Business Ethics in Healthcare: Beyond Compliance

Four: Patient Rights in a Just Organization

Respecting the rights of individual patients is a characteristic of an ethical healthcare organization. It is not the only characteristic, however. There is a need to understand clearly the ways in which respect for patient rights relates to a variety of ethical responsibilities. Medical ethicists have been engaged in ongoing re®ections on the nature and limits of patient rights. Concern that patients are sometimes subjected to unwanted treatment, especially near the end of life, has led to an emphasis on the patient’s right to refuse treatment. Concern that physicians are being forced to practice bad (futile) medicine has led to an effort to de¤ne the limits of the patient’s right to demand speci¤c treatment. Recognition of the diversity of cultural values in society has led to efforts to determine the accommodation that healthcare organizations should make to patients with different cultural values. Recognition of the importance of the non-dramatic ethical issues (“everyday ethics”) has led to concern about the rights of patients in relationship to institutional practices and concerns. The growth of managed care has led to efforts to clarify the rights of patients as enrollees in healthcare plans. The growing interest in complementary and alternative medicine may well lead to additional re¤nements of the meaning of patient rights. I have already explored, in the last chapter, some questions related to the nature of patient rights in regard to cost considerations. This chapter provides a discussion of the extent and limits of the rights of individual patients regarding treatment decisions, regarding accommodations to cultural values, and in relationship to other institutional interests. As was noted in Chapter 2, thinking carefully about ethical issues requires recognizing the difference between rights and wants or preferences. To say Four Patient Rights in a Just Organization that one has a right to something (using the word “right” in the strict sense) is to say that one can make a binding claim upon others. To honor and protect a true right is a fundamental ethical responsibility; to say that someone’s right has been violated is to make a most serious charge. Whether wants or preferences should be honored or accommodated, on the other hand, depends upon contextual considerations; one cannot usually make an ethically binding claim that wants or preferences be honored. Discussion of patient rights requires an effort to clarify, therefore, which interests should be considered rights and which are not at that level of ethical signi¤cance. Patient Rights and Treatment Decisions Case 4.1. The adult patient announces that his religious convictions as one of Jehovah’s Witnesses do not permit him to accept blood products under any circumstances. He is eager to get on with his recovery and does not object to medical treatment of any other sort. He asks for assurance that his beliefs regarding blood will be respected. Some members of the team caring for the patient later express their frustration about this request. They do not like having their “hands tied” by patients who want to bene¤t from aggressive medical care but who tell them not to do certain things that are part of that care. It is one thing for a patient to refuse medical intervention, they say; it is something else to tell the doctor what kind of medicine to practice. Medicine should not be looked upon as a menu from which the patient can pick and choose. The right of informed competent individuals to refuse unwanted treatment is one of the most basic rights of patients in healthcare. Even when a patient consents to other medical treatment as recommended by the physician, his or her refusal of a particular intervention should be honored. Respect for individuals means that they will not be treated, something will not be done to or for them, without their permission. As a basic protection of human dignity, the right to refuse treatment continues to merit the emphasis that it has received in the last three decades in American medical ethics. The hands of care providers are tied in cases like this only in one sense: they have no choice but to honor the patient’s refusal of blood products. Beyond that, however, they need to exercise their professional responsibility as in any other case. If, as a result of the patient’s refusal of speci¤c interventions , the proposed treatment no longer meets criteria for safety or effectiveness , it should not be provided. The patient’s decision may reduce options, but...