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The health care rights of patients are sometimes referred to as Patients’ Bill of Rights. The rapid change in medical care moved health care decision making from patients to medical professionals, and eventually to business entities, a move that resulted in an erosion of trust in the health care industry. The Patients’ Bill of Rights was created by the American Hospital Association in 1973, and revised in 1992, to affirm the rights of patients and thus help patients feel more confident in the U.S. health care system. The Patients’ Bill of Rights offers some guidance and protection to patients by stating the duties and responsibilities that physicians and other health care workers have toward their patients. Also, it gives patients a way to address any problems they may have.
The purpose of delineating patients’ rights is to ensure the ethical treatment of persons receiving medical care services. While health care professionals are morally obligated to respect the rights of patients, patients also have certain responsibilities. For example, patients are expected to treat health care workers and other patients with respect, provide complete and accurate health information, pay their medical bills, and follow the rules of their health plan coverage. Among one’s basic rights as a patient is the right to make decisions about the course of treatment received, as well as to know about all reasonable alternative treatments. One also has the right, as a competent adult, to refuse any proposed treatment, even if doing so may mean that one will become sicker, or even die.
Newer bills of rights have been established to reflect changes in the health care system. For example, in 2010, a new Patient’s Bill of Rights was established under the Affordable Care Act (ACA), informally known as Obamacare. This newer Patient’s Bill of Rights focuses on patients’ rights in dealing with insurance companies. It was designed to give patients protections in dealing with insurance companies. Some of the protections started in 2010, but others were fully implemented in 2014. Under the new laws, (1) patients have the right to purchase health insurance, regardless of preexisting medical conditions; (2) patients are entitled to certain preventive screening without paying extra fees or co-pays; and (3) insurance companies are required to justify premium increases of more than 10 percent. Furthermore, the ACA requires health insurance companies to sell coverage to anyone who applies. It prohibits charging women more than men and allows young adults to stay on their parents’ policy until age 26, if they meet certain requirements.
While most Americans appreciate these health care rights of patients, these rights were the subject of much public debate and legislative action in the United States in the latter half of the 20th century, and continuing into this century. For example, while some argue that having patients involved in their care increases the chance of the best possible outcomes, others maintain that patients’ interests are best served by allowing physicians to make medical decisions.
Older Patients’ Bill Of Rights: Some Advantages And Disadvantages
One of the rights from the Patients’ Bill of Rights is the right to treatment or to refuse treatment. Currently, one of the most fundamental principles of American health care law is that competent patients have the right to accept or reject any medical treatment. Also, the common law and the U.S. Constitution protect a competent individual’s right to refuse medical treatment. Physicians are required to respect the right of competent adults to make decisions concerning their health care. Physicians and other health care professionals who refuse to honor the expressed wishes of their competent patients may face civil and administrative sanctions. Some people have justified patients’ rights to treatment or to refuse treatment on the grounds that mentally competent patients are uniquely qualified to decide what is in their interest. However, some have argued against the patient’s right to decide whether or not to pursue medical treatment. They argue that most patients are laypersons who are not capable of grasping complicated scientific theories and terminologies. Critics maintain that most patients are not in the best position to know what is best for them; therefore, granting them the right to decide on medical treatments might go against their long-term best interest.
The doctrine of informed consent has been developed in the American health care law as the primary means of protecting patients’ right to control their medical treatment. Under this doctrine, no medical procedure may be undertaken without the patient’s explicit consent and without having first furnished the patient with the information needed to obtain an informed consent. A patient who is not informed of alternative forms of treatment and their associated risks is denied the opportunity to make an informed medical decision. While a physician may consider his patient’s decision medically unsound, the physician is bound in law by the patient’s choice. The physician may try to reason and dissuade the patient from carrying out his or her “irrational” decision; however, the physician cannot overrule the patient’s decision.
To put patients, not medical professionals, in control of their health care, some American states have adopted the legal device of an advance directive, also called a living will. An advance directive is a document intended to govern the kind of life-sustaining treatment that an otherwise competent person would receive, should the person later become mentally incapacitated. An advance directive may also identify the individual who should function as proxy or substitute decision maker. However, advance directives may be problematic, especially in cases of medical emergency. Critics have argued that advance directives are virtually useless if they are not accessible to the emergency team looking after the patient. They argue that medical professionals cannot ensure that patients’ decisions really reflect their genuine values, instead of being the results of values that have been imposed on them by a third party.
Another important health care right of patients is the right to confidentiality and privacy. Patients have the right to confidentiality from all health care professionals. Since patients routinely share certain sensitive and personal information with health care providers, if the confidentiality of this information is not safeguarded, trust in the physician-patient relationship will ultimately be broken. Eventually, trust in the health care system will disappear. Patients would be reluctant to share medical information with medical professionals, which could adversely affect their care. Also, for conditions that might be stigmatizing, confidentiality assures that private information is highly protected. Such information, if leaked, might lead to the patient being discriminated against. For example, psychiatric health concerns, if divulged to the public, could affect the patient’s right to obtain housing, employment, and medical insurance. For this reason, all health care providers have a legal and ethical duty to keep a patient’s personal health information private, unless the patient explicitly consents to release the information. The Hippocratic Oath, the American Medical Association Principles of Ethics, and the American Nurses Association Code all recognize the need to safeguard patients’ personal information. Failure to protect patients’ confidentiality can lead to legal and disciplinary action.
There are overriding concerns that can lead to the need to breach a patient’s confidentiality, in certain circumstances. For example, confidentiality can be broken when a patient poses a danger to himself or to others or when a patient has a communicable disease. Some state laws require the report of certain fatally communicable or infectious diseases to public health authorities. In these cases, the duty that the state has to protect public health overrides the duty to maintain a patient’s right to confidentiality. For example, in Washington State, diseases such as measles, rabies, anthrax, sexually transmitted diseases, and tuberculosis are all considered reportable diseases. Barring these few instances, health care professionals are required to keep a patient’s medical information confidential. However, some maintain that in the modern technological world, it is not realistic to expect that all medical records will remain secret. They point out that electronic medical records can pose challenges to confidentiality. The widespread use of computer and fax transmissions opens the potential for seriously compromising patient confidentiality.
Obama Administration’s New Patient’s Bill Of Rights
On March 23, 2010, President Obama signed a new Patient’s Bill of Rights under the ACA into law. The new Patient’s Bill of Rights focuses on patients’ rights in dealing with insurance companies. The ACA seeks to put an end to some of the worst insurance abuses and put consumers, not insurance companies, in control of their health coverage and care. Since the old Patients’ Bill of Rights still applies to the situations and settings for which it was written, the ACA is created to supplement the old Patients’ Bill of Rights, not be a substitute for it.
Among other things, the new Patient’s Bill of Rights prevents insurance companies from discriminating against women, and particularly people with preexisting conditions. Starting 2014, no one seeking coverage could be discriminated against on the grounds of a preexisting condition or gender. Also, insurance companies are banned from canceling patients’ coverage because of an honest mistake on their application, but they can still rescind coverage if patients deliberately lie on their application form. With the ACA, cancer patients and individuals suffering from other chronic diseases can no longer be forced to go without treatment because of an insurer’s lifetime limit on their coverage. Also, patients who purchase or join a new policy are guaranteed the right to appeal insurance company decisions to an independent third party.
Furthermore, the new Patient’s Bill of Rights allows young adults to remain on their parent’s plan until their 26th birthday, unless they are offered coverage at work. It is estimated that about 2.4 million young adults could gain affordable coverage through this provision of the new law. The ACA gives patients the right to purchase or join a new plan, without being limited by which emergency room to go to or being charged more by insurance companies for emergency services obtained out of network. With the introduction of the ACA, services like mammograms, colonoscopies, immunizations, prenatal care, and new baby care will be covered, and insurance companies will be prohibited from charging deductibles, co-payments, or coinsurance.
Economic Ramifications Of The ACA
Critics argue that the ACA is a government takeover of the health care system, which accounts for about a sixth of the economy. Thus, they are skeptical about the government’s ability to regulate the new health care policy. Also, it has been argued that the ACA focuses more on making sure that many people are covered than on addressing the exorbitant cost of care. They argue that because the new Patient’s Bill of Rights bans insurance companies from dropping people who become sick from coverage, and because people cannot be charged more for being sick, insurance companies are forced to cover all sick people by increasing the cost of everyone’s insurance premium. Thus, critics believe that the ACA will eventually make most people worse off than before. Paradoxically, the ACA, according to critics, is unaffordable. Supporters of the ACA have responded to this by contending that since the vast majority of Americans will still get their old health insurance the way they did before the ACA, that is, through their employers or through a public program, mainly Medicare and Medicaid, the claim that everyone’s premium will go up is unfounded.
While the ACA allows small businesses to receive tax credits for up to 50 percent of their employees’ health insurance premium costs, starting in 2015, businesses with more than 50 full-time employees were mandated to provide health care. To circumvent this mandate, some businesses started cutting employee hours. This, according to some critics, will have a negative impact on the national economy. Furthermore, detractors of the ACA have argued that for the poor to benefit from the new health care policy, the government needs to offer subsidies to more than half of the people to help them make their payments. The problem, however, is that the availability of subsidies will disincentivize work among middle-class Americans, and thus perpetuate economic dependence. Thus, critics believe that the ACA will facilitate laziness and poverty in the lowest classes. This is so because, critics argue, people work less if their costs are shared. Thus, it is feared that Obamacare will lead to what economists refer to as a “tragedy of the commons”: the tendency of people to withhold work from collective undertakings.
For the ACA to work successfully, the law’s new insurance marketplaces need millions to sign up and many healthy people paying into the system to offset the medical cost of the sick. Thus, the system will depend heavily on those who do not become sick to finance the care of those who do. Because young people tend to be healthy, the success of the ACA will depend largely on many young people signing up. The problem, however, is that healthy young people might choose not to sign up. While the individual mandate requires virtually every citizen in the country to have insurance or else pay a fee, the penalty for lacking coverage (which is a mere $95) is less than the insurance premium, so most young and healthy people will deem it economically prudent to choose to pay the annual fine, rather than paying 12 months’ hefty insurance premiums. The result is that there will not be enough money in the system to cover those who are sick. Since the new Patient’s Bill of Rights under ACA allows insurance companies to cancel coverage if premiums are not paid on time, many poor people may lose their coverage.
Thus, to achieve the government’s goal of extending health insurance coverage to millions of poor people, critics contend that the government will have no choice but to borrow to cover those who are sick. Thus, critics argue that the new health care law will increase the national deficit. In response, proponents of the new Patient’s Bill of Rights have argued that because the ACA includes new spending cuts and tax increases, which more than offset the cost of expanding health insurance to millions of Americans, the health care law will rather reduce the deficit. For example, they argue that the ACA includes new taxes on a number of health care industries, including hospitals, medicaldevice makers, insurers, and pharmaceutical companies. The pros and cons mirror the complex nature of the new health care law. Thus, the new Patient’s Bill of Rights will continue to be the subject of much public debate and legislative action in the United States.
- Kirsch, Richard. Fighting for Our Health: The Epic Battle to Make Health Care a Right in the United Albany, NY: Rockefeller Institute Press, 2011.
- Miles, Toni. Health Care Reform and Disparities: History, Hype, and Hope. Santa Barbara, CA: Praeger, 2012.
- White House. “Patient’s Bill of Rights.” http://www.whitehouse.gov/files/documents/healthcare-fact-sheets/patients-bill-rights.pdf (Accessed August 2014).