Patients’ Bill Of Rights Essay

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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.

Bibliography:

  1. Kirsch, Richard. Fighting for Our Health: The Epic Battle to Make  Health  Care a Right  in the United  Albany, NY: Rockefeller Institute  Press, 2011.
  2. Miles, Toni. Health Care Reform and Disparities: History, Hype, and Hope.  Santa Barbara, CA: Praeger, 2012.
  3. White House. “Patient’s Bill of Rights.”  http://www.whitehouse.gov/files/documents/healthcare-fact-sheets/patients-bill-rights.pdf (Accessed August 2014).

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