! i# Ti$!( o' I#(ol2!#+

The patients who are paupers ha e the right from the national and local go ernment pro isions for quality medical care in spite of insol ency. The national and local go ernment must pro ide for a system of payment to health care facilities and pro iders for all the alid and necessary medical expenses of their poor and marginali!ed citi!ens.

D!+la"atio# o' O)ligatio#( Th! O)ligatio# o' Pati!#t( $ Patients shall at all times fulfill their obligations and responsibilities regarding medical care and
their personal beha ior.

1. O)ligatio# to :#o; Right( $ the patient shall ensure that he;she knows and understands what
the patients( rights are and shall exercise those rights responsibly and reasonably.

%. O)ligatio# to P"o2id! Ad!9uat!4 A++u"at! a#d Co$/l!t! I#'o"$atio# $ the

patient shall pro ide, to the best of his knowledge, adequate, accurate and complete information about all matters pertaining to his;her health, including medications and past or present medical problems, ailments, medical history, consultation with other physicians, results of Diagnostic work,up and treatment to his;her health care pro ider.

&. O)ligatio# to R!/o"t U#!6/!+t!d H!alth Cha#g!( $ &t shall be the duty of e

ery patient to report unexpected changes to his;her condition or symptoms, including pain, to a member of the health care team.

*. O)ligatio# to U#d!"(ta#d Pu"/o(! a#d Co(t o' T"!at$!#t $ The patient shall
ensure that he;she understands the purpose and cost of any proposed treatment or procedure before deciding to accept it. 4e;she shall notify the health care pro ider or practitioner if he;she does not understand any information about his;her care or treatment. The patient shall insist upon explanations until adequately informed and consult with all rele ant persons before reaching a decision.

,. O)ligatio# to A++!/t Co#(!9u!#+!( o' O;# I#'o"$!d Co#(!#t $ the patient

shall accept all the consequences of the patient(s own informed consent. &f he;she refuses treatment or do not follow the instructions or ad ice of the health care pro ider or practitioner, he;she must accept the consequences of his;her decision. 4e is obligated to fore er free the physician of liability in his exercise of his right to self determination.

-. O)ligatio# to S!ttl! Fi#a#+ial O)ligatio#( $ the patient shall ensure that financial
obligations of his;her health care fulfilled as promptly as possible, otherwise he;she shall make appropriate arrangements to settle unpaid bills in the hospital and;or professional fees of the health care pro ider. Failure is considered estafa. Patients must seek support from the national and local go ernment to pro ide a system of payment to health workers and facilities.

.. O)ligatio# to R!(/!+t th! Right( o' H!alth Ca"! P"o2id!"(

Patients are required to gi e due respect to the rights of health care pro iders most especially their human rights. 4e is under obligation that his actions must be considerate, cooperati e and must ne er infringe on the rights and property of the health care pro ider.

0. O)ligatio# to R!(/!+t th! Right( o' H!alth I#(titutio#(

The patients are required to gi e due respect to rights of health care pro ider institutions and must ne er infringe upon their rights. This includes the obligation to know and follow the health institution(s policies, rules and regulations.

1. O)ligatio# to R!(/!+t th! Right( o' Oth!" Pati!#t( $ the patient is obligated to
conduct himself;herself in harmony with, respect to and must not interfere with the rights and property of other patients.

13. O)ligatio# to S!l'

The patient is obligated to maintain a state of wellness.

11. O)ligatio# to Ha2! Ad!9uat! H!alth I#'o"$atio# a#d A+ti2!l Pa"ti+i/at! i# Hi( T"!at$!#t
The patient is obligated to know the basic health information. This adequate knowledge is subsumed when a patient signs an informed consent. Patients are obligated to acti ely obtain the necessary information to enable him to acti ely participate in the formulation of his diagnostic and treatment plans.

1%. O)ligatio# to R!(/!+t th! Right to P"i2a+ o' H!alth 7o"8!"( a#d I#(titutio#(
Patients ha e the obligation to address grie ances to the proper authorities or enue and not resort to unwarranted publicity in the media. Patients shall not disclose to the public any alleged complain against health pro ider and institution not fully decided by a court or administrati e tribunal of proper jurisdiction.

1&. O)ligatio# to E6!"+i(! Fid!lit o# P"i2il!g!d Co$$u#i+atio#

' patient,physician relationship is a fiduciary one where mutual trust, respect and confidence is executed. 'll communications are pri ileged and the patient is obligated not to breech this pri ileged communication especially if it in ol es a third party.

1*. O)ligatio# Not to Fo"+! Ph (i+ia#( to T"!at Hi$<H!"

"hile patients ha e the right to choose their physicians, these patients are likewise obligated to respect the physician(s decision to choose whom he is going to ser e or to treat.

1,. O)ligatio# to R!(/!+t th! Ph (i+ia#=( D!+i(io# o# M!di+al R!a(o#( o# Hi( Right to R!ligiou( B!li!'(
Patients are obligated to respect and obey the health care pro ider(s decision on matters referable to medical reasons on his children not yet of legal age but whose li es and health are affected by the parents( rights to religious belief. Patients are obligated to respect the physician(s religious beliefs.

1-. O)ligatio# to M!di+al R!+o"d(

Patients are obligated to ensure the integrity and authenticity of his medical records. 'ny attempt to alter his records is a criminal offense subject to the pro isions to this bill and to the .e ised Penal 8ode.

1.. O)ligatio# to Pa"ti+i/at! i# th! T"ai#i#g o' Co$/!t!#t Futu"! Ph (i+ia#(

Training of competent future physicians is a necessary de elopment in the health care deli ery system of the country. Patients are, therefore, obligated to participate in the training of these future health workers pro ided the necessary information are pro ided him and the necessary ethical considerations employed.

10. O)ligatio# to I#'o"$

Patients are obligated to inform the health worker to any percei ed or alleged infraction of his rights by the health worker or institution through proper channels. This is to pro ide a system of immediate rectification to promote mutual trust, respect and confidence between the doctor and patient.

11. O)ligatio# to U(! Du! P"o+!(( a#d E6hau(t G"i!2a#+! M!+ha#i($(

'll grie ances of patients must be coursed through proper channels and process. The patient shall exhaust the grie ance mechanism pro ided in this 'ct before filing any administrati e or legal action.

G"i!2a#+! M!+ha#i($ M!diatio# $ 'ny written complaint arising from

iolation of any of the right and obligations of patients shall first be submitted to mediation with the %thics 8ommittee of the Philippine )edical 'ssociation through its component societies which shall afford all parties concerned with the opportunity to settle all grie ances amicably. The hearing procedure shall not be ad ersarial in nature. The patient and the health care pro ider or practitioner shall be gi en the opportunity to discuss the cause of complaint and efforts shall be made for its amicable settlement. 2o monetary compensation shall be in ol ed during this stage and neither shall a legal counsel be present. The ethics committee of the local component societies shall be constituted by three members of the said society, 1 members of the specialty society corresponding to the case and one representati e from the public or pri ate or religious sector. The aggrie ed party shall be gi en sixty *7<+ days from occurrence of incident to file his;her written complaint to the appropriate grie ance mechanism le el. :pon receipt of written complaint, the 8hairperson shall gi e notice to the respondent. :pon receipt of the written complaint, due notice to the respondent and conciliation meeting, the )ediation 8ommittee shall be gi en thirty *1<+ days to resol e the said complaint. #therwise, the complainant shall ha e the option to proceed to the next le el of grie ance system. The 8ommittee shall now constitute themsel es into an arbitration committee to hear and resol e the complaint.

A")it"atio# $ if and when the complaint is not resol

ed through mediation within the prescribed period, the complainant shall file a case of arbitration. #nly complaints with physical injuries shall proceed to the arbitration process. The 8ommittee shall base its decision on documentary e idence including depositions. The 8ommittee shall render a decision within thirty *1<+ days from receipt of the position papers of both parties. The decision is binding to all parties.

P"o+!(( $ The Philippine )edical 'ssociation shall ensure the establishment of these grie
necessary rules and regulations for its proper operation and implementation.

ance mechanism and issue the

These grie ance mechanisms shall be seniquanon before filing any complaint with the judicial body. 'll parties to the complaint shall be bound by the rules on confidentiality on all le els of the =rie ance )echanism. 'll minutes of the committee shall not be disclosed to any party unless authori!ed by the court of law.

P"!(+"i/ti2! P!"iod $ the time during which the case is submitted for mediation shall toll the running of the prescripti
for the filing of a ci il or criminal case under the .e ised Penal 8ode or any administrati e case.

e period

Mi(+!lla#!ou( P"o2i(io#(

I#+lu(io# i# S+hool Cu""i+ulu$ a#d Li+!#(u"! E6a$i#atio#( $ the pro

the medical and medical related school curriculum and licensure examinations.

isions of the 'ct shall be included in

Rul!( a#d R!gulatio#( $ The Philippine )edical 'ssociation, in consultation with the -ecretary of 4ealth, Philippine 4ospital
'ssociation and concerned people(s organi!ations like the People(s 4ealth "atch, shall promulgate the rules and regulations for its implementation. Presented and submitted during the public hearing at the 4ouse of .epresentati e on 'ugust /7, 0<<9.

.#)%# =. %28'2T#, ).D., )%), FP8-, FP-=8hairman, 8ommission on >egislation

)#D%-T# #. >>')'-, ).D. President