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Patient Rights LGG

This document discusses rights and ethics from a medical perspective. It addresses what rights are, how they work, and the types of rights that exist. Key points include: - Rights give a justified claim or entitlement and impose obligations on others not to interfere. They can exist morally even without legal recognition. - Rights provide a basis to object to wrongdoing and make demands if violated, as part of respecting each other. However, rights may be prima facie and outweighed by other considerations. - Rights entail obligations, though not all obligations stem from rights. Ethics also involves moral obligations and supererogatory actions beyond respecting rights alone. - There are negative rights requiring non-interference and positive

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244 views13 pages

Patient Rights LGG

This document discusses rights and ethics from a medical perspective. It addresses what rights are, how they work, and the types of rights that exist. Key points include: - Rights give a justified claim or entitlement and impose obligations on others not to interfere. They can exist morally even without legal recognition. - Rights provide a basis to object to wrongdoing and make demands if violated, as part of respecting each other. However, rights may be prima facie and outweighed by other considerations. - Rights entail obligations, though not all obligations stem from rights. Ethics also involves moral obligations and supererogatory actions beyond respecting rights alone. - There are negative rights requiring non-interference and positive

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LAURA GUIDRY-GRIMES, PHD

UAMS and Arkansas Children’s


Assistant Professor of Medical Humanities
Clinical Ethicist
WHAT’S IN A NAME?
 What is a right?
 “gives its holder a justified claim to something (an entitlement) and a
justified claim against another party” (Beauchamp)
 Can have moral rights even when there are no legally recognized rights!

 Provide a basis against serious wrongdoing


 Give moral legitimacy to making certain demands, including demands for
some form of apology or recompense if rights were violated or ignored
 Part of respecting each other in moral community, acknowledging our
moral status
HOW DO RIGHTS WORK?
 As a trump against all other moral considerations and interests?
 Not necessarily! (unless you’re Ronald Dworkin)
 Can be prima facie – meaning they obligate others unless they conflict with equal
or stronger moral considerations, including other rights
 Some rights might have fixed priority over others, so it will hardly ever (if ever)
be outweighed (e.g., human rights)
RIGHT TO HEALTH

start specifying

THE STRUCTURE OF A RIGHT what this should


(and could) mean
in our context

Apply everywhere to all General and indeterminate rights right to affordable healthcare,
relevant rights-bearers which involves x, y, z
right to competent providers,
which involves a, b, c
right to clean, potable water,
Specification and which involves d, e, f
prioritization based on
different cultural/ religious/ specify further based
philosophical commitments on particularities of
political/economic
structure, other
societal priorities and
values
Rights that reflect diversity of stakeholders
Apply to specific region EMTALA, healthcare subsidies, fair
or context and pluralistic perspectives– but still retain
trade practices, cost transparency,
minimal content of original precepts
care from licensed physician…
HOW DO RIGHTS WORK?
 Correlativity thesis
 Rights, by their nature, entail obligations

 NOTICE: This does NOT mean that all obligations entail rights
RIGHTS, OBLIGATIONS, & BEYOND Obligations
entailed by
rights

Moral
obligations
The realm of what
we ought to care Supererogatory actions
about goes beyond (beyond the realm of
merely respecting what is obligatory)
rights!
NEGATIVE & POSITIVE RIGHTS
 Negative rights entail negative obligations
 Right to be free from interference  obligation not to interfere

 Positive rights entail positive obligations


 Right to be provided something  obligation to provide
right to free speech
right to vote
WHAT KIND OF RIGHT? right to healthcare information
right to self-determination

POSITIVE &
NEGATIVE POSITIVE NEGATIVE
SOME QUESTIONS TO EXPLORE (AND THEY’RE BIG ONES)
 WHO has rights?
 All humans? All humans above a certain age? Fetuses? Non-humans? The dead?

 HOW should conflicts in rights be resolved?


 Absolute versus prima facie rights, potential for harm, role-specific
obligations…?

 HOW should certain rights be specified and prioritized?


 “Right to life” means…
right not to be killed? right to be given all chances of living?
right not to be killed except in cases of self-defense? right to any and all medical interventions to prolong life?
right not to be unjustly killed? right to access resources that are fundamental to survival?
PATIENT RIGHTS & RESPONSIBILITIES

click me click me
TRICKY CASE: THE ABUSIVE PATIENT
 Ms. Smith has advanced dementia with delirium, and she has been in
the unit for three days. She has no known family, friends, or decision-
maker. She has been “fired” from her nursing home for being abusive to
staff. On this admission, she has cursed at staff, thrown cans at a nurse,
tried to hoard food, pulled at lines, screamed whenever anyone touches
her, and called the police so many times that her phone was removed
from her room.

 What are some competing rights in this case? How should those rights be
weighed? What difference does it make, ethically, that Ms. Smith lacks
decisional capacity?
TRICKY CASE: KEEPING SECRETS FROM A MINOR
 Michael is a 16 year-old who presents with severe headaches. He was
diagnosed at age 10 with acute leukemia, and he went into remission after 3
years of intense treatment. On this admission, a glioblastoma multiforme (GBM)
was found on MRI, and no additional medical intervention was recommended.
The parents found some experimental therapies, and they insist the staff promise
not to tell Michael about the MRI findings or that he is terminal. Michael tells staff
that he is comfortable with decisions his parents have made for him in the past.
However, he finds out about the GBM through his patient portal and Googles
information about it. He directly asks his physician, while his parents are out of
the room, if he is dying.
 Does Michael have a right to know this information? Do the parents have a right to shield
their son from this information? What are the obligations of the physician?

Glover, Jacqueline. “Ethical Decision-Making Guidelines and Tools.” Ethical Health Informatics: Challenges and Opportunities. Eds. Laurinda Beebe Harman and
Frances H. Cornelius. Burlington, MA: Jones & Bartlett, 2017
THANK YOU! Questions? Comments?

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