Patient Rights

Patient Rights refer to the rights that individuals possess simply by virtue of being human, which are guaranteed by the constitution, international agreements, laws, and other regulations in the context of accessing health services. These rights are considered a reflection of fundamental human rights in the field of health care and derive their foundation from core documents on human rights. The concept encompasses legal, ethical, and moral standards that protect patients from unfair, unnecessary, and inappropriate procedures and treatments in their interactions with healthcare providers. Disciplines such as social work evaluate patient rights as a fundamental human right within the framework of respecting the dignity and worth of the individual.

Historical Development

The emergence and evolution of the concept of patient rights have paralleled advances in the field of human rights. Patient rights, arising from the application of human rights to health services, developed notably from the early 19th century and especially after World War I and World War II. The human rights violations and abuses experienced during these wars created an atmosphere of distrust toward medical professionals, prompting physicians and healthcare workers committed to ethical practice and human dignity to embrace the concept of patient rights.

Development at the International Level

The first official declaration concerning patient rights emerged in 1947 during the Nuremberg Trials, imposing on physicians the responsibility to obtain the patient’s informed consent before performing medical procedures. Comprehensive efforts are widely recognized as having originated in the United States of America (USA). In the USA, court rulings, the American Medical Association, and patient advocacy groups adopted the principle of informed consent as both a right and an ethical standard. The first known national document on patient rights is the “Patient Bill of Rights,” published in 1972 by the American Hospital Association. This document was the first national instrument to comprehensively address patient rights.

The first international document is the “Lisbon Declaration,” adopted by the World Medical Association in Lisbon in 1981. It was followed by the “Declaration on the Rights of the Patient in Europe” (Amsterdam Declaration), adopted by the World Health Organization European Office in 1994, and the “Bali Declaration,” issued by the World Medical Association in 1995. In 2002, the “European Statute on Patient Rights” was adopted in Rome.

Development in Türkiye

Efforts regarding patient rights in Türkiye have accelerated significantly in recent years. The right to health was first recognized in the 1961 Constitution. Article 14 of the 1982 Constitution affirms that everyone has the right to preserve and develop their material and spiritual existence and emphasizes that no one may be subjected to scientific or medical experiments without consent, and that bodily integrity may not be violated except for medical necessity.

The “Law on the Practice of Medicine and Allied Health Professions,” one of the earliest laws of the Republic and in effect since 1928, required patient consent prior to medical interventions. This was followed by the “Medical Deontology Regulations” of 1960, the “Patient Rights Regulation” of 1998, and the “Ethical Principles of the Turkish Medical Association” of 1999.

Additionally, the Council of Europe’s “Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine” (Oviedo Convention), adopted in 1997 and to which Türkiye is a party, was enacted into Turkish law by the Grand National Assembly of Türkiye in 2003 and became part of the domestic legal system.

Legal Framework and Core Documents

The legal basis for patient rights is established by international declarations, treaties, and national legislation.

International Documents

• American Hospital Association Patient Bill of Rights (1972): Emphasized the patient’s right to receive information about their illness, treatment, and prognosis in language they can understand.

• World Medical Association Lisbon Declaration (1981): Defined fundamental rights including the freedom to choose a physician, accept or refuse treatment, privacy, die with dignity, and receive or decline spiritual support.

• Declaration on the Rights of the Patient in Europe (Amsterdam, 1994): Prepared to establish and promote principles of patient rights in European countries.

• Oviedo Convention (1997): Legally guaranteed fundamental rights such as equitable access to health services, consent, respect for private life, and prohibition of the commercial exploitation of the human body.

• European Statute on Patient Rights (Rome, 2002): Contains fourteen articles covering protective measures, information, consent, free choice, privacy, quality, safety, and the right to complain.

Legal Regulations in Türkiye

In Türkiye, patient rights were previously regulated through scattered laws and regulations. The most comprehensive regulation in this field is the “Patient Rights Regulation,” published on 1 August 1998. This regulation was prepared to concretely reflect fundamental human rights in health services, prevent rights violations, and ensure access to legal remedies.

In 2003, the Ministry of Health issued the “Guideline on the Implementation of Patient Rights in Health Facilities” to ensure the enforcement of the regulation. The guideline aimed to prevent rights violations in health facilities, improve service quality, and ensure that health services are delivered in a manner consistent with human dignity. The guideline was revised in 2005 to align with contemporary conditions.

Scope of Patient Rights

According to the Patient Rights Regulation, the fundamental rights of individuals can be grouped under the following headings:

Right to Access Health Services

• Access in Accordance with Justice and Fairness (Article 6): Every patient has the right to access health services appropriate to their needs, in accordance with the principles of justice and fairness. This right also entails the obligation of healthcare personnel to provide services in compliance with these principles.

• Request for Information (Article 7): The patient may request information on how to access health services, the services and facilities available, and the procedures for application.

• Choice and Change of Health Facility (Article 8): The patient has the right to choose and change the health facility under the applicable regulations.

• Recognition, Selection, and Change of Personnel (Article 9): The patient has the right to learn the identity and title of personnel providing care and, within the scope of regulations, to select and change such personnel.

• Request for Priority Determination (Article 10): In situations where service capacity is limited, the patient may request that priority be determined objectively based on medical criteria. Provisions of relevant regulations apply to emergency and legal cases, the elderly, and persons with disabilities.

• Appropriate Diagnosis, Treatment, and Care (Article 11): The patient has the right to demand diagnosis, treatment, and care consistent with the requirements of modern medical knowledge and technology.

Right to Information Regarding Health Status

• Information and Request for Information: The patient has the right to receive information regarding the probable causes and course of their illness, planned medical interventions, alternative diagnostic and treatment options, risks, medications to be used, and lifestyle recommendations. Information must be clear, understandable, and continuous.

• Review and Copying of Records (Article 16): The patient may review and obtain a copy of files and records related to their health status.

• Request for Correction of Records (Article 17): The patient has the right to request correction of incomplete, unclear, or erroneous information in their records.

• Prohibition of Information Disclosure (Article 20): An individual may request that neither they nor their close relatives be informed about their health status and must declare this request in writing.

Right to Privacy and Consent

• Respect for Privacy (Article 21): Respect for the patient’s privacy is fundamental. This right includes the confidentiality of medical assessments, examinations, and treatments and continues after death.

• Non-Consensual Medical Intervention (Article 22): Except as provided by law, no one may be subjected to a medical procedure without consent. If the patient is a minor or incapacitated, consent must be obtained from a legal guardian or representative. In emergency situations involving loss of consciousness and imminent life-threatening risk, consent is not required.

• Confidentiality of Information (Article 23): Information obtained in the course of providing health services may not be disclosed except as permitted by law.

• Refusal or Withdrawal of Treatment (Article 25): The patient has the right to refuse or discontinue planned or ongoing treatment, except in legally mandated circumstances, and assumes responsibility for the consequences of such a decision.

Other Rights

• Guarantee of Safety (Article 37): Everyone has the right to demand the protection of their life and property within health institutions.

• Performance of Religious Duties (Article 38): Necessary measures shall be taken to enable patients to fulfill their religious obligations within the limits of institutional capacity.

• Respect for Human Dignity and Visitation (Article 39): The patient has the right to receive care in an environment respectful of their personal values, with a friendly, courteous, and compassionate approach.

• Accompaniment (Article 40): The patient has the right to have a companion present, provided the attending physician deems it appropriate and institutional capacity permits.

• Right to Petition, Complaint, and Legal Action (Article 42): In the event of a rights violation, the patient has the right to pursue all forms of petition, complaint, and legal action within the framework of applicable regulations.

Implementation Areas and Institutional Structure

To implement patient rights in Türkiye, structural arrangements have been established within institutions under the Ministry of Health. Through the Patient Rights Implementation Guideline, institutional units have been created in health facilities to prevent patient rights violations and manage complaints.

Implementation began in 2003 in 60 state hospitals across 38 provinces and was expanded by the end of 2004 to cover all 81 provinces and major districts. This structure consists of the following units:

Patient Rights Units

These units, established within health institutions, aim primarily to resolve problems encountered by patients and their families at the local level. Unit managers must be university graduates and selected from professionals such as social work experts or psychologists.

Patient Rights Committees

These committees are established within provincial health directorates, university hospitals, and other health institutions to evaluate and decide on written complaints that cannot be resolved locally. Committees are chaired by the provincial health director or their representative and include representatives from professional associations, unions, institutions, civil society organizations, and one citizen. Committees must reach a decision on complaints within 30 days. Committee decisions are advisory in nature and lack binding force.

Research has shown that patient rights implementation practices in hospitals under the Ministry of Health are consistent with international accreditation standards such as those of the Joint Commission International (JCI).

Patient Responsibilities

In addition to their rights, patients have responsibilities that contribute positively to the healthcare process. These responsibilities are defined in Article 42/A of the Patient Rights Regulation and in the policies of various institutions. Major patient responsibilities include:

• Providing Information: The patient must provide complete and accurate information regarding their symptoms, past illnesses, treatments received, and medications used.

• Compliance with Recommendations: The patient must follow the treatment plan prescribed by the physician, recognize their role in the treatment process, and comply with the physician’s instructions.

• Responsibility for Refusing Treatment: The patient assumes responsibility for the consequences of refusing treatment.

• Compliance with Health Facility Rules: The patient must comply with the rules and practices of the health facility they approach, including adherence to appointment times and visitation policies.

• Respect: The patient must respect the rights of other patients and staff and avoid verbal or physical aggression toward personnel.

• Complaint Procedure: In the event of a rights violation, the patient must first file a complaint with the Patient Rights Unit.