We were having a quiet
evening. S.Q. Lapius had graciously permitted me the use of his recliner
while he sat busily at his desk scribbling on his yellow foolscap. I struggled
to wade through the quarterly issue of the Archives, fighting sleep every inch
of the way. Finally, just to keep myself awake I called across, “What are
you writing, Simon? Another paper?”
“No, my boy,” he
answered without looking up. “Some amendments to the
Bill of Rights.”
“The
Bill of Rights.
You’re 200 years too late.”
“Not that Bill of
Rights. The new one. The
Patients’ Bill of Rights issued by the
“Ho hum,” I said,
closing my eyes again.
“Don’t be derisive,
Harry. It’s very important. The
“Go on,” I said, eyes
still closed trying to concentrate on the Bolero drifting in over the hi-fi.
“Harry, move over to the
hardback chair while I read. Then perhaps you will stay awake.”
“1.
‘The patient has the right to consideration and respectful care’.”
“Sounds okay so far,” I
said, while walking over to the hard-backed chair.
“No argument. It
goes without saying. It seems the one principle that is implicit in
patient care. Why does the AHA have to discover it at this late
date? Then they go on to the patient’s right to informed consent from his
doctor. Again no argument, but certainly not a matter
for hospital concern. But they say ‘The
patient has the right to receive from his physician information necessary to
give informed consent prior to the start of any procedure and-or treatment.’
That is very broad,
what? Does it include all medications? Will the doctor and his
patient have to discuss the pros and cons before an enema is ordered?”
Lapius was warming to the task.
“Here, “4,” ‘The patient has the right to refuse treatment to the extent
permitted by law – What law forbids a patient to refuse any treatment?”
I thought about that for
a moment. “I think they refer to guardianship. A patient under
guardianship probably couldn’t refuse treatment if the guardian approved.”
“Well, that’s a sticky
wicket,” Lapius said. I had never known him to retreat from an issue so
readily, but he was anxious to get on.
“Forget that.
Let’s go on. The following two emphasize the patient’s right to
privileged communications ‘The patient has the right to expect that all
communications and records pertaining to his care should be treated as
confidential.’” “Agreed.”
“Of
course agreed. But
then that would preclude review of the patient’s chart by utilization review
committees without the express approval of the patient. And since those
committees are only trying to determine whether the third parties, the Blues,
or government should continue paying the patients medical bills, why should the
patient agree to that?
Yet hospitals all have
these committees, and I doubt that the patient is ever consulted about whether
his case should be reviewed by any other than his doctor.”
“That’s a point,” I
said.
Lapius pursued the
matter relentlessly. “Look at “7,” ‘When medically permissible a patient
may be transferred to another facility only after he has received the complete
information and explanation concerning the needs for and alternatives to such a
transfer.’”
“That’s a step in the
right direction, isn’t it?”
“How? It doesn’t protect the patient’s rights.
They will move him whether he or his doctor wants him moved. They may
explain why, but they’ll move him nevertheless. Where does it say that
the patient has any rights of appeal against this decision.
It states that after informed consent the hospital can do what it wants.
It’s the hospital’s rights that are being protected, not the patient’s.
Let’s look at No. 9, ‘The patient has the right to be advised if the hospital
proposes to engage in or perform human experimentation affecting his care or
treatment.”
“That’s good, I don’t see anything wrong with that.”
“Harry,” he seemed
exasperated, “I think I know what they mean. They want to say that the
hospital will not allow members of its staff to perform experiments, etc. But
they didn’t say that. They said’—if the hospital proposes to
perform.’ Hospitals don’t do experiments. “A hospital is a
building, a haven for the ill, a hospice. It is made of brick and
mortar. It doesn’t treat, or do experiments or do any of the things that
people do. The AHA can no longer distinguish the inanimate. Of
course that’s their problem. They think in impersonal terms. Now
look at “10.” ‘The patient has the right to expect reasonable continuity of
care’? This isn’t a bill of Rights, it’s a bill
of Wrongs.”
“You take them too
seriously, Simon.” I said, hoping to get back to the recliner. But
that wasn’t the right thing to say.
“Of course I take them
seriously. This is a manifesto by the
1.
To know that all members of the
medical and nursing staff are duly accredited.
2.
The right to privileged communication
with their doctor. To know that their medical records
will not be shown to any third party or representative thereof without the
consent of the patient.
3. The right to proper continuity of care; there will be adequate staff
available day or night, weekends or holidays to properly carry out the doctor’s
orders.
4.
The hospital administration will not
evict a patient or transfer him to another facility without the consent of the
patient in accordance with that of his doctor.
5.
The ecology of the hospital will be
maintained at all times to the highest standards of cleanliness and comfort.
“Well,” Lapius said,
preening a little, “How’s that for starters, Harry?”
“Great. Can I go
back to the recliner now?”