{"id":4643,"date":"2017-01-25T17:45:58","date_gmt":"2017-01-25T17:45:58","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/Patient-rights-20160118.pdf"},"modified":"2017-02-24T17:28:31","modified_gmt":"2017-02-24T17:28:31","slug":"patient-rights-20160118-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/es\/noticias-y-prensa\/speeches-talks-interviews\/patient-rights-20160118-2\/","title":{"rendered":"Patient-rights-20160118"},"author":2,"comment_status":"open","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"<p class=\"attachment\"><a href='https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/Patient-rights-20160118.pdf'>Patient-rights-20160118<\/a><\/p>\n<p>\t 1<br \/>\nThe\tPatients\u2019\tRights\tAct\t20\tyears\ton\t\u2013<br \/>\nAchievements\tand\tChallenges<br \/>\nMonday,\t18\tJanuary\t2016<br \/>\nPeres\tCenter\tfor\tPeace<br \/>\nJaffa,\tIsrael\t<\/p>\n<p>Patients&#8217;\tRights\t&#8211;\tA\tWorld\tView<br \/>\nDr.\tOtmar\tKloiber<br \/>\nSecretary\tGeneral<br \/>\nWorld\tMedical\tAssociation\t<\/p>\n<p>President\tof\tthe\tIsraeli\tMedical\tAssociation,\tDr.\tEidelman,<br \/>\nDistinguished\tGuests,<br \/>\nShalom!\t<\/p>\n<p>Thank\tyou\tfor\tinviting\tthe\tWorld\tMedical\tAssociation\tto\tbe\twith\tyou\tat\tthis\tevent\tcelebrating<br \/>\n20\tyears\tof\ta\tlandmark\tlaw\there\tin\tIsrael.\t<\/p>\n<p>On\ta\tsummer\u2019s\tday,\tJune\t13th<br \/>\n,\ta\tseven-year\t-old\tgirl,\tlet\u2019s\tcall\ther\tAnna,\twas\tadmitted\tto\thospital<br \/>\nwith\tan\tulcer\ton\ther\tfoot.\t\t<\/p>\n<p>Conservative\ttreatment\tfailed\tand\ta\tweek\tlater\tthe\tsurgeon\trecommended\tamputating\tthe<br \/>\nforefoot\tin\torder\tto\tsave\tthe\tgirl\tfrom\ta\tpotentially\tascending\tinfection.\tHowever,\tthe\tfather\t\u2013\ta<br \/>\nbeliever\tin\tnaturopathy\t\u2013\tdid\tnot\twant\tthe\tsurgeon\tto\tamputate.\tOn\tJune\t23rd<br \/>\n\tthe\tsurgeon<br \/>\ndecided\tto\tresect\tparts\tof\tthe\tforefoot.\t<\/p>\n<p>Unfortunately,\tit\twas\ttoo\tlate\tor\tinsufficient.\tOn\tJuly\t28th<br \/>\n\tthe\tfoot\thad\tto\tbe\tamputated,\twhich<br \/>\nfinally\tbrought\tthe\tinfection\tunder\tcontrol.\tAgain,\tthis\twas\tagainst\tthe\texpress\twill\tof\tAnna\u2019s<br \/>\nfather,\twho,\tdespite\trisk,\tdidn\u2019t\twant\this\tgirl\tto\tbe\tcrippled.\t\t<\/p>\n<p>I\twill\tcome\tback\tto\tAnna.\t<\/p>\n<p>In\tthe\tmiddle\tof\tthe\tlast\tcentury,\tin\t1946,\tthe\tWorld\tHealth\tOrganization\twas\tfounded.\tIts<br \/>\nConstitution1<br \/>\n\tstates\tthat\t\u00abthe\tenjoyment\tof\tthe\thighest\tattainable\tstandard\tof\thealth\tis\tone\tof<br \/>\nthe\tfundamental\trights\tof\tevery\thuman\tbeing\twithout\tdistinction\tof\trace,\treligion,\tpolitical<br \/>\nbelief,\teconomic\tor\tsocial\tcondition,\u00bb\tmarking\tthe\tbeginning\tof\tinternational\tlaw\tdefining\thealth<br \/>\nas\ta\tright.\t<\/p>\n<p>In\t1948,\tArticle\t25\tof\tthe\tUnited\tNations\tUniversal\tDeclaration\tof\tHuman\tRights2<br \/>\n\tstated\tthat,<br \/>\n\u00abEveryone\thas\tthe\tright\tto\ta\tstandard\tof\tliving\tadequate\tfor\tthe\thealth\tand\twell-being\tof\thimself<br \/>\nand\tof\this\tfamily,\tincluding\tfood,\tclothing,\thousing\tand\tmedical\tcare\tand\tnecessary\tsocial<br \/>\nservices.\u00bb\t\t<\/p>\n<p>\t 2<br \/>\nThe\tUnited\tNations\tInternational\tCovenant\ton\tEconomic,\tSocial\tand\tCultural\tRights3<br \/>\n\tof\t1966<br \/>\nstates,\t\u201cThe\tStates\tParties\tto\tthe\tpresent\tCovenant\trecognize\tthe\tright\tof\teveryone\tto\tthe<br \/>\nenjoyment\tof\tthe\thighest\tattainable\tstandard\tof\tphysical\tand\tmental\thealth.\u201c\t(Article12),\tand<br \/>\nlists\tsome\tconcrete\tmeasure\tto\trealize\tthis\tright.\t\t<\/p>\n<p>But\tas\tyou\tmay\tguess,\tthe\twording\tis\tweak\tand\tthe\tphrase\t\u201dhighest\tattainable\u201c\tin\tmany\tplaces<br \/>\nliterally\tmeant\tnothing.\t<\/p>\n<p>The\tright\tto\thealth,\tand\tI\tam\tnot\tyet\tspeaking\tabout\tpatients\u2019\trights,\twas\tfor\ta\tlong\ttime<br \/>\nconsidered\tas\tgood,\tor\tas\taspirational\tto\tmake\tit\tsound\tmore\tpositive,\tas\ta\tright\tto\tblue\teyes\tor<br \/>\nsunny\tskies.\t<\/p>\n<p>Not\tuntil\tthe\tyear\t2000\tdid\tthe\tUnited\tNations&#8217;\tCommittee\ton\tEconomic,\tSocial\tand\tCultural<br \/>\nRights\tissue\ta\tstatement\tentitled\tComment\tNo.\t144<br \/>\n.\tThe\tcomment\televates\tthe\tHuman\tRight\tto<br \/>\nhealth\tfrom\ta\tmere\taspirational\tgoal\t\u201dto\tbe\thealthy\u201d\tto\tan\tentitlement,\tstating\tthat,\t\u00abStates<br \/>\nhave\ta\tspecial\tobligation\tto\tprovide\tthose\twho\tdo\tnot\thave\tsufficient\tmeans\twith\tthe\tnecessary<br \/>\nhealth\tinsurance\tand\thealth-care\tfacilities,\tand\tto\tprevent\tany\tdiscrimination\ton\tinternationally<br \/>\nprohibited\tgrounds\tin\tthe\tprovision\tof\thealth\tcare\tand\thealth\tservices.\u00bb\t<\/p>\n<p>Now\tyou\tmay\tthink\tat\tthis\tpoint\tthat\twe\thave\tarrived\tat\tthe\tdiscussion\tof\tpatient\trights.\tWell,<br \/>\nyes\tand\tno.\tToday\tmany\tstates,\tespecially\tthose\twith\tstate-run\thealth\tcare\tsystems,\tstill\tsee\tthe<br \/>\nentitlement\tto\thealth\tcare\tas\ta\tcollective\tone,\twhich\tgives\trationing\tsuperiority\tover\tindividual<br \/>\nentitlements.\t<\/p>\n<p>Parallel\tto\tthis\tdevelopment,\tthe\tWorld\tMedical\tAssociation\tsince\t1947\thas\tbeen\tdeveloping\ta<br \/>\nsystem\tof\tethical\tobligations\tor\ta\tprofessional\tdeontology,\twhich\tmore\tclearly\tdescribes\tthe<br \/>\nphysician\u2019s\trole\tversus\tthe\trights\tof\tindividual\tpatients.<br \/>\nIn\tthe\tDeclaration\tof\tGeneva\tof\t19485<br \/>\n\tand\tthe\tfirst\tInternational\tCode\tof\tMedical\tEthics\tof\t19496<\/p>\n<p>patient\trights\tdo\tnot\tappear\tas\ta\tself-standing\tconcept.\tThey\tare\trather\tthe\tresult\tof\ta\tmatrix\tof<br \/>\nphysicians\u2019\tobligations\tto\tpatients.\t<\/p>\n<p>In\t1964,\twith\tthe\tDeclaration\tof\tHelsinki7<br \/>\n\tas\tthe\tfirst\tinternational\tdocument\tsetting\tout\tthe<br \/>\nrules\tfor\tmedical\texperiments\twith\thumans,\tInformed\tConsent\tbecomes\tthe\tstrong\ttool\tfor<br \/>\nprotecting\tpatient\tautonomy.\tAt\tfirst\tthis\twas\tmeant\tto\tprotect\tagainst\tunwarranted\tinclusion\tin<br \/>\nexperimentation,\tit\tlater\tbecame\tthe\tgenerally\taccepted\tstandard\tfor\tconsent\tto\tmedical<br \/>\ntreatment.\t<\/p>\n<p>Eleven\tyears\tlater\tin\t1975,\tthe\tWorld\tMedical\tAssociation\u2019s\tDeclaration\tof\tTokyo8<br \/>\n\tcommanded<br \/>\nthe\tphysicians\tof\tthe\tworld\tto\tstay\taway\tfrom\tinvolvement\tin\ttorture\tand\tdegrading\ttreatment.<br \/>\nUnfortunately,\ta\tdemand\tthat\thas\tnot\tlost\tits\trelevance\teven\tin\tour\tday\tand\tage.\tJust\tthink\tof<br \/>\nthe\tforce\tfeeding\tof\thunger\tstrikers,\twhich\tfor\tmore\tthan\t40\tyears\tnow\thas\tclearly\tbeen\tdeemed<br \/>\nunethical.\t<\/p>\n<p>\t 3<br \/>\nIn\t1981,\tthe\tWorld\tMedical\tAssociation\tstarted\twording\ta\tfirst\tdeclaration\ton\tpatient\trights.\tThe<br \/>\nDeclaration\tof\tLisbon9<br \/>\n\tturned\tthe\tparadigm\tof\thealth\tas\tan\taspirational\taim\tto\tan\tindividual\tright<br \/>\nof\teach\tand\tevery\tperson.\tInitially\ta\trather\tshort\tdocument,\tit\twas\tmade\tdetailed\tand<br \/>\ndescriptive\tin\t1995,\tlisting\tvarious\trights\tincluding:<br \/>\n\u2022 Right\tto\tappropriate\tmedical\tcare\tof\tgood\tquality\twithout\tdiscrimination<br \/>\n\u2022 freedom\tof\tchoice<br \/>\n\u2022 dignity\tand\tself-determination<br \/>\n\u2022 the\tright\tto\tinformation\tas\twell\tas\tthe\tright\tnot\tto\tknow<br \/>\n\u2022 the\tright\tto\tconfidentiality<br \/>\n\u2022 and\tthe\tright\tto\treligious\tassistance\tand<br \/>\n\u2022 they\tshould\trestrict\ttreatment\tagainst\tthe\tfree\twill\tof\tthe\tpatient.\t<\/p>\n<p>At\tthat\ttime,\ta\tnumber\tof\tcountries\thad\talready\tdeveloped\tsimilar\tsets\tof\trights\t\u2013\tnot<br \/>\nnecessarily\tcalled\t\u201cpatient\trights\u201d,\tbut\tthey\tde\tfacto\texisted.\tThe\tWorld\tMedical\tAssociation<br \/>\nbrought\tthem\ttogether\tin\tan\tinternational\tdeclaration.\t<\/p>\n<p>But\tto\tunderstand\tpatient\trights\tand\tthe\trelation\tof\thealth\tprofessionals\tto\tthem\tit\tis\timportant<br \/>\nto\tbe\tclear\twhat\tpatients\tare.\tTowards\tthe\tend\tof\tthe\tlast\tcentury,\tparticularly\tduring\tthe\t1990s,<br \/>\nthe\tnotion\tcame\tinto\tbeing\tthat\tpatients\tare\t\u201ccustomers\u201d.\tNow\tsome\tprefer\tthe\tword\t\u201cclients\u201d,<br \/>\nwhich\tsounds\tmuch\tmore\telaborate\tand\telegant,\thowever\tit\tis\tmerely\tthe\tFrench\tword\tfor<br \/>\n\u201ccustomer\u201d.\t\t<\/p>\n<p>It\tis\tundeniable\tthat\tin\tany\trelationship\twhere\tone\tpays\tmoney\tfor\ta\tservice\tthere\tis\tan\taspect<br \/>\nor\tan\texpectation\tthat\tclassifies\tone\tparty\tas\ta\t\u201ccustomer\u201d\tand\tthe\tother\tas\ta\t\u201cprovider\u201d\tor<br \/>\n\u201cvendor\u201d.\tBut\ttransferring\tthis\tparadigm\tas\tthe\tdescription\tfor\tthe\tpatient\/physician<br \/>\nrelationship\tfalls\tdangerously\tshort\tof\treality.\t<\/p>\n<p>Between\tpatients\tand\tphysicians\tthere\tis\tusually\ta\tsevere\timbalance\tof\tinformation\twhich\tlimits<br \/>\nthe\tability\tof\tthe\tpatient\tto\thave\tthe\tsovereignty\tnecessary\tto\tbe\tan\tequal\tpartner\tin\t\u201cmaking\ta<br \/>\ndeal\u201d.\tEven\tworse,\tas\tthe\tLatin\tword\tpatient\timplies,\tpatients\tare\tsuffering\tfrom\ta\tcondition,<br \/>\nillness\tor\tinjury\twhich\toften\tlimits\ttheir\tdegree\tof\tfreedom,\tif\tnot\teven\tincapacitating\tthem.\t<\/p>\n<p>The\tunderstanding\tof\ta\tpatient\tas\ta\tcustomer,\tbeing\table\tto\t\u201cmake\ta\tdeal\u201d\tas\tan\texpression\tof<br \/>\nhis\tor\ther\tbuyer\tautonomy\tis\tunrealistic,\tespecially\tif\tthe\tpatient\tis\treally\till.\tOf\tcourse,<br \/>\ndescribing\tthis\timbalanced\trelationship\tis\tusually\tdisqualified\twith\tthe\tterm\t\u201cpaternalistic\u201d\tand\tit<br \/>\nmay\tnot\tbe\t\u201cpolitically\tcorrect\u201d\tnowadays.\tHowever,\tit\thas\tthe\tdistinct\tadvantage\tof\tbeing\ttrue.\t\t<\/p>\n<p>The\tability\tof\ta\tsick\tor\tinjured\tperson\tto\tact\tas\ta\tcompetent\tand\tfreely\tdeciding\tcustomer\tin<br \/>\nhealth\tcare\tis\textremely\tlimited,\tbut\texactly\tthat\twould\tbe\tnecessary\tto\thave\ta\tbalanced<br \/>\ncustomer-vendor\trelationship.\t<\/p>\n<p>Respecting\tthe\tpatient\u2019s\tautonomy\tdoes\tnot\tmean\tseeing\thim\tor\ther\tas\ta\tpurchaser\tof\tservices,<br \/>\nbut\trather\ta\tpartner\tseeking\tthe\tsupport\tand\tguidance\tof\ta\tphysician,\tideally\tto\treach\ta\tstate<br \/>\nwhere\ta\tfully\tautonomous\tdecision\tcan\tbe\ttaken.\tThis\tstate\tis\tsometimes\treached\tin\ta\tmoment,<br \/>\nsometimes\tit\twill\ttake\tmonths\tand\tsometimes\tit\tis\tunachievable,\tthink\tof\tpeople\tsuffering\tfrom<br \/>\n\t 4<br \/>\ndementia\tor\tchildren,\tand\tsometimes\tit\tis\tnot\teven\tdesirable.\tI\tregularly\thave\tthis\tsituation\twith<br \/>\nmy\tdentist.\t<\/p>\n<p>Some\teconomists\tand\tpoliticians\ttry\tto\tcircumvent\tthe\treality\tby\tcalling\tpatients\t\u201chealth\tcare<br \/>\nconsumers\u201d\t\u2013\tbut\tthat\tis\teven\tworse.\t\t<\/p>\n<p>\u201dHow\tdid\tit\tbecome\tnormal,\tor\tfor\tthat\tmatter\teven\tacceptable,\tto\trefer\tto\tmedical\tpatients\tas<br \/>\n\u201cconsumers\u201d?\tThe\trelationship\tbetween\tpatient\tand\tdoctor\tused\tto\tbe\tconsidered\tsomething<br \/>\nspecial,\talmost\tsacred.\tNow\tpoliticians\tand\tsupposed\treformers\ttalk\tabout\tthe\tact\tof\treceiving<br \/>\ncare\tas\tif\tit\twere\tno\tdifferent\tfrom\ta\tcommercial\ttransaction,\tlike\tbuying\ta\tcar\t\u2014\tand\ttheir\tonly<br \/>\ncomplaint\tis\tthat\tit\tisn\u2019t\tcommercial\tenough.\u201c\t<\/p>\n<p>The\tquestion\twas\tnot\traised\tby\ta\tmedical\tdoctor;\tit\twas\traised\tby\tPaul\tKrugman10<br \/>\n,\tan\teconomist<br \/>\nhimself.\tAnd\the\tconcludes:\t<\/p>\n<p>\u201dThe\tidea\tthat\tall\tthis\tcan\tbe\treduced\tto\tmoney\t\u2014\tthat\tdoctors\tare\tjust\t\u201cproviders\u201d\tselling<br \/>\nservices\tto\thealth\tcare\t\u201cconsumers\u201d\t\u2014\tis,\twell,\tsickening.\tAnd\tthe\tprevalence\tof\tthis\tkind\tof<br \/>\nlanguage\tis\ta\tsign\tthat\tsomething\thas\tgone\tvery\twrong\tnot\tjust\twith\tthis\tdiscussion,\tbut\twith\tour<br \/>\nsociety\u2019s\tvalues.\u201c\t\t<\/p>\n<p>Well\tastonishingly\tenough,\tpatients\tare\tpatients.\tBut\tthis\tdoes\tnot\tprevent\tany\thospital\tor\tclinic<br \/>\nextending\tcourtesy\tand\tfriendliness\ttowards\tthem\tas\tif\tthey\twere\tvalued\tcustomers.\t<\/p>\n<p>The\tneeds\tof\tpatients\trequire\tour\tcare;\ttheir\tspecial\tsituation\trequires\tour\tethical\tbehaviour.<br \/>\nBut\tthe\tethical\tbehaviour\tof\tdoctors,\tnurses\tand\tother\thealth\tprofessionals\twould\tnot\tbe<br \/>\nenough\tto\tprotect\tthis\trelationship.\tThe\tautonomy\tof\ta\tpatient,\tas\tI\tsaid,\twill\toften\tbe\tlimited.<br \/>\nSelf-determination,\tbut\teven\tmore\thuman\tdignity,\trequires\tprotection\tand\tassistance.<br \/>\nIn\tsituations\tof\thelplessness,\tpain\tand\tdespair,\tprotecting\tthe\tdignity\tof\tthe\tperson\tand\tenabling<br \/>\nself-determination\tare\teminent\tchallenges\tfor\tour\tprofession.\tUnlike\tmerchants\tor\tvendors,\tare<br \/>\nwe\tnot\tallowed\tto\t\u201cmake\ta\tdeal\u201d\tin\tour\tfavour\tbecause\twe\tare\tcleverer\tor\tin\ta\tfavourable<br \/>\nposition.\tIn\tsuch\tmoments\twe\tare\tthe\tguarantors\tof\tpatient\trights\tand\thave\tto\tput\ttheir<br \/>\ninterests\tbefore\tours.\t\t<\/p>\n<p>In\ta\tfree\tmarket\tthis\twould\tbe\truinous.\tRegulation\thas\tto\tbe\tin\tplace\tto\tprotect\tthe\tweak\tagainst<br \/>\nthe\tstrong,\tthe\till\tagainst\tthe\thealthy.\tCommercial\tdecisions\tin\ta\tconsumer-driven\tmarket\twill<br \/>\nregularly\tgo\tagainst\tpatient\tinterests.\tIf\tdoctors\thave\tto\tfollow\tan\teconomic\tdictate\t\u2013\tand<br \/>\nunfortunately\tfor\tvarious\treasons\tthis\tis\tmore\tand\tmore\tthe\tcase\t\u2013\tdecisions\tare\ttaken\tin\tfavour<br \/>\nof\tprofits\tor\tsavings\tand\tnot\tin\tfavour\tof\thealth.\t\t<\/p>\n<p>The\tstrongest\tsafeguards\tagainst\tsuch\tundue\tinfluence\tare\tprofessional\tautonomy\tand\tclinical<br \/>\nindependence.\tThe\tprotection\tof\tpatients\u2019\trights\tbecomes\ta\tpure\tillusion\tif\tphysicians\thave\tto<br \/>\ntake\tdecisions\tdictated\tby\tprofit\tmargins.\t\t<\/p>\n<p>Clinical\tindependence\tand\tprofessional\tautonomy\tare\tnot\tthe\tGod-given\tprivileges\tof\tthose\tin<br \/>\nwhite\tcoats,\tthey\tare\tderivatives\tof\tpatient\trights.\tTheir\taim\tmust\tbe\tto\tsafeguard\tthe\tinterests<br \/>\n\t 5<br \/>\nof\tpatients\tin\torder\tto\tguarantee\tappropriate\ttreatment,\taccess\tto\tmedical\tresources\tand\tto<br \/>\navoid\tunfair\tdiscrimination.\t<\/p>\n<p>Current\tattempts\tby\tsome\tgovernments,\tbut\talso\tby\tsome\thealth\tcare\torganizations,\tto\tinvade<br \/>\nor\treverse\tthe\tprofessional\tautonomy\tof\tphysicians\thas\tnot\tbeen\ttaken\tsufficient\tnotice\tof\tby<br \/>\npatient\torganizations.\tPatients\thave\tto\task\tthe\tquestion\twhether\tthey\twant\tto\thave\ta\tdoctor<br \/>\nwho\tis\tbound\tby\this\tprofessional\tethical\tcode\tor\tby\tfinancially\tmotivated\torders\tfrom\tthe<br \/>\ngovernment\tor\tcommercially\tdriven\torganizations.\t<\/p>\n<p>While\ton\tthe\tindividual\tlevel\tprofessional\tautonomy\tsafeguards\tthe\tpatient-physician<br \/>\nrelationship,\tat\tthe\torganizational\tlevel\tthis\tis\treflected\tin\tthe\tmedical\tethics\tand\tthe\tself-<br \/>\ngoverning\tstructures\twhich\tmake\tit\tup.\t<\/p>\n<p>But\tpatients\u2019\trights\talso\thave\tlimits.\t<\/p>\n<p>The\trights\tof\tpatients,\tlike\tother\tindividual\trights,\tare\tlimited\tas\tany\tother\trights\tare.<br \/>\nThe\tmost\tobvious\tlimitation\tit\tthe\tone\tof\tlimited\tresources.\tWhether\tthese\tare\tnatural\tlimits\tor<br \/>\nartificial\tlimits\t&#8211;\tat\tany\tpoint\tseveral\tpatients\tor\tindividuals\tmay\tcompete\tfor\tthe\tsame<br \/>\nresources.\t\t<\/p>\n<p>While\tin\tthe\tdistribution\tof\twelfare\twe\tusually\tapply\tthe\tprinciple\tof\tproximity,\twe\tserve\tthose<br \/>\nclose\tto\tus\tin\tour\tcommunities\tfirst.\tThe\trationing\tof\tmedical\tcare\tis\tbound\tto\tmedical\tneed\tand<br \/>\nnot\tto\taffiliation\tof\tany\tkind.\tTraditionally,\tthis\tmodel\tcomprises\ta\tproduct\tof\tmedical\tneed\tand<br \/>\nlikelihood\tof\tbenefiting\tfrom\ttreatment,\tand\tmore\trecently\tit\tis\toften\tcombined\twith\ta\tmeasure<br \/>\nof\tefficacy,\tconsidering\tthe\tcost\tof\ttreatment.\t<\/p>\n<p>But\tpatient\trights\tcan\talso\tbe\tlimited\tin\tcompetition\twith\tthe\trights\tof\tthe\tphysician.\tFirstly,<br \/>\nthere\tis\tno\tright\tof\ta\tpatient\tto\tdemand\ttreatment\tfrom\ta\tspecific\tphysician\t\u2013\tat\tleast\tas\tlong\tas<br \/>\nalternatives\tare\tavailable.\tIn\tprinciple,\tand\tthis\tmay\tbe\taltered\tby\tcontracts,\ta\tphysician\thas\tthe<br \/>\nright\tto\trefuse\ttreatment\tif\tan\temergency\tsituation\tdoes\tnot\tforce\thim\tto\tact\timmediately.\tThis<br \/>\nmay\thappen\tbecause\tthe\tphysician\thas\tlost\tthe\ttrusting\trelationship\twith\this\tor\ther\tpatient,\tit<br \/>\nmay\tbe\tbecause\tthe\tphysician\tis\toverworked,\tor\tsimply\tfor\treasons\tthe\tphysician\twill\tnot<br \/>\ndeclare.\tAgain,\tthis\tis\tonly\tfeasible\twhen\tthere\tis\tno\temergency\tsituation\tand\tthe\tpatient\tcan<br \/>\nreceive\ttreatment\telsewhere.\t<\/p>\n<p>The\tDeclaration\tof\tGeneva\tand\tthe\tInternational\tCode\tof\tMedical\tEthics\tdemand\tthe\tphysician<br \/>\nto\texercise\this\tor\ther\tprofession\twith\tconscience.\tThat,\tof\tcourse,\tis\tmeaningless\tif\ta<br \/>\nconscientious\tobjection\tis\timpossible.\tNo\tphysician\tmust\tbe\tforced\tto\tcarry\tout\tactivities\tthat<br \/>\nare\teither\tdeemed\tto\tbe\tunethical\taltogether,\tlike\tparticipation\tin\tcapital\tor\tcorporal<br \/>\npunishment,\tthe\tforce\tfeeding\tof\tprisoners\tor\tto\tperform\tservices\the\tmorally\tcannot\tsubscribe<br \/>\nto.\t<\/p>\n<p>In\tessence,\tphysicians\tdo\tnot\tsurrender\ttheir\thuman\trights\twhen\tbecoming\ta\tphysician.\tNot\tbe<br \/>\ncoerced\tto\tprovide\tcertain\ttreatments\tis\ta\tmatter\tof\tdignity\tand\tintegrity\tfor\tthe\tphysician\tas<br \/>\nwell.\tAnd\tlikewise,\ta\tphysician\tdoes\tnot\tlose\tthe\tright\tto\tbuild\tcoalitions\tfor\this\tinterests\ti.e.\this<br \/>\n\t 6<br \/>\nor\ther\tsalary\tor\tworking\tconditions.\tWhere\tthe\tright\tto\tstrike\texists,\tthere\tis\tno\tjustifiable\treason<br \/>\nto\tdeny\tthis\tright\tto\tphysicians\tin\tparticular.\t<\/p>\n<p>Achieving\ta\tbalance\tbetween\tthe\trights\tof\tpatients\tto\tbe\ttreated\tand\tthe\tright\tof\tphysicians\tto<br \/>\nindustrial\taction\tappears\tfor\tmany\tphysicians\tto\tbe\tan\tinsurmountable\ttask.\tMany\tof\tus\tsee<br \/>\ngoing\ton\tstrike\tas\ta\tviolation\tof\tthe\tethical\timperative\tto\tdo\tno\tharm.\tHowever,\tphysician\tstrikes<br \/>\nof\tthe\tpast\tdecades\thave\tshown\tthat\tpatients\twho\tunderstand\tthe\tphysicians\u2019\tperspective\tand<br \/>\nwho\tfeel\treassured\tthat\tthey\twill\treceive\turgent\ttreatment\tshow\tunderstanding,\trespect\tand<br \/>\nsometimes\teven\tsupport\tfor\ttheir\tphysicians.\tSuch\tsuccessful\tstrikes\thave\teither\tconcentrated<br \/>\non\tadministrative\ttasks\tin\thospitals\tor\tclinics,\tthereby\tmaking\tbilling\textremely\tdifficult,\tor\tthey<br \/>\nhave\tstrictly\tensured\tthat\twhile\ttruly\telective\ttreatments\twere\tpostponed,\temergency\tand<br \/>\npressing\ttreatments\twere\tcarried\tout\tproperly\tand\ton\ttime.\t<\/p>\n<p>And\twhile\tmost\tof\tmy\tcolleagues\twould\tagree\twith\tme\tthat\tphysician\tstrikes\tare\ta\tmethod\tof<br \/>\nlast\tresort,\tthey\tare\tnot\tprincipally\texcluded\tfor\tethical\treasons,\tas\tlong\tas\tthis\tdoes\tnot\tcause<br \/>\nharm\tto\tthe\tpatients.\t<\/p>\n<p>Let\tme\tsummarize:\t<\/p>\n<p>Patient\trights\tshould\tthey\tbe\tmeaningful\tand\tmust\tinclude\tan\tindividual\tright\tto\teffective\tand<br \/>\ntimely\ttreatment\tthat\tis\tmedically\tnecessary\tand\tdesired\tby\tthe\tpatient.\tThese\trights\tshould\talso<br \/>\ninclude\tor\tenable\tthe<br \/>\n\u2022 freedom\tof\tchoice<br \/>\n\u2022 dignity\tand\tself-determination<br \/>\n\u2022 the\tright\tto\tinformation\tas\twell\tas\tthe\tright\tnot\tto\tknow<br \/>\n\u2022 the\tright\tto\tconfidentiality<br \/>\n\u2022 and\tthe\tright\tto\treligious\tassistance\t<\/p>\n<p>Secondly,\tpatient\trights\tare\tnot\tto\tbe\tconfused\twith\t\u201cconsumer\trights\u201d.\tPatient\trights\textend\tfar<br \/>\nbeyond\tthat\tconcept.\tPatients\tare\tnot\tsimply\t\u201ccustomers\u201d\tand\tdoctors\tare\tnot\tsimply\t\u201cservice<br \/>\nproviders\u201d.\t\t<\/p>\n<p>Thirdly,\tprotecting\tpatient\trights\trequires\tdoctors\tto\thave\tnecessary\tprofessional\tautonomy<br \/>\nallowing\tthem\tto\tput\ttheir\tpatients\tfirst\tand\tnot\tthe\tfinancial\tinterest\tof\tany\tother\tparty,<br \/>\nincluding\tthemselves.\tThis\tdoesn\u2019t\trule\tout\tthe\tobligation\tto\tsave\tand\tshare\tresources,\tbut\tit<br \/>\ndoes\tnot\tallow\tfinancial\tinterests\tto\tbe\tput\tfirst.\t<\/p>\n<p>Fourthly,\ta\tsolid\tself-governing\tstructure\tis\tnecessary\tto\tprovide\tthe\tethical\tand\tprofessional<br \/>\nframework\tto\tguide\tthe\tbehaviour\tof\tphysicians.\tIdeally,\tleading\ta\tpatient\tby\tshared\tdecision-<br \/>\nmaking\tthrough\tan\tultimately\tself-determined\tprocess\t&#8211;\tif\tthe\tpatient\twishes\tto\tdo\tso.\t<\/p>\n<p>Fifth,\tpatient\trights\thave\tlimits.\tThey\tmay\tbe\tlimited\tby\tthe\tcompeting\trights\tof\tother\tpatients\tor<br \/>\nsociety,\tbut\talso\tby\tthe\trights\tof\ttheir\tphysicians.\tPatients\u2019\trights\tto\tan\teffective\tmedically<br \/>\nindicated\ttreatment\tdo\tnot\tautomatically\tforce\tobligations\ton\tother\tindividuals,\tunless\tserious<br \/>\ndanger\tor\tsuffering\tis\timminent.<br \/>\n\t 7\t<\/p>\n<p>Let\tus\tgo\tback\tto\tAnna,\tthe\tlittle\tgirl\tin\tthe\thospital.\tAnna\thad\tbone\ttuberculosis.\tThe\tsurgery\tto<br \/>\namputate\ther\tfoot\tmost\tlikely\tsaved\ther\tlife.\tNevertheless,\ther\tfather\tsued\tthe\tphysician<br \/>\nbecause\tthe\tamputation\twas\tcarried\tout\tagainst\this\twill.\t<\/p>\n<p>A\tyear\tlater\tthe\tnational\tcourt\tstated:\t\t<\/p>\n<p>\u201cThe\tfact\tthat\tsomebody,\taccording\tto\this\tconviction\tor\tthe\tjudgment\tof\this\tpeers,\thas\tthe<br \/>\nability\tto\tunderstand\tthe\treal\tinterest\tof\this\tnearest\tbetter\tthan\thim\tor\therself,\t[&#8230;]\tdoes\tnot<br \/>\ngive\tthat\tperson\tthe\tlegal\tright\t[&#8230;]\tto\texercise\tforce\tand\tto\tuse\tthe\tother\tperson\u2019s\tbody\tfor\twell-<br \/>\nmeant\ttreatment\tattempts.\u201c\tThis\twas\tthe\timperial\tcourt\tof\tGermany\ton\tMay\t31st<br \/>\n,\t189411<br \/>\n.\t<\/p>\n<p>More\tthan\t120\tyears\tlater,\twe\tare\tstill\tlearning.\t<\/p>\n<p>Thank\tyou\tvery\tmuch\tfor\tyour\tattention.\t<\/p>\n<p>1<br \/>\n\tConstitution\tof\tthe\tWorld\tHealth\tOrganization,\t1946<br \/>\nhttp:\/\/www.who.int\/governance\/eb\/who_constitution_en.pdf<br \/>\n2<br \/>\nUnited\tNations\tUniversal\tDeclaration\tof\tHuman\tRights,\t1948<br \/>\nhttp:\/\/www.un.org\/en\/universal-declaration-human-rights\/<br \/>\n3<br \/>\nUnited\tNations\tInternational\tCovenant\ton\tEconomic,\tSocial\tand\tCultural\tRights<br \/>\nhttp:\/\/www.ohchr.org\/EN\/ProfessionalInterest\/Pages\/CESCR.aspx\t1966,\t1976\t(entry\tinto\tforce)<br \/>\n4<br \/>\nUnited\tNations&#8217;\tCommittee\ton\tEconomic,\tSocial\tand\tCultural\tRights\tissue\ta\tstatement\tentitled<br \/>\nComment\tNo.\t14\tE\/C.12\/2000\/4\t,\t11\tAugust\t2000<br \/>\nhttp:\/\/www.nesri.org\/resources\/general-comment-no-14-the-right-to-the-highest-attainable-standard-of-<br \/>\nhealth-un-committee-on-economic-social-and<br \/>\n5<br \/>\nWMA\tDeclaration\tof\tGeneva\t1948,\t2006\t(last\tversion)<br \/>\nhttps:\/\/www.wma.net\/en\/30publications\/10policies\/g1\/<br \/>\n6<br \/>\nWMA\tInternational\tCode\tof\tMedical\tEthics,\t1949,\t2006\t(last\tversion)<br \/>\nhttps:\/\/www.wma.net\/en\/30publications\/10policies\/c8\/<br \/>\n7<br \/>\nWMA\tDeclaration\tof\tHelsinki\t1964,\t2013\t(last\tversion)<br \/>\nhttps:\/\/www.wma.net\/en\/20activities\/10ethics\/10helsinki\/<br \/>\n8<br \/>\nWMA\tDeclaration\tof\tTokyo\t1975,\t2005\t(last\tversion)<br \/>\nhttps:\/\/www.wma.net\/en\/20activities\/10ethics\/20tokyo\/<br \/>\n9<br \/>\nWMA\tDeclaration\tof\tLisbon\t1981,\t2015\t(last\tversion)<br \/>\nhttps:\/\/www.wma.net\/en\/30publications\/10policies\/l4\/<br \/>\n10<br \/>\nPaul\tKrugman.\tPatients\tAre\tNot\tConsumers,\tNew\tYork\tTimes\t21.04.2011<br \/>\n11<br \/>\nReichsgericht\tRGSt\t25,\t375\tEntscheidungen\tdes\tReichsgerichts\tin\tStrafsachen,\t1894\t<\/p>\n"},"caption":{"rendered":"<p>Patient-rights-20160118 1 The Patients\u2019 Rights Act 20 years on \u2013 Achievements and Challenges Monday, 18 January 2016 Peres Center for Peace Jaffa, Israel Patients&#8217; Rights &#8211; A World View Dr. Otmar Kloiber Secretary General World Medical Association President of the Israeli Medical Association, Dr. Eidelman, Distinguished Guests, Shalom! Thank you for inviting the World Medical [&hellip;]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":13299,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/Patient-rights-20160118.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media\/4643"}],"collection":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/comments?post=4643"}]}}