1158

1. Patients:
Rights, Values and
the Law.
ED HOROWICZ

2. Objectives
 To review the characteristics and beliefs that may
influence treatment and care needs.
 Discuss how ethical principles apply to these.
 Introduction to the Equality Act 2010.
 Introduction to the Human Rights Act 1999.
 To recognise the rare occasions when beliefs can
be overridden.
 Exploring how the law protects patients using
case based discussions.

3. What characteristics influence a
patient’s healthcare?
 A patient’s healthcare, from decision making to treatment can be
influenced by their belief's and values.
 These include;
 Age
 Disability
 Religion
 Culture
 Gender
 Social Issues

4. Group Work
Identify examples of how those
characteristics could influence a
person’s healthcare.
Consider what the patient could
perceive and what the professional
could perceive.

5. AGE
RELIGION
GENDER
CULTURE
DISABILITY
SOCIAL ISSUES

6. How are these beliefs and values
respected and protected?
The Law and professional codes
of conduct.

7. How do we ethically consider a
patient’s rights?
Autonomy:
“a form of ‘self government’, where a person
should be able to control their own lives,
including their own bodies, by exercise of their
own faculties”(Harris, 1985, at p195).
 Is it ever ethically acceptable to not protect
the right of autonomy?

8. Beneficence
 Positive obligation to do good for the patient,
not the healthcare professional.
 How does beneficence affect a patient’s
rights and beliefs in healthcare?
 Should a patient’s values and beliefs ever
be overridden?

9. Non-maleficence
 ‘First do no harm’.
 Is it harmful to not respect beliefs and
values in healthcare?
 Can beliefs and values be harmful to a
patient?

10. Justice
 Equality and fairness in how beliefs and values
are respected.
 Are all beliefs and values regarded
equally?
 Should they be?
 How do we consider beliefs and values
when they are different to our own?

11. What legal rights do we have?
 Anti-Discrimination law for healthcare professionals
is provided by the Equality Act 2010.
 The Act provides that it is unlawful for public and
private healthcare providers, including healthcare
professionals, to discriminate against a person with a
protected characteristic.
 These characteristics are;
Age, Gender, Gender Reassignment, Sexuality,
Marital Status, Religion or Belief, Race and
Disability.

12. There are exceptions!
 Beliefs and values must not contravene any domestic laws.
-Consider a cultural belief that has been interpreted as religious
but if manifested would be an illegal act.
e.g. Female Genital Mutilation Act
 If the discrimination is a ‘proportionate means to legitimate
aim’.
 Consider the transsexual male patient requesting to be cared
for on a female ward/bay.
-If no side rooms are available, the legitimate aim may be to
keep to the single sex accommodation policy to protect the
privacy and dignity of female patients.

13. The Human Rights Act 1998
 Resulting from the European Convention on
Human Rights and Fundamental Freedoms.
 Renders certain Convention rights enforceable
against public authorities, into domestic law.
 What essentially does it do?
The Act sets out fundamental rights and freedoms
that individuals in the UK have access to.
Provides individuals with judicial recourse
domestically and through the ECHR in Strasbourg.

14. These rights and freedoms include;
 Right to life
 Freedom from torture and inhuman or degrading treatment
 Right to liberty and security
 Freedom from slavery and forced labour
 Right to a fair trial
 No punishment without law
 Respect for your private and family life, home and correspondence
 Freedom of thought, belief and religion
 Freedom of expression
 Freedom of assembly and association
 Right to marry and start a family
 Protection from discrimination in respect of these rights and freedoms
 Right to peaceful enjoyment of your property
 Right to education
 Right to participate in free elections

15. Which of these rights protects values
and beliefs?
 Article 3- Prohibition of torture
Lack of healthcare provided to prisoners is contrary to the value that all
individuals should be provided with access to healthcare.
 Article 8- Right to respect for private and family life
Least defined but considered by the Supreme Court as ‘the right to
autonomy’.
-Consider imposing treatment without consent of a mentally competent
person.
-Consider the beliefs and values that a person may hold on end of life care;
euthanasia and assisted suicide. However, the state can contravene this right.

16.  Article 9- Freedom of thought, conscience and religion.
Right to manifest religion or belief in worship, practice, teaching
and observance.
-Consider children, does male circumcision based on parental
religious beliefs, breach the child’s rights?
-Consider the child whose parents refuse to allow a blood
transfusion.
These would both be considered under the Children’s Act 1989,
in whether the parents are acting in the child’s best interests.

17.  Article 14- Prohibition of Discrimination
Prohibits unjustified discrimination of Convention Rights.
(This is different to discrimination per se)
-Consider the right to marry and found a family under Article 12.
If the NHS offered fertility treatment to only heterosexual couples
but refused the same treatment to a lesbian couple then Article
14 is breached.

18. What if a person’s beliefs are
considered detrimental?
 The Mental Capacity Act 2005 provides that a providing a person is
mentally competent, decisions are valid even if they are ‘unwise’.
 The exceptions to these in law are;
 Children, a parent/guardian is not deemed to be acting in the best
interests of the child, under the Children’s Act 1989 this
responsibility will be given to the courts/social services.
 Where the belief is not based on a patient’s values but as a result of
severe mental illness, which after the test for mental capacity under
the MCA 2005, demonstrates that they are incompetent.
 Safety, if a physical requirement could cause harm during surgery;
crucifix necklace remaining on when electrosurgery is to be used.

19. What if a practitioners beliefs are
detrimental?
 ODP’s cannot refuse to treat a patient almost without
exception.
 Any refusal based on a protected characteristic would not only
breach HCPC Code of Conduct but would constitute direct
discrimination.
 The exception to this is elective termination of pregnancy and
this is known as Conscientious Objection.
 However, an ODP or Nurse cannot refuse to care for a patient
before or post termination of pregnancy.
 An ODP or nurse cannot refuse to treat or participate in
termination where the mother’s life is or could be at risk.

20. End of Life Issues
 The ODP has to recognise that to act in accordance with a
person’s beliefs does include respect for end of life care.
 Consider provision of religious chaplaincy .
 Consider continued presence of relatives.
 After death consider issues such as;
 burial/cremation,
 leaving a body unattended and
 ceremonial duties requested or expected as part of a person’s
faith.

21. Scenario 1
 Liz is a 20 year old paraplegic who uses a wheelchair to
mobilise.
 Liz has been admitted for elective routine surgery and the
policy for transfer to theatre states that patients should walk to
theatre (covered up), in order to promote patient dignity.
 A theatre porter and the ODP come to escort Liz to theatre but
bring a trolley.
 Liz asks to wheel herself to theatre.
 How is Liz protected by law to be treated equally?
 Could this be refused?

22. Scenario 2
Don is a 42 year old male who has come
for a revision of a total hip replacement.
Don is a Jehovah's Witness and has
refused the use of blood products.
How is Don protected by law?
Can this ever be overridden?

23. Scenario 3
 Paul is a senior anaesthetic ODP working within an
all female team on a gynaecology elective list.
 Tim introduces himself to Cheryl, a patient waiting in
the anaesthetic room.
 Maria states that she will not have any surgery with a
male member of staff present.
 Is this enforceable by law?
 How would you handle this?

24. Summary
 We have reviewed the characteristics and beliefs that may
influence treatment and care needs.
 We have discussed how ethical principles apply to these.
 We have been introduced to the principles that apply the
Equality Act 2010 to healthcare.
 We have looked at the Human Rights Act 1999 and how it
applies to healthcare.
 We have explored the rare occasions when beliefs can be
overridden.
 We have applied the objectives to learning scenarios.

25. References
 Beauchamp.T and Childress.J, 2009. Principles of Biomedical Ethics, 6th
Edition, Oxford: Oxford University Press.
 Brazier.M. and Cave.E, 2011. Medicine, Patients and the Law. 5th Edition,
London :LexisNexis / Penguin.
 General Medical Council. 2008. ‘Consent: patients and doctors making
decisions together’. GMC: London.
www.gmc-uk.org/guidance/ethical_guidance.asp (accessed 02/02/2015).
 Herring.J, 2011. Medical Law and Ethics. 5th Edition, Oxford: Oxford
University Press.
 legislation.gov.uk