Patients Rights Essay

The level-headed interests of persons who submit to medical interrogative intervention. For m both years, common medical habituate meant that recreates made decisions for their uncomplaining roles. This paternalistic view has gradu solely(prenominal)(a)y been supplanted by one promoting diligent autonomy, whereby unhurrieds and deposits sh be the decision-making responsibility. Consequently touch on- forbearing family relationships atomic number 18 very different now than they were just a hardly a(prenominal) decades ago. However, conflicts st poorly(predicate) abound as the medical community and those it serves struggle to define their respective roles. ConsentConsent, particularly informed assume, is the cornerstone of endurings reclaims. Consent is establish on the inviolability of ones person. It mode that sterilizes do non return the right to touch or treat a diligent without that patients approval be take the patient is the one who essential alert w ith the consequences and deal with any dis-comfort caused by intercession. A doctor suffer be held liable for committing a outpouring if the doctor touches the patient without first obtaining the patients coincide. The shift in doctor-patient relationships seems inevitable in hindsight. In one early consent good example, a doctor told a charwoman he would plainly be repairing around cervical and rectal tears instead he performed a hysterectomy. In a nonher(prenominal) case, a patient permitted her doctors to examine her chthonian anesthesia alone insisted that they not operate the doctors removed a fibroid neoplasm during the procedure.In yet another case, a doctor assured a man that a proposed action was simple and essentially without luck the patients left hand was paralyzed as a result of the surgery. Consent must be voluntary, able, and informed. Voluntary means that, when the patient gives consent, he or she is gratis(p) from extreme duress and is not intoxicated or under the influence of medication and that the doctor has not coerced the patient into giving consent. The legal philosophy presumes that an adult is competent, but competency whitethorn be an issue in many instances. Competence is typically only challenged when a patient dis adds with a doctors recommended treatment or recants treatment altogether. If an individual understands the schooling presented regarding treatment, she or he is competent to consent to or d be treatment. Consent can be given verbally, in writing, or by ones actions. For example, a person has consented to a vaccination if she stands in line with others who argon receiving vaccinations, observes the procedure, and thenpresents her arm to a health c ar earmarkr. Consent is inferred in cases of collar or unanticipated mass. For example, if unforeseen serious or life-threatening circumstances develop during surgery for which consent has been given, consent is inferred to allow doctors to take immedia te further action to save serious injury or last. Consent is in addition inferred when an adult or child is found unconscious, or when an speck otherwise necessitates immediate treatment to prevent serious harm or death. Consent is not valid if the patient does not understand its meaning or if a patient has been misled. Children typically whitethorn not give consent instead a parent or guardian must consent to medical treatment. Competency issues may eject with morally ill individuals or those who occupy diminished mental capacity due to retardation or other problems. However, the fact that soulfulness suffers from a mental illness or diminished mental capacity does not mean that the individual is incompetent. Depending on the type and ghastliness of the disability, the patient may still wear the ability to understand a proposed turn tail of treatment. For example, in young years most jurisdictions withdraw recognized the right of infirmaryized mental patients to traverse medication under trusted circumstances.Numerous greets fall in govern that a mental patient may redeem the right to refuse antipsychotic drugs, which can produce disturbing side effects. If a patient is incompetent, technically only a lawfully appointed guardian can make treatment decisions. Commonly, however, physicians defer to family members on an informal keister, on that pointby avoiding a lengthy and expensive competency hearing. Consent by a family member demonstrates that the doctor consulted almostone who knows the patient well and is likely to be concerned about the patients well-being. This will believably be sufficient to dissuade a patient from suing for failure to obtain consent should the patient recover. Legal, moral, and good questions arise in competency cases involving medical procedures not primarily for the patients gain ground. These cases typically arise in the context of organ donation from one sibling to another. galore(postnominal) of these cases are approved in the lower judicatures the decisions a great deal turn on an examination of the relationship between the donor and recipient. If the donor and recipient have a relationship that the donor is aware of, actively participates in, and benefits from, courts generally conclude that the benefits of continuing the relationship outweigh the risks and discomfortsof the procedure.For example, one court granted permission for a kidney transplant from a developmentally modify patient into his brother because the developmentally disabled boy was very dependent on the brother. In another case, a court approved a seven-year-old missys donation of a kidney to her identical equal sister after experts and family testified to the close bond between the two. Conversely, a mother succeederfully fought to prevent interrogatory of her three-and-a-half-year-old twins for a likely bone marrow transplant for a half brother because the children had only met the boy twice an d were unaware that he was their brother. Married or emancipated belittleds, including those in the Armed Services, are capable of giving their own consent. Emancipated means that the minor is self-supporting and lives independently of parents and parental control. In addition, under a theory known as the mature minor belief, certain bush league may consent to treatment without first obtaining parental consent. If the minor is capable of understanding the nature, extent, and consequences of medical treatment, he or she may consent to medical care. Such office staffs typically involve older minors and treatments for the benefit of the minor (i.e., not organ transplant donors or blood donors) and unremarkably involve relatively low-risk procedures. In juvenile years, however, some(a) minors have sought the right to make life- or-death decisions. In 1989, a deposit court first recognized that a minor could make much(prenominal) a grave decision.A 17-year-old leukemia patient re fused life-saving blood transfusions based on a deeply held, family-shared religious conviction. A psychologist testified that the girl had the maturity of a 22-year-old. Ironically, the young woman won her right to refuse treatment but was alive and healthy when the case was finally indomitable. She had been transfused in advance the slow juridical mathematical operation needed to decide such a unwieldy question led to a ruling in her favor. Some suppose statutes limitedally tender that minors may give consent in certain highly charged situations, such as cases of genital disease, pregnancy, and drug or alcohol abuse. A minor may withal overrule parental consent in certain situations. In one case, a mother gave consent for an Abortion for her 16-year-old unemancipated daughter, but the girl disagreed. A court upheld the daughters right to withhold consent. tourist courts oft reach divergent outcomes when decision making whether to interfere with a parents refusal to cons ent to a non-life-threatening procedure. One court refused to override afathers denial of consent for surgery to repair his sons harelip and fracture palate. But a different court permitted an operation on a boy suffering from a severe facial deformity even though his mother objected on religious grounds to the come with blood transfusion. In another case, a child was say to undergo medical treatments after the parents unsuccessfully treated the childs severe burns with herbal remedies. Courts rarely hesitate to step in where a childs life is in danger. To deny a child a beneficial, life-sustaining treatment constitutes child neglect, and states have a duty to protect children from neglect. One case involved a mother who testified that she did not believe that her child was HIV positive, despite medical evidence to the contrary. The court ordered treatment, including AZT, for the child. Many other cases involve parents who want to treat a serious illness with nontraditional metho ds or whose religious beliefs forbid blood transfusions. Cases involving religious beliefs raise difficult questions under the First Amendments broad Excise of Religion Clause, Common Law, statutory rights of a parent in raising a child, and the states traditional interest in protecting those unable to protect themselves.When a childs life is in danger and parental consent is withheld, a hospital hears a court-appointed guardian for the child. The guardian, often a hospital administrator, then consents to the treatment on behalf of the child. In an emergency case, a figure may make a decision over the telephone. In some cases, doctors may choose to act without judicial permission if cartridge clip constraints do not allow enough time to reach a judge by telephone. In 1982, a six-day-old infant with Downs syndrome died after a court approved a parental decision to withhold life-saving surgery. The child had a condition that made eating impossible. The queer was medicated but giv en no nourishment. The public furor over the Baby Doe case last helped spur the department of health and human run to create regulations delineating when treatment may be withheld from a disabled infant. give-and-take may be withheld if an infant is chronically and irreversibly comatose, if such treatment would scarcely prolong dying or would otherwise be futile in terms of survival of the infant, or if such treatment would be virtually futile in terms of survival and the treatment would be inhumane under these circumstances. Although courts overrule parental refusal to allow treatment in many instances, far little common are cases where a court overrides anotherwise competent adults denial of consent. The cases where courts have compelled treatment of an adult usually fall into two categories when the patient was so physically weak that the court ruled that the patient could not reflect and make a choice to consent or refuse or when the patient had minor children, even though the patient was fully competent to refuse consent. The possible civil or criminal liability of a hospital energy withal factor into a decision. A court typically will not order a terminally ill patient to undergo treatments to prolong life. Informed ConsentSimply consenting to treatment is not enough. A patient must give informed consent. In essence, informed consent means that forrader a doctor can treat or touch a patient, the patient must be given some basic information about what the doctor proposes to do. Informed consent has been called the most important legal doctrine in patients rights. State laws and court decisions vary regarding informed consent, but the trend is haply toward more(prenominal) manifestation rather than less. Informed consent is required not only in life-or-death situations but also in clinic and outpatient adapttings as well. A healthcare bearr must first present information regarding risks, alternatives, and success rates. The information mus t be presented in language the patient can understand and typically should complicate the following * A description of the recommended treatment or procedure * A description of the risks and benefitsparticularly exploring the risk of serious bodily disability or death * A description of alternative treatments and the risks and benefits of alternatives * The probable results if no treatment is undertaken* The probability of success and a definition of what the doctor means by success * length and challenges of recuperation and* Any other information generally provided to patients in this situation by other do physicians. Only material risks must be disclosed. A material risk is one that might cause a mediocre patient to decide not to undergo a recommended treatment. The magnitude of the risk also factors into the definition of a material risk. For example, one would expect that a one in 10,000 risk of death would everlastingly be disclosed, but not a one in 10,000 risk of a two- hour headache. tractile surgery and vasectomies illustrate twoareas where the probability of success and the meaning of success should be explicitly delineated. For example, a man successfully sued his doctor after the doctor assured him that a vasectomy would be 100 per centum effective as Birth Control the mans wife later became pregnant. Because the only draw a bead on for having the procedure was complete sterilization, a careful explanation of probability of success was essential.Occasionally, informed consent is not required. In an emergency situation where immediate treatment is needed to preserve a patients health or life, a physician may be justified in failing to provide full and complete information to a patient. Moreover, where the risks are minor and well known to the average person, such as in drawing blood, a physician may dispense with full disclosure. In addition, some patients explicitly ask not to be informed of specific risks. In this situation, a doctor must only ascertain that the patient understands that there are unspecified risks of death and serious bodily disabilities the doctor might ask the patient to sign a waiver of informed consent. Finally, informed consent may be bypassed in rare cases in which a physician has objective evidence that informing a patient would render the patient unable to make a rational decision. Under these circumstances, a physician must disclose the information to another person designated by the patient. Informed consent is rarely legally required to be in writing, but this does provide evidence that consent was in fact obtained.The more specific the consent, the less likely it will be construed against a doctor or a hospital in court. Conversely, drape consent forms cover almost everything a doctor or hospital might do to a patient without mentioning anything specific and are easily construed against a doctor or hospital. However, blanket forms are frequently used upon admission to a hospital to provi de proof of consent to noninvasive routine hospital procedures such as taking blood pressure. A consent form may not contain a clause waiving a patients right to sue, unless state law provides for binding Arbitration upon mutual agreement. Moreover, consent can be predicated upon a certain surgeon doing a surgery. It can also be withdrawn at any time, subject to practical limitations. Right to TreatmentIn an emergency situation, a patient has a right to treatment, regardless of ability to redeem. If a situation is likely to cause death, serious injury, ordisability if not attended to promptly, it is an emergency. Cardiac arrest, heavy bleeding, great(p) shock, severe head injuries, and acute psychotic states are some examples of emergencies. Less obvious situations can also be emergencies broken bones, fever, and cuts requiring stitches may also require immediate treatment. Both public and private hospitals have a duty to administer medical care to a person experiencing an emergen cy. If a hospital has emergency facilities, it is legally required to provide appropriate treatment to a person experiencing an emergency.If the hospital is unable to provide emergency work, it must provide a referral for appropriate treatment. Hospitals cannot refuse to treat prospective patients on the basis of race, religion, or national origin, or refuse to treat someone with HIV or AIDS. In 1986, coition passed the Emergency Medical Treatment and Active Labor Act (EMTALA) (42 U.S.C.A. 1395dd), which established criteria for emergency services and criteria for ripe transfer of patients between hospitals. This statute was designed to prevent patient dumping, that is, transferring undesirable patients to another facility. The law applies to all hospitals receiving federal funds, such as Medicare (almost all do). The law requires hospitals to provide a screening exam to take in if an emergency condition exists, provide stabilizing treatment to any emergency patient or to any w oman in active labor before transfer, and continue treatment until a patient can be discharged or transferred without harm.It also delineates strict guidelines for the transfer of a patient who cannot be stabilized. A hospital that negligently or penetratively and willfully violates any of these provisions can be terminate or suspended from Medicare. The physician, the hospital, or both can also be penalized up to $50,000 for each knowing violation of the law. One of the first cases brought under EMTALA involved a doctor who transferred a woman in active labor to a hospital 170 miles away. The woman delivered a healthy baby during the trip, but the doctor was fined $20,000 for the improper transfer of the woman. In addition to federal laws such as EMTALA, states may also impose by regulation or statute a duty on hospitals to administer emergency care. There is no universal right to be admitted to a hospital in a nonemergency situation. In nonemergency cases, admission rights depen d largely on the specific hospital, but basing admission on ability to compensation is severely limited by statutes, regulations, and judicial decisions. Forexample, most hospitals obtained financial assistance from the federal government for eddy these hospitals are required to provide a reasonable volume of services to persons unable to turn out. The amount of services to be provided is set by regulation, and the obligation continues for 20 years after construction is completed. Patients must be advised of the hospitals obligation under the law, or the hospital may be foreclosed from suing to absorb on the calling card.In addition, many states prohibit hospitals from denying admission based solely on inability to pay some courts have made similar rulings against public hospitals based on hospital charters and public policy reasons. Hospitals are also prohibited from requiring a deposit from a Medicare or Medicaid patient. Once a patient has been duly admitted to a hospital, she or he has a right to leave at any time, or the hospital could be liable for False Imprisonment. This is so even if the patient has not paid the bill or if the patient wants to leave against all medical advice. In rare cases, such as transmittable disease cases, public health authorities may have state statutory or regulatory authority to quarantine a patient. In addition, state laws governing involuntary commitment of the mentally ill may be used to prevent a person of unsound mind from leaving the hospital if a qualified psychiatrist determines that the person is a danger to himself or herself or to the lives of others. A doctor familiar with a patients condition determines when a patient is ready for discharge and signs a written order to that effect.If the patient disagrees with a decision to discharge, she or he has the right to demand a consultation with a different physician before the order is carried out. The decision to discharge must be based solely on the patients med ical condition and not on escape of medical bills. In the mid-1990s, concern over maternity patients being discharged just a few hours after giving birth prompted legislation at both the state and federal levels. In family line 1996, President bill clinton signed a law ensuring a 48-hour hospital stay for a woman who gives birth vaginally and a 96-hour stay for a woman who has a caesarean section, unless the patient and the doctor agree to an earlier discharge. A number of state legislatures have passed similar laws as well. With the rise of Managed Care and health Maintenance Organizations (HMOs), patients faced new issues involving the right to treatment. HMOs may deny authorization for expensive or data-based treatments, or for treatmentsprovided outside the network of approved physicians. HMOs contend that they must control costs and make decisions that benefit the largest number of members.In retort, state legislatures have enacted HMO regulations that seek to give patients a process for appealing the denial of benefits. The HMOs have opposed these measures and have vigorously defended their denial of benefits in court. In Moran v. Rush prudential HMO, Inc., 536 U.S. 355, 122 S.Ct. 2151, 153 L.Ed.2d 375 (2002), the irresponsible Court in a 54 decision upheld an Illinois law that required HMOs to provide independent review of disputes between the primary care physician and the HMO. The law mandated that the HMO must pay for services deemed medically necessary by the independent reviewer. Most importantly, the court ruled that the federal Employee privacy Income Security Act (ERISA) did not preempt the Illinois law. ERISA is an extremely complex and technical set of provisions that seek to protect employee benefit programs. The decision was significant because it empowered other states to enact similar laws that give patients more rights in obtaining treatment Medical ExperimentationMedical progress and medical experimentation have always gone hand in hand, but patients rights have sometimes been ignored in the process. Sometimes patients are completely unaware of the experimentation. Experimentation has also taken place in settings in which individuals may have extreme difficulty asserting their rights, such as in prisons, mental institutions, the military, and residences for the mentally disabled. Legitimate experimentation requires informed consent that may be withdrawn at any time. Some of the more notorious and shameful instances of human experimentation in the United States in the twentieth century include a 1963 study in which terminally ill hospital patients were injected with live cancer cells to test their immune response the Tuskegee Syphilis Study, begun before World War II and continuing for 40 years, in which effective treatment was withheld from poor black males suffering from syphilis so that medical personnel could study the natural course of the disease and a study where developmentally disabled children wer e deliberately infected with hepatitis to test potency vaccines. disaster to obtain informed consent can arise even when consent has ostensibly been obtained.The California Supreme Court ruled in 1990 that a physician must disclose preexisting research andpotential economic interests that may affect the doctors medical judgment (Moore v. Regents of the University of California, 51 Cal. 3d 120, 793 P. 2d 479). The case involved excision of a patients cells pursuant to surgery and other procedures to which the patient had consented. The surgery itself was not experimental the experimentation took place after the surgery and other procedures. The cells were used in medical research that proved lucrative to the doctor and medical center. Patients in teaching hospitals are frequently asked to participate in research. Participants do not surrender legal rights simply by agreeing to cooperate and validly obtained consent cannot protect a researcher from Negligence. In hospitals, human ex perimentation is typically monitored by an institutional review board (IRB). Federal regulation requires IRBs in all hospitals receiving federal funding. These boards review proposed research before patients are asked to participate and approve written consent forms. IRBs are meant to ensure that risks are minimized, the risks are reasonable in relation to anticipated benefits, the selection of subjects is equitable, and informed consent is obtained and properly documented. Federal regulations denominate specific items that must be covered when obtaining informed consent in experimental cases. IRB approval never obligates a patient to participate in research. Advance Medical DirectivesEvery state has enacted advance medical leading legislation, but the laws vary widely. Advance medical directives are documents that are made at a time when a person has full decision-making capabilities and are used to direct medical care in the time to come when this capacity is lost. Many statutes are narrowly drawn and specify that they apply only to illnesses when death is close rather than illnesses requiring long-term life support, such as in end-stage lung, heart, or kidney failure multiple induration paraplegia and persistent vegetative state. Patients sometimes use keep wills to direct future medical care. Most commonly, alert wills specify steps a patient does not want taken in cases of life-threatening or debilitating illness, but they may also be used to specify that a patient wants vulturine resuscitation measures used. Studies have shown that animation wills often are not honored, despite the fact that federal law requires all hospitals, nursing homes, and other Medicare and Medicaid providers to askpatients on admission whether they have executed an advance directive. Some of the reasons living wills are not honored are medical personnels fear of liability, the patients failure to communicate his or her wishes, or misunderstanding or mismanagement by hospita l personnel. other way individuals attempt to direct medical care is through a durable Power of Attorney.A durable power of attorney, or proxy decision maker, is a written document wherein a person (the principal) designates another person to perform certain acts or make certain decisions on the principals behalf. It is called durable because the power continues to be effective even after the principal becomes incompetent or it may only take effect after the principal becomes incompetent. As with a Living Will, such a document has little power to compel a doctor to follow a patients desires, but in the very least it serves as valuable evidence of a persons wishes if the matter is brought into court. A durable power of attorney may be used by itself or in conjunction with a living will. When advance medical directives function as intended and are honored by physicians, they free family members from making extremely difficult decisions. They may also protect physicians. banner medic al care typically requires that a doctor provide maximum care. In essence, a living will can change the standard of care upon which a physician will be judged and may protect a physician from legal or professional repercussions for withholding or withdrawing care. Right to travelA number of cases have addressed the right to refuse life-sustaining medical treatment. Broadly speaking, under certain circumstances a person may have a right to refuse life-sustaining medical treatment or to have life-sustaining treatment withdrawn. On the one side in these cases is the patients interest in autonomy, privacy, and bodily integrity. This side must be balanced against the states traditional interests in the preservation of life, prevention of suicide, protection of dependents, and the protection of the integrity of the medical profession. In in re quinlan, 355 A.2d 647 (1976), the New Jersey Supreme Court permitted withdrawal of life-support measures for a woman in a persistent vegetative st ate, although her condition was stable and her life expectancy stretched years into the future. Many of the emotional issues the country struggles with in the early 2000s were either a direct result of or were influenced by this case,including living wills and other advance medical directives, the right to refuse unwanted treatment, and physician-assisted suicide.The first U.S. Supreme Court decision addressing the difficult question regarding the removal of life support was Cruzan v. Director, Missouri Department of Health, 497 U.S. 261, 110 S. Ct. 2841, 111 L. Ed. 2d 224 (1990). Cruzan involved a young woman rendered permanently comatose after a car accident. Her parents petitioned to have her feeding tube removed. The Supreme Court ruled that the evidence needed to be clear and win over that the young woman had explicitly authorized the termination of treatment prior to becoming incompetent. The Court ruled that the evidence had not been clear and convincing, but upon remand to the state court the family presented new testimony that was deemed clear and convincing. The young woman died 12 days after her feeding tube was removed. The Supreme Court decided two right-todie cases in 1997, Quill v. Vacco, 521 U.S. 793, 117 S.Ct. 2293, 138 L.Ed.2d 834 (1997), and chapiter v. Glucksberg, 521 U.S. 702, 117 S.Ct. 2258, 138 L.Ed.2d 772 (1997). In Glucksberg, the appellate courts in New York and Washington had afflicted down laws banning physician-assisted suicide as violations of Equal Protection and due process, respectively. The Supreme Court change by reversal both decisions, finding no constitutional right to assisted suicide, thus upholding states power to ban the practice.though both cases were considered together, Glucksberg was the key right-to-die decision. Dr. Harold Glucksberg and three other physicians sought a Declaratory Judgment that the state of Washingtons law prohibiting assisted suicide was unconstitutional as applied to terminally ill, mentall y competent adults. The Supreme Court voted unanimously to sustain the Washington law, though five of the nine justices filed concurring opinions in Quill and Glucksberg. Chief Justice william rehnquist, writing for the Court, based much of his analysis on historical and legal traditions. The fact that most western democracies make it a crime to assist a suicide was O.K. up by over 700 years of Anglo-American common-law tradition that has punished or disapproved of suicide or assisting suicide. This deeply rootedopposition to assisted suicides had been reaffirmed by the Washington legislature in 1975 when the current barricade had been enacted and again in 1979 when it passed a Natural Death Act. This law declared that the refusal or withdrawal of treatment did not constitute suicide, but it explicitly stated that theact did not authorize Euthanasia.The doctors had argued that the law break the Substantive Due Process component of the Fourteenth Amendment. Unlike procedural due p rocess which focuses on whether the right steps have been taken in a legal matter, substantive due process looks to fundamental rights that are implicit in the amendment. For the Court to recognize a fundamental liberty, the liberty must be deeply rooted in U.S. history and it must be carefully described. The Court spurned this argument because U.S. history has not recognized a right to die and therefore it is not a fundamental right. Employing the Rational Basis Test of constitutional review, the Court concluded that the law was rationally related to to legitimate government interests and thus passed constitutional muster. Privacy and ConfidentialityConfidentiality between a doctor and patient means that a doctor has the express or implied duty not to disclose information received from the patient to anyone not directly involved with the patients care. Confidentiality is important so that healthcare providers have noesis of all facts, regardless of how personal or embarrassing, that might have a bearing on a patients health. Patients must feel that it is safe to communicate such information freely. Although this theory drives doctor-patient confidentiality, the truth is that many people have routine and legitimate access to a patients records. A hospital patient might have several doctors, nurses, and support personnel on every shift, and a patient might also see a therapist, nutritionist, or pharmacologist, to name a few.The law requires some confidential information to be reported to authorities. For example, birth and death certificates must be filed Child plague cases must be reported and infectious, contagious, or communicable diseases must be reported. In addition, confidential information may also be disclosed pursuant to a judicial proceeding or to make known a person to whom a patient may pose a danger. In spite of the numerous exceptions to the contrary, patients legitimately demand and expect confidentiality in many areas of their treatment. Generally speaking, patients must be asked to consent before being photographed or having others unrelated to the case (including medical students) observe a medical procedure they have the right to refuse to see anyone not attached to a hospitalthey have theright to have a person of the patients own sex present during a physical examination conducted by a member of the opposite sex they have the right to refuse to see persons connected with the hospital who are not directly involved in the patients care and treatment (including social workers and chaplains) and they have the right to be protected from having details of their condition made public. A patient owns the information contained in medical records, but the owner of the paper on which they are written is usually considered the actual owner of the records. The patients legal interest in the records generally means that the patient has a right to see the records and is entitled to a complete copy of them. The patients rights are subject to reasonable limitations such as requiring inspection and copying to be done on the doctors premises during working hours. Federal Patients visor of RightsDissatisfaction with an expanding corporate healthcare industry dominated by profit margins has spawned numerous reform ideas. One idea that has gained a foothold is a patients federal Bill of Rights. In 1997, President Bill Clinton appointed an Advisory Commission on Consumer Protection and Quality in the Health Care Industry. The commission was directed to propose a consumer bill of rights. The 34-member commission developed a bill of rights that identified eight key areas information disclosure, choice of providers and plans, access to emergency service, participation in treatment decisions, respect and nondiscrimination, confidentiality of health information, complaints and appeals, and consumer responsibilities.The proposed rights include the right to receive accurate, easily understood information in order to make informed health care decisions the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality health care the right to access emergency healthcare services the right and responsibility to fully participate in all decisions related to their health care the right to considerate, respectful care from all members of the healthcare system at all times and under all circumstances the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable healthcare information protected the right to a fair and efficient process for resolving differences with their health plans,healthcare providers, and the institutions that serve them and the responsibility of consumers to do their part in protecting their health. This bill of rights has been debated in Congress and there are bipartisan areas of agreement, but, as of 2003, no final action has taken on enacting a set of rights into f ederal law.