Human Rights in Patient Care: Practitioner Guides

"Health systems can too often be places of punishment, coercion, and violations of basic rights - rather than places of treatment and care. In many cases, existing laws and tools that provide remedies are not adequately used to protect rights."

Through a collaborative networked process, the Open Society Foundations are creating practitioner guides to inform and facilitate the utilisation of legal tools to advance human rights in patient care. The Practitioner Guide Series offers practical, how-to manuals for lawyers interested in taking cases around human rights in patient care. The context is that, "[i]n all countries of the practitioner guide project, structural issues related to the turbulent transition of the health care and legal systems, such as degree and quality of oversight and financing, further complicate a human rights agenda in the health care sphere. In view of these structural limitations, utilizing administrative and alternative dispute resolution channels is often a strategy superior to Western-style legal advocacy. The human rights framework provides a critical lens for addressing a spectrum of problems in the health care sphere, including discrimination, breach of confidentiality, compulsory treatment, and labor rights. Vulnerable groups stand to gain the most from efforts to bolster equity, quality, access, and other human rights in patient care."

In that light, the manuals examine patient and provider rights and responsibilities, as well as procedures for protection through both the formal court system and alternative mechanisms in 10 countries. Each practitioner guide is country-specific, supplementing coverage of the international and regional framework with national standards and procedures in these countries: Armenia, Georgia, Kazakhstan, Kyrgyzstan, Macedonia, Moldova (forthcoming), Romania (forthcoming), Russia (forthcoming), Serbia (forthcoming), and Ukraine. The guides are designed to be useful for medical professionals, public health mangers, Ministries of Health and Justice personnel, patient advocacy groups, and patients themselves.

For example, an excerpt from the Armenia guide has various communication implications: "The aim of the guide is to strengthen awareness of existing legal tools that can be used to remedy abuses in patient care. If adequately implemented, current laws have the potential to address pervasive violations of rights to informed consent, confidentiality, privacy, and nondiscrimination. As this effect can be accomplished through both formal and informal mechanisms, this guide covers litigation and alternative forums for resolving claims, such as enlisting ombudspersons and ethics review committees."

Advancing Human Rights in Patient Care: The Law in Seven Transitional Countries is a compendium that supplements the practitioner guides. It provides a comparative overview of legal norms, practice cannons, and procedures for addressing rights in health care in Armenia, Georgia, Kazakhstan, Kyrgyzstan, Macedonia, Russia, and Ukraine. After defining and situating the concept of human rights in patient care, describing the general setting for health care in the region, and detailing the background and methodology of the project, the paper compares and contrasts the legal mechanisms, cultural and professional contexts, and procedural particularities for vindicating patient and provider rights in these particular transitional settings. The findings suggest that significant formal legal reform over the last two decades has created significant gains in the legal frameworks and institutions designed to address human rights abuses in patient care. The findings also suggest, however, that a number of challenges in six of the countries are intrinsic to a common heritage that includes vestiges of Soviet legal concepts, institutions, and attitudes that complicate the full implementation of human rights legislation. The actual expression of this legal, cultural, and institutional heritage varies significantly across the participating countries, providing an opportunity to build on successes in a horizontal exchange through knowledge transfer and regional advocacy.

A Legal Fellow in Human Rights in each country is undertaking the updating of each guide and building the field of human rights in patient care through trainings and the development of materials, networks, and jurisprudence. Fellows are recent law graduates based at a local organisation with expertise and an interest in expanding work in law, human rights, and patient care.