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National Institute for Patient Rights |
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Protecting and Promoting Patient Rights |
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Know Your Rights |
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No discussion of patient autonomy rights would be complete without a consideration of the standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The Joint Commission has been on the forefront of trying to resolve the most challenging problem confronting modern health care delivery: a failure to communicate. So, consider precisely how JCAHO works to strengthen your hand in protecting yourself from the violation of patient rights. Patient rights are a primary focus of the Joint Commission. This fact is reflected in the first set of standards for operational accreditation entitled, “Ethics, Rights, and Responsibilities.” Patient rights occupy first place among all JCAHO standards, because the Commission believes they lay an essential foundation to, and provide the framework for, the delivery of your care. Specifically, the standards in this section ensure that: (1) healthcare professionals pursue your good as a patient; (2) they deliver your care in a way that respects your rights to self-determination and to informed consent; and (3) that you and your significant others are intimately involved in all aspects of the medical treatment decision-making process. In its accreditation process, the Joint Commission states that it seeks evidence your hospital respects patient autonomy by engaging in “shared decision-making.” The Commission pointedly defines ‘shared decision-making’ in terms of the ‘subjective’ or ‘patient-centered’ interpretation of informed consent. Rather than a mere list of options for your consideration, your doctor must open up a dialogue with you based on what he or she knows of your unique lifestyle. ‘Shared decision-making’ is a model for negotiation and collaboration among healthcare professionals and between doctors and patients. The Joint Commission is clear: healthcare professionals must not interpret informed consent as a one-time event or as a signature on a form. Informed consent is a process. It is a process intended to protect patient autonomy through the documentation of information-sharing between doctor and patient, such as an advance directive. Here is a sampling of patient rights protected under the Joint Commission: You have the right to consent or refuse any treatment, as permitted by law—if you refuse a recommended treatment, you have the right to receive other needed and available care. You have the right to know about hospital rules that affect you and your treatment and about charges and payment methods. You have the right to receive compassionate care that respects your personal, spiritual, cultural, and religious values and beliefs. You have the right to be told of realistic care alternatives when hospital care is no longer appropriate. You have the right to have an advance directive, such as a living will or health care proxy. You have the right to privacy. You have the right to expect that treatment records are confidential unless you have given permission to release information or reporting is required or permitted by law. You have the right to review your medical records and to receive an accounting of disclosures regarding your own health information, as permitted by law. You have the right to review your bill, have the information explained to you, and get a copy of the bill. You have the right to know about hospital resources, such as patient complaints and grievance processes, patient representatives or ethics committees, that can help you promptly resolve problems and questions about your hospital stay and care. You have the right to lodge a grievance with a state or federal agency directly, regardless of whether you first use a hospital’s grievance process. You have the right to know the identity and professional status of those who care for you. |