Abstract:
Patients have the right to be treated and dealt with in a humane and respectful manner. A patient, during the course of treatment, is to be given utmost consideration in terms of good quality of care and regard for his health and related affairs. That a patient explored medical or dental treatment or advice, does not in any way place him at the mercy of the Doctor neither does it mean, as it is often colloquially put; that the patient has no say, during the course of the Doctor-patient relationship. The patient actually does but over and above having a say, the patient does have a bundle of rights that can not be infringed upon without consequences.
Introduction:
Human interactions and affairs are generally guarded, among other things, by rights, duties, liabilities, and responsibilities. A person has a right when it is the duty of another to do or not to do any act that will bring him some good or cause him some harm. The existence of rights and duties necessarily calls for responsibility and infringement of rights bears consequences in liability. The foregoing serves to emphasize the reverence with which rights or better put, human rights are accorded. Patients like other humans have a bundle of rights. Patients’ rights are derivatives of human rights. Patient’s rights make for required or allowable practices necessary for the improvement of the patient’s health during the pendency of the medical relationship. Patient rights are legally recognized and enforceable standards which make for medically acceptable behaviors and conduct during the course of a doctor-patient relationship, regardless of race, tribe, ethnicity, nationality, gender, religion, social class. These standards cover areas such as; access to medical care, respect for dignity, confidentiality, informed consent, etc. The need for the patient to be fully informed of their rights and limitations, as well as means of enforcement, remains vital in improving medical practice and upholding medical ethics in any given country.
Patients, amongst other rights, have the right to be treated and dealt with in a humane and respectful manner.[1] A patient, during the course of treatment, is to be given utmost consideration in terms of good quality of care and regard for his health and related affairs.[2] That a patient explored medical or dental treatment or advice, does not in any way place him at the mercy of the Doctor neither does it mean, as it is often colloquially put; that the patient has no say, during the course of the Doctor-patient relationship.
The patient does have a say but over and above having a say, the patient has a bundle of rights that can not be infringed upon without consequences. These rights, as well as the mechanism for their enforcement, have been given statutory flavoring by both international and municipal instruments. International instruments like the Universal Declaration of Human Rights, 1948[3], International Covenants on Civil and Political Rights, 1966 all have provisions seeking to protect patients’ rights. The Constitution of the Federal Republic of Nigeria, 1999 (as amended), as the grundnorm, contains these rights, though admittedly not explicitly but implied from its tenor and spirit.
Patient’s rights, it must be noted, are different from health rights. Put differently, there exists a thin line between health rights and rights of the patients; while health rights apply to everyone by virtue of his humanity, the rights of patients only apply to patients and can be enforced by only those in a doctor-patient relationship, where there is a breach.
The National Health Act, 2014(hereinafter referred to as the Act), the Medical and Dental Practitioners Act, and also the Nigerian Code of Medical Ethics, 2004, et al, form the basis for the recognition of the rights of patients within the Nigerian context. This article will examine these rights and their limitations in the context of Nigerian laws and the medical ethical code of Nigeria, and also explain the legally recognized means of seeking redress in the event of their infringement or breach.
Patient rights and limitations:
The following are some of the rights of patients recognized by law to help protect, and to an extent, make for an effective relationship that ultimately leads to health improvement. It is instructive to note that these rights are activated when a doctor-patient relationship is established.
Right for a good quality care: Patients are entitled to adequate care and treatment, a failure of which is a breach.[4] In a doctor-patient relationship, the patient is entitled to safe and secure health care environment, access to clean water, quality health care plans, regardless of gender, tribe, religion, creed or nationality.[5] He is also free to ask questions regarding his health care, receiving timely care in emergency situations, access to special needs in relation to new born babies, pregnant women, aged person, people with disabilities and patients living with HIV and AIDS.
Right to full disclosure and informed consent: The patient has the right to be given a comprehensive and accurate information concerning his health to enable him make guided decisions concerning the best treatment options or medical procedure to be administered.[6] The Physician informs the patient of the range of diagnostic procedures and treatment options available[7], the benefits, risks, cost and consequences of each treatment option or procedure.[8] It is the information at the disposal of the patient that enables him give his consent. This is because every human being of legal adulthood and sound mind, has the right to know and decide what should be done with his body.[9] A failure to obtain the patient’s consent before treatment is administered will make the doctor liable for the tort of assault and battery, and also a breach of the patient’s fundamental human rights.[10] The physician is ethically bound to disclose all relevant information to the patient in a simple an unambiguous manner, putting into consideration the patient’s literacy.[11] Where a physician fails to obtain the consent of the patient in treatment, he is deemed to have infringed on the patient’s right to dignity of human person.[12] Consent could be express or implied; it is express when an oral or written consent is given and implied when a patient presents himself for minor procedures like clinical tests, etc. In all, implied consent cannot be perceived in all treatments and procedures. Although the physician under the Act, is permitted to withhold information about the patient’s health in circumstances where substantial evidence show that the disclosure of the health status of the patient will not be in the best interest of the patient,[13] the physician is advised that in order to avoid any form of medical negligence during such a situation, the formal consent of the patient should be sought through his next of kin or guardian or legal representative,[14] as in our opinion, the word ‘circumstances’ as used by the Act will be a matter viewed from the lens of medical ethics and not strictly law.
Right of confidentiality: All records of the patient are supposed to be kept confidential.[15] These records include; test results and diagnosis, medical records during and after treatment, et al. The law however, creates for circumstances where the information of the patient can be made public or given to certain individuals, bodies, agencies of government, etc. These circumstances include;
when the health user of patient gives his consent,[16]
where there is a Court order or when there is a legislative requirement to that effect,[17]
in the case of minor, with request of parent or guardian,[18]
when guardian or representative of a patient who is incapable of giving consent, gives consent,[19]
where the secrecy will lead to threat of public health[20] and
where it is in the interest of the patient.[21]
Access to emergency care: The health care provider must not refuse any patient treatment in emergency situations. Every patient in emergency circumstances is entitled to adequate treatment by the health care service provider or health establishment. The National Health Act, 2014, provides thus;
“A health care provider, health worker or health establishment shall not refuse a person treatment for any reason.”[22]
It is, therefore, safe to say that the urgent, immediate, and sufficient intervention and care in the event of an emergency, is considered most expedient, over other factors including; cost and payment, as well as law enforcement requirements, if any. It is a legally protected right that can be enforced if breached. It is noteworthy that when this right is breached, and the defendant found liable, it amounts to an offense that is punishable with a fine of 100,000 or an imprisonment term not exceeding six months or both.[23]
Right to visitation: The right of the patient to receive visitors cannot be waived. He is to be informed by his health care service provider of his visitation schedule or plan to enable him entertain needed visitors.[24]In the exercise of this right however, the patient must have regards for the visiting schedule or plan of the health care service provider, as reasonable steps can be taken to refuse visitations that fall outside the prescribed visiting plan.
Right to religious assistance: That a patient explores medical treatment or health services, does not take away his right to freedom of religion.[25] The Supreme Court in the case of Medical and Dental Practitioners Disciplinary Tribunal v. Dr. John E, N. Okonkwo[26] affirmed the right to self-determination in the context of freedom of thought, conscience and religion. He is still empowered to seek religious assistance where he deems fit for the purpose of his health, carry out his normal religious practices like prayers, studying the Holy Writ, etc. However, in the exercise of this right, he is to consider the peace and privacy of other patients and health care service providers. The Supreme Court affirming the limit of this right, held thus:
“…The right to freedom of thought, conscience, and religion implies a right not to be prevented, without lawful justification, from choosing the course of one’s life, fashioned on what one believes in, and a right not to be coerced into acting contrary to one’s life, religious belief. The limits of these freedoms, as in all cases, are where they impinge on the rights of others or where they put the welfare of society or public health in jeopardy. The sum total of the rights of privacy and of freedom of thought, conscience, or religion which an individual has, put in a nutshell, is that an individual should be left alone to choose a course for his life unless a clear and compelling overriding state interest justifies the contrary…” [27]per Ayoola JSC
Religious practice like fasting is sometimes not advisable for patients receiving treatment or having some health complications. This is merely a piece of advice and not binding on the patient.
Right to lay complaints and have them investigated: The patient also has the right to submit complaints either verbally or in writing to the relevant bodies regarding any violation of his health rights. Section 30 of the Act provides that:
“A person may lay a complaint concerning the manner in which he or she was treated by a health establishment and have the complaint investigated”[28]
The procedure for laying such complaints shall be established by the Minister or Commissioner of Health in public health establishments, while all complaints in private establishments are to be addressed to the head of the establishment.[29]
In serious rights violation leading to death, injury, etc, the patient can file a petition to the Medical and Dental Practitioners Investigating Panel which after their investigation and upon conclusive proof that there was a breach, refer the matter to the Medical and Dental Practitioners Disciplinary Tribunal for the determination of the matter.
Right to refuse treatment: Patients have the right to refuse any treatment that goes against their religious beliefs or any such treatment they feel uncomfortable with.[30] The Supreme Court by way of obiter explained infra:
“I am completely satisfied that under normal circumstances no medical doctor can forcibly proceed to apply treatment to a patient of full age and sane faculty without the patient’s consent, particularly if that treatment is of a radical nature such as surgery or blood transfusion. So, the doctor must ensure that there is valid consent and that he does nothing that will amount to trespass to the patient. Secondly, he must exercise a duty of care to advise and inform the patient of the risks involved in the contemplated treatment and the consequences of his refusal to give consent.”[31]per Uwaifo JSC
The law, therefore, recognizes this right by the affirmation of the apex court.
- Right to terminate health services: The Code provides that patients who are of sound mind or their guardian or representative acting in their capacity can terminate health services. Rule 20 of the Code provides thus:
“Patients who are not in a defective state of judgment, or in their stead their competent relatives, may be at liberty to terminate services against medical advice upon a formal undertaking to that effect: but such services should be restored without prejudice if they return for help…”[32]
This is legally recognized as patients cannot be held against their own will[33] except in cases where they are incapable of making decisions for themselves, failed to fulfill their medical obligations like payment of medical bills, etc.
- Right to knowledge of interruption of health service provider: The patient has the right to be informed about any interruption or disengagement of health services of primary or attending professionals responsible for patient care. The health service provider is also duty bound to inform the patient of any methodical and practical transition of treatment for the patient’s safety and continuity of care. The patient is obliged to ask questions regarding any contingency plan or alternative plans regarding his health care.[34]
Enforcement of patients’ rights in the event of breach:
Generally speaking, in enforcing the rights of the patient, the Medical and Dental Practitioners Act,[35] empowers the Medical and Dental Practitioners Investigating Panel (hereinafter referred to as the Panel)[36] and the Medical and Dental Practitioners Disciplinary Tribunal (hereinafter referred to as the Disciplinary Tribunal)[37] to perform separate functions in ensuring redress.
This panel has the powers to do the following:
- “Conduct preliminary investigations into any case where it is alleged that a registered person has misbehaved in his capacity as a medical practitioner or dental surgeon, or should for any other reason be the subject of proceedings before the Disciplinary Tribunal.”[38]
- Can compel any person by way of subpoena to appear before it to give evidence.[39]
- Can, when they feel it is necessary, for the protection of members of the public, make orders for interim suspension from the medical and dental profession in the case they have decided to refer to the Disciplinary Tribunal and also conditional registrations
It is noteworthy that the panel does not determine any matter brought before it, but merely investigates and conditionally suspends members pending the determination of the matter by the Disciplinary Tribunal.
The Disciplinary Tribunal, on the other hand, based on the findings of the Panel, considers and determines matters referred to it. The Disciplinary Tribunal has the status of the High Court and appeals from it, lie to the Court of Appeal and finally to the Supreme Court, where the aggrieved party is not satisfied by the decision of the appellate court.
Conclusion:
In the final analysis, it is expedient to note that the knowledge of these rights is not motivated by the need to limit the medical or dental know-how of the Physician in the provision of health care to the patient, nor does it seek to make the patient a lord above the physician, but only to strike a balance in terms of protection of the patient from medical mishaps, and to serve as a compass for the health care provider in his duties.
ENDNOTES:
- Adewunmi Akinola v. Ocean Marine Solutions Ltd. NICN/LA/410/2019/
- African Declaration of Human and People’s Rights, 1948.
- Ajang Precious, “Doctor-Patient Relationship: The Legal and Ethical Expectations in the Medical Practice of Nigeria” published on simplylaw.com November 2021.
- Code of Medical Ethics of Nigeria, 2004.
- Constitution of the Federal Republic of Nigeria, 1999 (as amended).
- International Covenants on Civil and Political Rights,1966.
- Jadesola Lokulo-sodipe “An examination of the legal rights of surgical patients under the Nigerian laws” Journal of Law and Conflict Resolution Vol. 1(4), pp. 079-087, September, 2009. Available online at http://www.academicjournals.org/JLCR © 2009 Academic Journals.
- Medical and Dental Practitioners Act CAP M8, LAWs of the Federation 2004.
- Medical and Dental Practitioners Disciplinary Tribunal v. Dr. John E, N. Okonkwo (2001) 2MJSC 67
- Michel Daher “Patient’s Rights” Encyclopedia of Global Bioethics DOI 10.1007/978-3-319-05544-2_329-1 Springer Science+Business Media Dordrecht 2015, p 01-02.
- Nasiru Tijani: Physician, patients and blood: Informed consent to Medical Treatment and Fundamental Rights, published (2006), Legal Principles and Policies: Essays in Honour of Justice Chukwunweike Idigbe.
- National Health Act,2014.
- Patients’ bill of rights, illustrated guide, prepared by the Consumer Protection Council and the Federal Ministry of Health of Nigeria.
- Schloendorff vs. Society of the New York Hospitals 211 NY 125, 105 N.E. 29, 1914
- Sideway v Board of Governors of Bethlehem Royal Hospital (1985) 11 A.C 871
- Trinity Health Mid-Atlantic, “Patient’s rights and responsibilities” Mercy Catholic Medical Centre, Mercy Fitzgerald Campus
- United Nations Universal Declaration of Human Rights, 1948.
- Wyatt v. Stickney 325 F. supp. 781 (M.D. Ala. 1971)
[1] Michel Daher “Patient’s Rights” Encyclopedia of Global Bioethics DOI 10.1007/978-3-319-05544-2_329-1
# Springer Science+Business Media Dordrecht 2015
[2] This is closely related to the right to dignity of human person as enshrined in S. 34 of the Constitution of the Federal Republic of Nigeria, 1999 (as amended).
[4] Wyatt v. Stickney 325 F. Supp. 781 (M.D. Ala. 1971)
[5] Article 25, United Nations Universal Declaration of Human Rights, 1948.
[6] Ajang Precious, “Doctor-Patient Relationship: The Legal and Ethical Expectations in the Medical Practice of Nigeria” published on simplylaw.com November 2021.
[7] S. 23(1)(b), National Health Act, 2014.
[8] S.23(1)(c), ibid
[9] Schloendorff vs. Society of the New York Hospitals 211 NY 125, 105 N.E. 29, 1914.
[10] Nasiru Tijani: Physician, patients and blood: Informed consent to Medical Treatment and Fundamental Rights, published (2006), Legal Principles and Policies: Essays in Honour of Justice Chukwunweike Idigbe, p.359.
[11] See S. 23(2), National Health Act, 2014 and Rule 19 Code of Medical Ethics,2004.
[12] Adewunmi Akinola v. Ocean Marine Solutions Ltd. NICN/LA/410/2019SS
[13] S.23 (1)(a), ibid
[14] Rule 19, ibid
[15] S.26(1), ibid.
[16] S.26(a) National Health Act, 2014.
[17] Ibid (b)
[18] Ibid (C)
[19] Ibid (d)
[20] Ibid (e)
[21] S.27, National Health Act, 2014.
[22] S.20(1), National Health Act, 2014.
[23] S. 20(2), National Health Act, 2014.
[24] Trinity Health Mid-Atlantic, “Patient’s rights and responsibilities” Mercy Catholic Medical Centre, Mercy Fitzgerald Campus
[25] S.38(1), Constitution of the Federal Republic of Nigeria, 1999 (as amended).
[26] (2001) 2MJSC 67.
[27] ibid
[28] S.30(1), National Health Act, 2014
[29] S. 30 (2) and (3), ibid
[30] Sideway v Board of Governors of Bethlehem Royal Hospital (1985) 11 A.C 871; See also the South African case of Esterhuizen v Administrator, Transvaal 1957 (3) SA 710 (T) where it was held that person of sound mind may refuse medical treatment irrespective of whether it would lead to his death or not.
[31] Ibid, per Uwaifo JSC, pp.
[32]Ibid Rule 20
[33] S.35, Constitution of the Federal Republic of Nigeria, 1999 (as amended).
[34] Patients’ bill of rights, illustrated guide, prepared by the Consumer Protection Council and the Federal Ministry of Health of Nigeria.
[35] CAP M8, Laws of the Federation 2004.
[36] Ibid S. 15(3)
[37] Ibid S. 15(1)
[38] Ibid S.15(3)(a)
[39] Ibid S. 15 (3)(b)
