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Beyond ill-will

R. Desikan

On a recent visit to Kuala Lumpur, I came across an interesting document, Patients' Charter, prepared by Sothi Rachagan, Regional Director, Consumer International -- Asia-Pacific.

The most impressive feature of the charter, which took six years to prepare, is that it has been accepted by the Malaysian Medical Association, Malaysian Dental Association and the Malaysian Pharmaceutical Society, which have signed a memorandum of under standing (MoU) with FOMCA.

Rachagan's seminal work found mention in the prestigious British journal, Lancet. It went on to become the basis for similar efforts in other countries. To begin with, the MoU recognises the following:

``The consumer of medical services has his rights. These rights are not, and should not be automatically forfeited on entering a doctor-patient relationship or a healthcare facility such as a hospital or nursing home. Patients should not be required to c heck-in their rights along with other valuables when they enter healthcare institutions. A right to something is a value claim to it. Rights give dignity and protection. If we have a right to something, we can insist on it without embarrassment or fear. If patients exercise their rights more often, such insistence would no longer be seen as unusual and it would become increasingly easy for other patients to exercise their rights as well.''

Dealing with the right to adequate information and consent, the MoU says:

* The patient's consent shall be required for the inclusion of the patient in any research.

* The patient shall be adequately informed of the aims, methods, anticipated benefits and potential hazards of the study and the discomfort such a study entails.

* The patient shall be informed that he or she is at liberty to abstain from participation in the study and that he or she is free to withdraw his or her consent to participate in the study at any time.

* To ensure that informed consent is not obtained under duress or from a patient in a dependant relationship to the health professional, the informed consent shall be obtained by a health professional who is not engaged in the investigation and who is co mpletely independent of the official relationship between the patient and the health professional. In the case of a child, the informed consent shall be obtained from the parent or a guardian.

Rachagan says, initially, there was some resistance to the MoU. He had to quote medical literature and other sources to see his efforts through. In fact, the `rights to adequate information and consent' is derived from the `Code of Ethics on Human Experi mentation' drafted by the World Medical Association in 1964. The document is also known as the Helsinki Declaration.

On the brighter side, though, Malaysian medical professionals participated actively to lend clarity to the charter. For instance, says Rachagan, the `right to choice of care' originally stated that a patient was entitled to a copy of his or her case hist ory and medical records and to have them explained. However, many believed this would put health professionals on the defensive and they would resort to writing brief and inadequate notes which would prove detrimental to the patient's interests.

The Patients' Charter was amended to read, ``A patient shall have the right to know the investigation conducted, the results of the investigation and a copy of the medical reports and have them explained.''

Other highlights of the MoU include:

* Healthcare services shall be available on the basis of clinical need, regardless of ability to pay.

* All drugs dispensed shall be of acceptable standards in terms of quality, efficacy and safety.

* Every individual shall have the right to prompt emergency/ first-aid treatment from government or private medical facilities.

* If a patient's health professional refuses to allow another health professional to be called in, or breaches any provision of the charter, the patient shall have the right to discharge the health professional and seek the services of another.

* The patient shall have the right to a clear, concise explanation, in lay terms, of the proposed procedure and on alternatives available.

* The explanation shall incorporate information on significant risks, side-effects or after-effects, problems relating to recuperation, likelihood of success, risk of death and whether the proposed procedure is to be administered by or in the presence of students.

* A patient may refuse any treatment or investigation.

* A patient shall have the right to an itemised account after any treatment or consultation and to have this explained.

In our country, the mental make-up of patients is one of abject surrender to the doctor or hospital, often leading to exploitation. As patients are largely ignorant of their rights, it is the responsibility of medical professionals to provide adequate in formation on the condition of the patient's health, the medication suggested, the tests needed and so on.

Provision of healthcare is no longer the preserve of the Government or the family doctor. Private institutions have made inroads rapidly. Modern medical technology tends to distance the doctor from the patient and turn the hospital into an alien and alie nating environment. In fact, from the moment a patient enters a hospital, he feels his life passing from his hands, and from those of near and dear ones, into the hands of `strangers'. Today, technicians, laboratories, chemicals and machines play a major role in healthcare which is marked by growing commercialisation.

The Malaysian patients' charter offers a ray of hope in this stark scenario. Readers are welcome to e-mail me for a full copy of the MoU.

The author is former chairman, Federation of Consumer Organisations, Tamil Nadu. He can be reached at rdesikan@vsnl.com