The department of health of the ‘Generalitat de Catalunya’ has elaborated a new letter of rights and duties of their citizens concerning health and sanitary attention. This letter was adapted to the rights and duties of the citizens at the actual moment and incorporates new aspects in respect to the dignity of everyone and the improvement of the health system.
2- Rights related to the autonomy of the person:
2.1- The right to be previously informed to be able to give your consent so that any therapeutic or diagnostic procedures can be done.
It is understood by ‘Informed Consent’, the acceptance of the procedure, on behalf of a patient, after having all the suitable information with sufficient advance, to participate freely in the decision (risks, benefits, secondary effects of the procedure, alternative procedure, etc.)
In any case, the patient can withdraw his/her consent, with total freedom at the time of their choice.
Exceptional situations when it comes to the Informed Consent,
-When no intervention implies a risk to public health.
-When the emergency does not allow delays that can cause irreversible damage or risk of death.
Informed Consent granted by substitution;
When the patient, at the doctor’s criteria, is not able to understand the situation due to his/her poor physical and psychological state, the consent will be obtained from the family, representatives or anyone related to the patient.
In cases of legal disability, the person with the patient’s guardianship needs judicial authorization to apply to the disabled person medical treatments that could risk their physical or psychological integrity. When the time comes to apply this treatment without an authorization, the communication will be done by a probate court within 24 hours máximum.
In case of an interned person with psychological disorders, the person itself or the family of this person will need judicial authorization to apply the necessary medical treatment that could risk his/her life or be a physical or psychological threat. When the time comes to apply this treatment without an authorization, the communication will be done by a probate court within 24 hours máximum.
This consent has to be done in writing in case of surgery or invasive treatments, or anything that could put the life of the patient, or fetus in case of a pregnant woman, at risk.
In all cases, the patient is entitled to have a written copy of such consent by a signed document.
2.2- RIGHT OF THE ILL TO CHOOSE BETWEEN DIFFERENT THERAPEUTIC OPTIONS AND TO REJECT ANY MEDICAL TREATMENTS PROPOSED.
The ill has the right to choose freely between the options proposed by the medical doctor and reject treatments in case he/she does not agree.
The ill has the right to choose freely the different therapeutic options and reject them even if they are vital. The informed consent will be done in accordance with the patient’s autonomy rights and will be applied under the same exceptions.
In any case, treatment, care and support cannot be denied and therefore, alternative treatment should be offered at the center or after the patient is discharged from the hospital.
2.3- RIGHT OF THE MINOR TO BE CONSULTED, SO HIS/HER OPINION WILL BE TAKEN INTO CONSIDERATION AS A DETERMINANT FACTOR, IN FUNCTION OF HIS/HER AGE AND LEVEL OF MATURITY, ABOUT THE DECISIONS OF INTERVENTIONS OVER HIS/HER HEALTH.
When the minor is not competent intellectually or emotionally, in order to comprehend the reach of the intervention over his/her health, the consent has to be given by his representative in case the minor is under 12 years of age. In the rest of the cases, being emancipated minors or minors 16 years of age or older, the consent has to be given personally by them.
2.4- EVERY PERSON HAS THE RIGHT TO LIVE HIS/HER DEATH PROCESS IN ACCORDANCE WITH THE CONCEPT OF DIGNITY.
Every person has the right to live the process of his/her own death with Dignity. The ill has the right to reject any treatment that is meant to lengthen his/her own life, especially when a therapy or treatment can reduce the quality of life up to a degree that is not compatible with the dignity of the person.
Every person has the right to have palliative comfort treatments, and in particular, pain treatment. This one being available in all possible environments; at home or at the hospital.
When the patient is at the hospital, the accompaniment of family members should be easily facilitated, in a suitable social context, so that it allows intimacy and, finally, grief.
If death takes place at the hospital, a special care will take place so that family members and people close to the deceased receive proper treatment and orientation suitable to the circumstances.
The corresponding procedures and acts will not carry any actions against the legal system.
RIGHT TO TAKE INTO ACCOUNT THE ‘LIVING WILL’ OR WISHES ESTABLISHED IN SUCH DOCUMENT.
In the ‘Living Will’, an adult with sufficient capacity and in a free way, expresses the instructions to take into account when the circumstances don’t allow this person (patient) to freely express his/herself about his/her own will.
Anticipated wishes or acts that try to add previsions against the legal system or medical praxis, or that do not correspond with the one originally written and signed by the subject (patient), will not be taken into account. In these cases, the clinical history of the patient will be observed.
5.1.2- RIGHT OF THE PATIENT TO CHOOSE AMONG THE DIFFERENT THERAPEUTIC OPTIONS AND TO REJECT MEDICAL TREATMENTS AND NURSING CURES.
The patient has the right to choose or reject freely any diagnostic test, intervention, treatment or cure or all sanitary proposals. The rejecting of all these treatments, by no means compromises the abandonment of the patient itself, who will still be receiving all sanitary support possible including alternative treatment.
9.1- RIGHT TO HAVE THE “LETTER OF RIGHTS AND DUTIES OF THE PATIENT” IN ALL SANITARY CENTERS”
In every medical or sanitary center, there should be by law for the people to have a ‘letter of rights and duties’ of the citizens in relation to their health and sanitary services, as a relation frame between the center and the users.
10.3- RIGHT TO RECEIVE A CONTINUED AND INTEGRAL SANITARY AID.
All patients have specific rights on this field;
-To have a professional appointed doctor responsible for the integration of the medical attention received in time (patient’s history) and also a responsible professional nurse.
-To receive medical attention that includes diagnosis, prevention, treatment and rehabilitation.
-To have different mechanisms of coordination and cooperation among different levels, entities and professionals in your attention with the only purpose to guarantee its quality.