Charter of Patients’ Rights (Draft)
The Ministry of Health and Family Welfare released the draft Charter of Patients’ Rights compiled by the National Human Rights Commission in August 2018. The recommendations from this draft were the basis for India’s first Charter of Patients’ Rights, published by the health ministry in a letter to the state governments dated June 2019. The Charter was updated to include 20 rights (from the original 13) in August 2021.
The Preamble to this draft Charter invokes the Universal Declaration of Human Rights, stating that patients are entitled to certain basic rights in seeking healthcare services. It notes the absence of an instrument that integrates and codifies patients’ rights in India, stating that the rights are spread across provisions like the Constitution of India, the Indian Medical Council Regulations, 2002, and the Consumer Protection Act, 1986. The Charter aims at making citizens aware of their rights as well as responsibilities as patients, to inform them of the facilities and treatment due to them from medical professionals and establishments, and to ensure better recognition of patients’ rights by health professionals.
The 27-page document delineates 17 rights of patients, provides a description for each, and lists where each right appears in existing legal provisions. It delineates five responsibilities of patients – to provide all the necessary information to their doctor; to cooperate during medical examinations, tests and treatment; to follow instructions and cooperate with hospital staff; to respect the dignity of doctors and hospital staff; and to take responsibility for their choices with regard to treatment options. The draft also discusses grievance redressal mechanisms for the Charter’s implementation.
The following are excerpts from the 17 rights delineated in the Charter:
Right to information: Every patient has a right to adequate relevant information about the nature, cause of illness, provisional/confirmed diagnosis, proposed investigations, and management, and possible complications. Every patient and his/her designated caretaker have the right to factual information regarding the expected cost of treatment based on evidence. Patients and their caretakers also have a right to know the identity and professional status of various service providers who are providing service to him/her.
Right to records and reports: Every patient or his caregiver has the right to access originals/copies of case papers, indoor patient records, investigation reports. The relatives/caregivers of the patient have a right to get discharge summary or in case of death, death summary along with original copies of investigations.
Right to emergency medical care: All hospitals, both in the government and in the private sector are duty bound to provide basic Emergency Medical Care, and injured persons have a right to get Emergency Medical Care. Such cases must be initiated without demanding payment/advance and basic care should be provided to the patient irrespective of paying capacity.
Right to informed consent: Every patient has a right that informed consent must be sought prior to any potentially hazardous test/treatment (e.g. invasive investigation/surgery/chemotherapy) which carries certain risks. It is the duty of the primary treating doctor administering the potentially hazardous test/treatment to explain to the patients and caregivers the main risks that are involved in the procedure.
Right to confidentiality, human dignity and privacy: All patients have a right to privacy, and doctors have a duty to hold information about their health conditions and treatment plan in strict confidentiality, unless it is essential in specific circumstances to communicate such information in the interest of protecting others or due to public health considerations. Female patients have a right to presence of another female person during physical examinations by a male practitioner.
Right to second opinion: Every patient has the right to seek second opinion from an appropriate clinician of patients’/caregivers’ choice. The hospital management has a duty to respect the patient’s right to second opinion, and should provide to the patients’ caregivers all necessary records and information required for seeking such opinion without any extra cost or delay.
Right to transparency in rates, and care according to prescribed rates wherever relevant: Every patient and their caregivers have a right to information on the rates to be charged by the hospital for each type of service provided and facilities available on a prominent display board and a brochure. They have a right to receive an itemized detailed bill at the time of payment. Every patient has a right to receive health care services within the range of rates for procedures and services prescribed by Central and State Governments from time to time, wherever relevant. However, no patient can be denied choice in terms of medicines, devices and standard treatment guidelines based on the affordability of the patients right to choice.
Right to non-discrimination: Every patient has the right to receive treatment without any discrimination based on his or her illnesses or conditions, including HIV status or other health condition, religion, caste, ethnicity, gender, age, sexual orientation, linguistic or geographical/social origins.
Right to safety and quality care according to standards: Patients have a right to safety and security in the hospital premises. They have a right to be provided with care in an environment having requisite cleanliness, infection control measures, safe drinking water as per BIS/FSSAI Standards and sanitation facilities.
Right to choose alternative treatment options if available: Patients and their caregivers have a right to choose between alternative treatment/management options, if these are available, after considering all aspects of the situation. This includes the option of the patient refusing care after considering all available options, with responsibility for consequences being borne by the patient and his/her caregivers.
Right to choose source for obtaining medicines or tests: When any medicine is prescribed by a doctor or a hospital, the patients and their caregivers have the right to choose any registered pharmacy of their choice to purchase them. Similarly, when a particular investigation is advised by a doctor or a hospital, the patient and his caregiver have a right to obtain this investigation from any registered diagnostic centre/laboratory having qualified personnel and accredited by National Accreditation Board for Laboratories (NABL).
Right to proper referral and transfer, which is free from perverse commercial influences: When being transferred from one healthcare facility to another, the patient/caregiver must receive a complete explanation of the justification for the transfer, the alternative options for a transfer and it must be confirmed that the transfer is acceptable to the receiving facility. In regard to all referrals of patients, including referrals to other hospitals, specialists, laboratories or imaging services, the decision regarding facility to which referral is made must be guided entirely by the best interest of the patient. The referral process must not be influenced by any commercial consideration such as kickbacks, commissions, incentives, or other perverse business practices.
Right to protection for patients involved in clinical trials: Participation of patients in clinical trials must always be based on informed consent, given after provision of all relevant information. A participant’s right to agree or decline consent to take part in a clinical trial must be respected and her/his refusal should not affect routine care. The patient should also be informed in writing about the name of the drug / intervention that is undergoing trial along with dates, dose and duration of administration. Trial participants who suffer any adverse impact during their participation in a trial are entitled to free medical management of adverse events, irrespective of relatedness to the clinical trial, which should be given for as long as required or till such time as it is established that the injury is not related to the clinical trial. In addition, financial or other assistance must be given to compensate them for any impairment or disability. In case of death, their dependents have the right to compensation.
Right to protection of participants involved in biomedical and health research: Documented informed consent of the research participants should be taken. Additional safeguards should be taken in research involving vulnerable population. Right to dignity, right to privacy and confidentiality of individuals and communities should be protected. Research participants who suffer any direct physical, psychological, social, legal or economic harm as a result of their participation are entitled, after due assessment, to financial or other assistance to compensate them equitably for any temporary or permanent impairment or disability.
Right to take discharge of patient, or receive body of deceased from hospital: A patient has the right to take discharge and cannot be detained in a hospital, on procedural grounds such as dispute in payment of hospital charges. Similarly, caretakers have the right to the dead body of a patient who had been treated in a hospital and the dead body cannot be detailed [detained] on procedural grounds.
Right to patient education: Patients have the right to receive education about major facts relevant to his/her condition and healthy living practices, their rights and responsibilities, officially supported health insurance schemes relevant to the patient, relevant entitlements in case of charitable hospitals, and how to seek redressal of grievances in the language the patients understand or seek the education.
Right to be heard and seek redressal:
Every patient and their caregivers have the right to give feedback, make
comments, or lodge complaints about the health care they are receiving or had
received from a doctor or hospital. Patients and caregivers have the right to
seek redressal in case they are aggrieved, on account of infringement of any of
the above mentioned rights in the charter.
Focus and Factoids by Swadesha Sharma.
National Human Rights Commission
National Human Rights Commission