Declaration of Lisbon on the Rights of the Patient
DECLARATION OF LISBON ON THE RIGHTS OF THE PATIENT
World Medical Association
Whereas most of the early documents on patients' rights, such as the American Hospital Association's A Patient's Bill of Rights, focus on the rights of individuals within healthcare facilities (hospitals, nursing homes), the Declaration of Lisbon, adopted in 1981 by the 34th World Medical Assembly at Lisbon, is an international statement of the rights of patients in general. In conjunction with the International Code of Medical Ethics (Section II), it illustrates the relatively recent emphasis placed on "the rights of patients" in addition to the traditional "duties of physicians." Physicians not only "ought" to behave in certain ways, but patients also are entitled to have them do so. The Declaration of Lisbon was amended by the 47th General Assembly in Bali, Indonesia in September, 1995. This most recent version provides much more detail regarding the nature of the rights patients possess, particularly rights to quality information and health education.
The relationship between physicians, their patients and broader society has undergone significant changes in recent times. While a physician should always act according to his/ her conscience, and always in the best interests of the patient, equal effort must be made to guarantee patient autonomy and justice. The following Declaration represents some of the principal rights of the patient which the medical profession endorses and promotes. Physicians and other persons or bodies involved in the provision of health care have a joint responsibility to recognize and uphold these rights. 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.
In the context of biomedical research involving human subjects—including non therapeutic biomedical research— the subject is entitled to the same rights and consideration as any patient in a normal therapeutic situation.
- 1. Right to medical care of good quality
- a. Every person is entitled without discrimination to appropriate medical care.
- b. Every patient has the right to be cared for by a physician whom he/she knows to be free to make clinical and ethical judgements without any outside interference.
- c. The patient shall always be treated in accordance with his/her best interests. The treatment applied shall be in accordance with generally approved medical principles.
- d. Quality assurance always should be a part of health care. Physicians, in particular, should accept responsibility for being guardians of the quality of medical services.
- e. In circumstances where a choice must be made between potential patients for a particular treatment which is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.
- f. The patient has the right of continuity of health care. The physician has an obligation to cooperate in the coordination of medically indicated care with other health care providers treating the patient. The physician may not discontinue treatment of a patient as long as further treatment is medically indicated, without giving the patient reasonable assistance and sufficient opportunity to make alternative arrangements for care.
- 2. Right to freedom of choice
- a. The patient has the right to choose freely and change his/her physician and hospital or health service institution, regardless of whether they are based in the private or public sector.
- b. The patient has the right to ask for the opinion of another physician at any stage.
- 3. Right to self-determination
- a. The patient has the right to self-determination, to make free decisions regarding himself/herself. The physician will inform the patient of the consequences of his/her decisions.
- b. A mentally competent adult patient has the right to give or withhold consent to any diagnostic procedure or therapy. The patient has the right to the information necessary to make his/her decisions. The patient should understand clearly what is the purpose of any test or treatment, what the results would imply, and what would be the implications of withholding consent.
- c. The patient has the right to refuse to participate in research or the teaching of medicine.
- 4. The unconscious patient
- a. If the patient is unconscious or otherwise unable to express his/her will, informed consent must be obtained whenever possible, from a legally entitled representative where legally relevant.
- b. If a legally entitled representative is not available, but a medical intervention is urgently needed, consent of the patient may be presumed, unless it is obvious and beyond any doubt on the basis of the patient's previous firm expression or conviction that he/she would refuse consent to the intervention in that situation.
- c. However, physicians should always try to save the life of a patient unconscious due to a suicide attempt.
- 5. The legally incompetent patient
- a. If a patient is a minor or otherwise legally incompetent the consent of a legally entitled representative, where legally relevant, is required. Nevertheless the patient must be involved in the decision making to the fullest extent allowed by his/her capacity.
- b. If the legally incompetent patient can make rational decisions, his/her decisions must be respected, and he/she has the right to forbid the disclosure of information to his/her legally entitled representative.
- c. If the patient's legally entitled representative, or a person authorized by the patient, forbids treatment which is, in the opinion of the physician, in the patient's best interest, the physician should challenge this decision in the relevant legal or other institution. In case of emergency, the physician will act in the patient's best interest.
- 6. Procedures against the patient's will
- a. Diagnostic procedures or treatment against the patient's will can be carried out only in exceptional cases, if specifically permitted by law and conforming to the principles of medical ethics.
- 7. Right to information
- a. The patient has the right to receive information about himself/herself recorded in any of his/her medical records, and to be fully informed about his/her health status including the medical facts about his/her condition. However, confidential information in the patient's records about a third party should not be given to the patient without the consent of that third party.
- b. Exceptionally, information may be withheld from the patient when there is good reason to believe that this information would create a serious hazard to his/her life or health.
- c. Information must be given in a way appropriate to the local culture and in such a way that the patient can understand.
- d. The patient has the right not to be informed on his/her 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/her behalf.
- 8. Right to confidentiality
- 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. Exceptionally, descendants may have a right of access to information that would inform them of their health risks.
- b. Confidential information can only be disclosed if the patient gives explicit consent or if expressly provided for in the law. Information can be disclosed to other health care providers only on a strictly "need to know" basis unless the patient has given explicit consent.
- c. All identifiable patient data must be protected. The protection of the data must be appropriate to the manner of its storage. Human substances from which identifiable data can be derived must be likewise protected.
- 9. Right to health education
- a. Every person has the right to health education that will assist him/her 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/her own health should be stressed. Physicians have an obligation to participate actively in educational efforts.
- 10. Right to dignity
- a. The patient's dignity and right to privacy shall be respected at all times in medical care and teaching, as shall his/her culture and values.
- b. The patient is entitled to relief of his/her suffering according to the current state of knowledge.
- c. The patient is entitled to humane terminal care and to be provided with all available assistance in making dying as dignified and comfortable as possible.
- 11. Right to religious assistance
- a. The patient has the right to receive or to decline spiritual and moral comfort including the help of a minister of his/her chosen religion.