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	Human rights in patient care
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Human rights in patient care

Chapter 1: Introduction

This Guide is part of a series published in cooperation with the Law and Health Initiative of the Open Society Institute (OSI) Public Health Program, OSI’s Human Rights and Governance Grants Program, OSI’s Russia Project, and the Soros Foundations of Armenia, Georgia, Kazakhstan, Kyrgyzstan, Macedonia, and Ukraine. Designed as a practical, “how to” manual for lawyers, it aims to provide an understanding of how to use legal tools to protect basic rights in the delivery of health services. The Guide systematically reviews the diverse constitutional provisions, statutes, regulations, by-laws, and orders applicable to patients and health care providers and categorizes them by right or responsibility. It additionally highlights examples and actual cases previously taken by lawyers.

The aim of the Guide is to strengthen awareness of existing legal tools that can be used to remedy abuses within patient care. If adequately implemented, current laws have the potential to address pervasive violations of rights to informed consent, confidentiality, privacy, and non-discrimination. As this can be accomplished through both formal and informal mechanisms, this Guide covers litigation and alternative forums for resolving claims, such as ombudspersons and ethics review committees. It is hoped that lawyers and other professionals will find this book a useful reference in a post-Soviet legal landscape, often rapidly in flux.

This Guide uses the concept of “human rights in patient care,” which brings together the rights of both patients and health care providers. The concept of human rights in patient care refers to the application of general human rights principles to all stakeholders in the delivery of health care. These general human rights principles can be found in international and regional treaties such as the International Covenant on Civil and Political Rights, the International Covenant on Economic, Social and Cultural Rights, the European Convention on the Protection of Human Rights and Fundamental Freedoms, and the European Social Charter. These rights are universal and can be applied to the delivery of health care as to any other context.

Overview of the Guide

Chapters 2 and 3 of the Guide respectively cover the international and regional law governing human rights in patient care. They examine relevant “hard” and “soft” law and provide examples of cases and interpretations of treaty provisions. These two chapters are identically organized around established human rights applicable to both patients and providers. These are rights to liberty and security of the person; privacy; information; bodily integrity; life; highest attainable standard of health; freedom from torture, cruel, inhuman, and degrading treatment; participation in public policy; and non-discrimination and equality for patients and rights to work in decent conditions, freedom of association; and due process for providers. Chapter 4 then provides information on the international and regional procedures for protecting these rights.

Chapters 5, 6, 7, and 8 are country-specific. Chapter 5 clarifies the legal status of international and regional treaties ratified, signed or adopted by Russia, explains the country’s use of precedent, and includes a brief description of the legal and health system. Chapter 6 deals with patient rights and responsibilities. The patient rights section is organized according to the rights in the European Charter of Patients’ Rights, with the addition of any country-specific rights not specifically covered by the Charter. Drawn up in 2002 by the Active Citizenship Network—a European network of civic consumer, and patient organizations—the European Charter of Patients’ Rights is not legally binding, but is generally regarded as the clearest and most comprehensive statement of patient rights. The Charter attempts to translate regional documents on health and human rights into 14 concrete provisions for patients: rights to preventive measures, access, information, consent, free choice, privacy and confidentiality, respect of patients’ time, observance of quality standards, safety, innovation, avoidance of unnecessary suffering and pain, personalised treatment, the filing of complaints, and compensation. These rights have been used as a reference point to monitor and evaluate health care systems across Europe and as a model for national laws. Chapter 6 thus uses the rights enumerated in the European Charter of Patients’ Rights as an organizing principle, but under each right, the applicable binding provisions under the national laws are presented and analyzed. These rights are then cross-referenced with the more general formulation of rights in the international and regional chapters. Chapter 7 focuses on provider rights and responsibilities, including the rights to work in decent conditions, freedom of association, due process, and other relevant country-specific rights.

Chapter 8 covers the national mechanisms for enforcement of both patient and provider rights and responsibilities. This encompasses administrative, civil, and criminal procedures and alternative mechanisms, including the Office of the Public Prosecutor, ombudspersons, ministries of internal affairs, ethics review committees, and inspectorates of health facilities. It additionally contains an annex of sample forms and documents lawyers would need to file.

The final section is a glossary of terms applicable to the field of human rights in patient care. Some Guides also include a section of the glossary with country-specific terminology. The glossary will enable greater accessibility of law, health, and human rights material.

Uses of the Guide

The Guide has been designed as a resource for both litigation and training. The Guide may be particularly useful in clinical legal education programs. Although designed for lawyers, it may additionally be of interest to medical professionals, public health managers, Ministries of Health and Justice personnel, patient advocacy groups, and patients themselves, who desire a firmer understanding of the legal basis for patient and provider rights and responsibilities and available mechanisms for enforcement.

Accompanying Websites

The field of human rights in patient care is constantly changing and evolving, necessitating the need for regular updates to the Guide. Electronic versions of the Guides will thus be periodically updated at: http://www.health-rights.org/. This international homepage links to country websites which also include additional resources gathered by the country working groups that prepared each Guide. These include relevant laws and regulations, case law, tools and sample forms, and practical tips for lawyers. The websites also provide a way to connect lawyers, health providers, and patients concerned about human rights in health care. Each of the websites provides a mechanism for feedback on the Guides.

Note from the Authors

The material in this Guide represents the views of an interdisciplinary working group composed of legal and medical experts. The Guide does not carry judicial or legislative authority, nor does it substitute for legal advice from a qualified lawyer. Rather, it represents the authors’ attempt to capture the current state of the law and legal practice in the field of human rights in patient care in Russia. The authors welcome any comments about errors, omissions, or suggested additions to the Guide, as well as questions about how the law might apply to a particular factual scenario.

As this Guide illustrates, the field of human rights in patient care is still new and evolving in Russia. Many of the statutory provisions cited in the Guide have not been authoritatively interpreted by courts, and those that have still remain open to additional application and interpretation. There remain huge gaps in understanding of how human rights in patient care apply in practice. This Guide is thus a starting point for legal inquiry, not a final answer. It is hoped that this Guide will attract new professionals to the field of human rights in patient care, and that future editions will be much richer in their elaboration of legal protections.