4. Directory of patient rights and responsibilities: legal content analysis

Patients' rights and responsibilities are linked to the principle of equality between the parties involved in the healthcare relationship and the prevention of consumerism in this relationship. As the legal status of a patient as a patient arises from the moment when he or she is referred to a health care facility, not only the exercise of rights but also the fulfilment of his or her duties are an integral part and a condition of health care services. This part covers the range of rights and obligations, their legal content, and problems in the implementation and application of the legal norms when establishing the duties.

The Law on the Rights of Patients and Compensation for Health Damages of the Republic of Lithuania states that the patient has the right to quality healthcare. This means that a healthcare institution may be subject to civil, administrative or criminal liability for violation of the patient's right and, in a broader sense, a healthcare professional (e.g. doctor, nurse) as a healthcare worker, may encounter criminal, administrative, disciplinary, material or civil liability. However, the nature of the legal relationship itself - whether personal health care services are provided by a personal health care institution for saving the health or life of the patient - is of greater legal significance.[41] These statements lead to the conclusion that more emphasis is placed on the exercise of patients' rights than on the fulfilment of their duties. In general, law has the complex task of responding to society's expectations of predicting and defining unpredictable and uncertain future phenomena, thus ensuring the durability and validity of its effects[42]. To achieve this goal, the law has to balance against different interests and views on the basis of justice, which means giving the behaviour of the participants a balance of rights and responsibilities without favouring any of the participants, by consistently upholding equality of subjects, blocking any attempt to put the interests of one person above the interests of others. The theory of law in this conception of unity of rights and duties, in the context of the development of human rights, foresees the direction of the problems - the increasing separation of individual rights from their duties.[43] For this reason, it is considered that in the European Union, patients' obligations are governed by legislation in only three countries[44]. Since 2010, a comprehensive Directory of patients' responsibilities, grouped in general and specialist positions under the scientific doctrine[45] has come into effect in Lithuania. General obligations include standards of conduct for all patients as participants in a civil legal relationship, such as fair use of their rights, prohibition of their abuse, duties of cooperation and health care, as well as an ethical duty to treat all participants in a health care relationship properly. Special obligations include: the obligation to confirm in writing the fact of acquaintance with the rules of procedure of the health care institution and other documents, as established by the health care institution, and to comply with the duties specified therein; the obligation to provide identification documents; the obligation, in cases established by law, to confirm in writing their consent to or refusal of health care services; an obligation to provide health professionals with information about their health, to follow appointments and recommendations made by health professionals, and to report any deviations in the appointments or prescribed regimes the patient has consented to. The point of entry of duties coincides with the moment of entitlement to quality healthcare, i.e. from the moment the patient becomes a legal entity, such as a referral to a healthcare provider.

In the context of the content in question, the obligations of patients are distinguished in more detail: the duty to exercise patient rights in good faith and the prohibition of their abuse; the duty to treat all healthcare workers and other patients with respect and dignity. These responsibilities fall within the general duties of the patient.

The obligation to exercise patient rights in good faith and the prohibition of their abuse are linked to the general requirement of the conduct of the participants in a civil law relationship. The category of law "fairness" appeared in Roman law as "bona fides" (Latin - for good faith, sincerely, quite frankly). It is a valuable measure of human behaviour, which is determined by two criteria – the objective and the subjective one. Objective honesty is the behaviour of a person in line with the behaviour of a reasonable, caring, and truthful person in a given situation, i.e. whether the person had to do something or not. The interpretation of this principle in the Civil Code is based on the other two general principles of law, reasonableness and justice, as criteria that complement good faith. Subjective honesty is understood as the mental state of a person, i.e. whether the person was able to do or not do something. Concretizing this valuable measure of human behaviour through the prism of patient behaviour, it is distinctive that, subjectively, a patient's honesty should be measured through his or her internal relation to reality, mental, and health status in a given situation - i.e. whether the patient knew or could have known certain circumstances, was able to do or not do something, taking into account subjective actions, such as their age, disease status, etc. This criterion is particularly important when assessing patient behaviour in the context of legal liability.

Obligation to treat all healthcare workers and other patients with respect and dignity. It is a moral-ethical norm and its consolidation is linked to the prevention of inappropriate behaviour by patients. This duty of the patient is aimed at a wide range of subjects, primarily healthcare workers. [46] Disrespect is characterized by rudeness, indifference, neglect, disregard of others, hostility, harshness, verbal and physical aggression, severity, insulting, humiliating, harassment, ruthlessness, obsession, obscenity of mannerisms, being tactless, disregarding other etiquette norms (such as punctuality, decency, benevolence, humanity, correctness, attentiveness, and flexibility).  The standard of good conduct includes respect for the time and privacy of health care personnel and other patients, and compliance with prohibitions and requirements set forth in its internal rules, such as not disturbing, littering, stealing, and smoking or drinking, to demonstrate respectful attitude towards the staff, other patients and visitors, follow personal hygiene standards, etc.

In accordance with the Law on Patients' Rights and Compensation for Health Damages, the legislator also foresees legal consequences for the patient for failure to perform or improper performance of their duties. Paragraph 9 of Article 12 of the said Law confers on the healthcare institution the right to suspend the provision of healthcare to the patient in the event of the latter's breach of his / her obligations. The norm formulates two alternative conditions: breach of duties, endangering their own and other patients' health and life, or impeding their access to quality healthcare. At the same time, however, there is an exception, which, even in the case of the abovementioned infringements, prohibits the termination of healthcare. These are cases where the health care provider is obliged to provide services (i.e. cannot interrupt their provision) when the patient's life is at risk.

 

 

 

Review questions:

1. What does the principle of unity of rights and duties mean and what are the legal problems that are reflected in the concept of rights and obligations in the field of healthcare?

2. What are the obligations of patients and what are the legal requirements for such duties?

3. What are the legal consequences of the patient's failure to perform his / her duties?