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Patients' rights or patients' neglect: the impact of the patients' rights movement on delivery systems.

This paper offers a clinician's perspective on the complex and controversial issues related to "patients' rights." It is suggested that such "rights" interpreted and applied literally may contravene the basic right of the individual to receive needed treatment. Related issues are discussed, and a mechanism for exploring resolutions to the conflict between psychiatry and the law is suggested.

Adolescent

Take patient rights seriously to improve patient care and to lower costs.

Administrators can increase the quality of care and lower costs by taking patient rights seriously. Small rural hospitals as well as large urban ones can do this by encouraging the patient's right to self-determination and by gaining the support of employees and community alike.

Community-Institutional Relations

Professional ethics and patients' rights: past realities, future imperatives.

The nature and application of professional ethics in relation to patients' rights is not always clearly understood by healthcare professionals. As a result, patients' rights are not always respected or upheld in a way that they ought to be. An undersirable consequence of this has been that patients have suffered otherwise avoidable harms. The issue of professional ethics and patients' rights is one of concern to all healthcare professionals. It is of particular concern to nurses since they are the ones who are often caught in situations involving abuses of patients' rights. This paper briefly examines the failure of professional ethics to prevent patients' rights' abuses in healthcare contexts. It also makes recommendations on how the nursing profession could respond to this problem.

Altruism

Drug rechallenge and patients' rights.

Challenging a hypersensitive patient with a potentially harmful drug is most important to the development of medical knowledge. However, it does not always serve the interest of the particular patient. In order to protect the interest of an individual patient, one must abstain from challenge unless it is vital to the health of the particular patient at the time and has no substitute. Patients' rights demand the establishment of limitations and guidelines for the procedure of rechallenge in all its aspects. An approach which will bring physicians closer to a solution, which will protect the patient from uncontrolled decisions and from unnecessary risks, is suggested.

Clinical Protocols

Michigan's system for protecting patients' rights.

Michigan's approach to protecting patients' rights is based on the statutory guarantee of those rights, through the 1975 mental health code, and on a set of specific administrative procedures. An office of recipient rights was established in the Department of Mental Health, and rights advisers appointed in all 23 state institutions. When a complaint is filed, the institution is allowed to act first, to investigate the complaint and provide a remedy if it is substantiated. The state office monitors the institution's actions and intervenes when necessary or when a complainant appeals the outcome. During the first 17 months, 2258 complaints were filed. Of the 1866 resolved in that period, 572, or 31%, were substantiated and resulted in remedial action.

Civil Rights

[Patients' rights in the Czech Republic].

The ethical code, the so-called Patients' rights, was published on February 25, 1992 and applies in Bohemia and Moravia. The initiative in this matter was taken by the Central ethical commission of the Ministry of Health of the Czech Republic. The latter commission prepared a draft of the Czech version and after comments supplemented the text approved and proclaimed it. In the submitted paper the text of the document is presented in extenso and the author explains the history of patients' rights in Europe.

Czechoslovakia

Patients' rights in a Third World southern African country, with special reference to Bophuthatswana: is there any potential for privatisation?

Patients' rights to medical care, to inviolability without informed consent, and to medical screening tests, for example, are determined by the legal system to which they are subject. The interests of the individual must be weighed against the interests of the society to which he or she belongs, as this must be the criterion used to establish the extent of their rights, if any. The rights of an AIDS patient in a First World country and those of an AIDS patient in a Third World country are bound to differ in extent. The emphasis in the simultaneous duties of the state towards an individual AIDS patient and to society as a whole will differ from state to state. The First and Third World sectors are differentiated with reference to privatisation, and legal forms are touched upon.

Africa, Southern

A system for patients' rights advocacy in state psychiatric inpatient facilities in Maryland.

A patients' rights advocacy system was developed in 1986 by the Maryland Department of Health and Mental Hygiene to serve patients hospitalized in 12 state facilities. The system includes a four-level appeal program that attempts to resolve grievances through mediation between patients and state staff and a legal assistance program operated by attorneys under state contract. Data from fiscal year 1990 indicate that issues related to treatment, to seclusion and restraint, and to admission, discharge, and transfer generated the most complaints. The majority of complaints were resolved without legal intervention at the first stage of the appeal program, usually in a meeting between a rights adviser, the patient, and the patient's primary physician.

Commitment of Persons with Psychiatric Disorders

The therapeutic community: toward a model for implementing patients' rights in psychiatric treatment programs.

This article identifies patients' rights demands and discusses the therapeutic community's potential to act as the conceptual framework for implementing these demands. The author cites five areas in which policy and procedural changes will have to be made: philosophy, physical environment, organizational structure, program, and staff roles and attitudes. Recommendations for change are made in each area. The author concludes that the therapeutic community concept and its philosophy of treatment provide a viable alternative to traditional mental health policy and practice and have the capacity to become the conceptual framework for future residential treatment.

Attitude of Health Personnel