NationStates Jolt Archive

Patient's Rights Act

A resolution to improve worldwide human and civil rights.


Category: Human Rights


Strength: Significant


Proposed by: Yeldan WA Guinea Pig

Description: NOTING that a healthy population is a more productive population and that the better the overall health of citizens, the better a nation’s economy can thrive;

BELIEVING that all persons have the right to participate in the assessment of their needs, the development of their treatment plans and to receive information concerning their condition and treatment;

ASSERTING that medical professionals must be able to provide these services without government interference in the doctor/patient relationship or corruption;

FURTHER ASSERTING that patients have the right to expect confidential treatment of all communications and records relating to their care;

The nations of the World Assembly declare that:

(I) Decisions concerning medical treatment, medical procedures and treatment options shall rest with the patient and any physicians involved in his or her care.

(II) All citizens of all WA member nations have the right to undergo any medical procedure, provided that the procedure is approved by a recognized major medical association, is deemed necessary and beneficial to the patient by his or her physician, and is legal in the nation where the procedure is performed..

(III) Patients may refuse treatment and such refusal shall be verbal or in writing provided that such refusal does not endanger the health of others.
(i) A physician may give emergency medical treatment without the patient’s consent if, because of the emergency circumstances, including the patient’s physical or mental state, it is not possible to obtain his consent.

(IV) Patients have the right to be given full and accurate information about the nature of their illnesses, diagnostic procedures, the proposed treatment and the costs involved.

(V) Patients have the right to be given full and accurate information about the persons and institutions directly and personally involved in their care as it relates to their care.

(VI) Personal medical records and the contents of such records, including consultations between patients and physicians, shall be held in the strictest confidentiality and shall not be made available to any third party without the consent of the patient, with the following exceptions:
(i)Records shall be released in response to a warrant, subpoena, or similar legal instrument issued by a court of jurisdiction.
(ii)Physicians may make the patients personal medical records and the contents of such records available to their colleagues and any healthcare professionals involved in the patients treatment for the purpose of providing medical care to the patient and for the purpose of epidemiological and morbidity study.

(VII) No medical facility or physician shall discriminate between patients on grounds of religion, race, sex, nationality, country of birth, or other such grounds.

(VIII) For the purposes of this legislation, "patient" may also refer to a legal guardian if the patient is under the age of majority, or is an adult unable to understand his or her rights under this Act.

(IX) In cases involving adult conjoined twins who are both capable of exercising their rights under this act, acceptance or refusal of treatment shall be required of each twin. In cases involving minor conjoined twins or in instances where one or both twins are incapable of giving consent, decisions shall rest with the guardian or physician as per Articles III(i) and VIII.

I love this legislation.

The only thing I would like to see is a guarantee of medical action where the life of the patient is threatened... something along the lines of "Patients have the right to medical action under circumstances require life-saving procedures," or the like.

We don't want to get into murky insurance/socialized medicine waters, but I'm afraid that a lack of such a guarantee would allow medical providers to deny care to patients whose lives are in danger. "Not having insurance" or "not having a credit card" isn't covered under Article VII, I don't think.

Wens Foroun
Symposium Subjugant

I love this legislation.

The only thing I would like to see is a guarantee of medical action where the life of the patient is threatened... something along the lines of "Patients have the right to medical action under circumstances require life-saving procedures," or the like.

We don't want to get into murky insurance/socialized medicine waters, but I'm afraid that a lack of such a guarantee would allow medical providers to deny care to patients whose lives are in danger. "Not having insurance" or "not having a credit card" isn't covered under Article VII, I don't think.

Wens Foroun
Symposium Subjugant
Yes, it probably should include a provision for emergency services. I'll add that.

Aüþgæþ Spøtyiú
Ambassador

This is an excellent proposal and is masterfully well written. We will doubtless vote yes for it should it reach that stage. We are concerned about clause 9 though, should it not be the case that everyone despite their congenital condition should have the right to avail of treatment should they wish to. There are similar overlaps of morals regarding abortion which the resolution rightly does not mention outright but which it legally allows for, should a conjoined twin not have the same rights over their own body as an expectant mother?

yours e.t.c.,

This is an excellent proposal and is masterfully well written. We will doubtless vote yes for it should it reach that stage. We are concerned about clause 9 though, should it not be the case that everyone despite their congenital condition should have the right to avail of treatment should they wish to. There are similar overlaps of morals regarding abortion which the resolution rightly does not mention outright but which it legally allows for, should a conjoined twin not have the same rights over their own body as an expectant mother?

yours e.t.c.,
OOC: *sigh*

Do you know the history of the original Patients Rights Act in the old UN? This time I'd rather steer well clear of any ideological wars involving abortion, socialized medicine, etc.

I'd like for this to just be a patient's rights act. We can battle to the death over abortion some other day.

The conjoined twins part has always seemed a bit odd and out of place to me. It was suggested by _Myopia_ and I added it, but was uneasy about doing so. The only reason it's still there in this version is that I haven't figured out how to handle that particular circumstance without including it.

OOC: *sigh*

Do you know the history of the original Patients Rights Act in the old UN? This time I'd rather steer well clear of any ideological wars involving abortion, socialized medicine, etc.

I'd like for this to just be a patient's rights act. We can battle to the death over abortion some other day.

The conjoined twins part has always seemed a bit odd and out of place to me. It was suggested by _Myopia_ and I added it, but was uneasy about doing so. The only reason it's still there in this version is that I haven't figured out how to handle that particular circumstance without including it.


No we do not have a working familiarity with the debates of the Old UN.

We assure you we have no interest whatsoever in raising abortion as an issue of debate, we understood your purpose in writing a patients rights bill. We only wanted to better understand why conjoined twins seemed to be being singled out in this way. You have explained why, thank you.

We can edit or delete our previous post if you are annoyed and worried that it will start an avalanche of pro and anti abortion ranting?

Yours,

I don't think it's necessary at all, because the situation would be covered under other clauses of the bill; since the procedure affects both people, and consent must be given for any operations, the logical result is that consent must be given by both. Specifying that situation seems like micromanaging.

W.F.
etc.

We can edit or delete our previous post if you are annoyed and worried that it will start an avalanche of pro and anti abortion ranting?
No no, don't delete it. If anyone starts going on about abortion I'll just throw them out the window...or have Felix do it.

Aüþgæþ Spøtyiú
Ambassador

I don't think it's necessary at all, because the situation would be covered under other clauses of the bill; since the procedure affects both people, and consent must be given for any operations, the logical result is that consent must be given by both. Specifying that situation seems like micromanaging.

W.F.
etc.
Probably right. I'll look it over some more and make a decision. This is the first time I've read the thing in months and there may actually not be a need for that clause.

Aüþgæþ Spøtyiú
Ambassador

Probably right. I'll look it over some more and make a decision. This is the first time I've read the thing in months and there may actually not be a need for that clause.

Aüþgæþ Spøtyiú
Ambassador

It is certainly a very morally loaded clause, one which might give rise to exactly the kind of (foolish we now see) questions as we put. Other clauses do seem to cover the issue pretty squarely.

yours e.t.c. ,

No no, don't delete it. If anyone starts going on about abortion I'll just throw them out the window...or have Felix do it.

Aüþgæþ Spøtyiú
Ambassador

Woo HOO! Defenstration time!! :p

(sorry, i really don't have anything to add to this. I'll pass this onto my delegate when it goes live)

Sara Mavenu
UN Rep

The collective body and mind of Atheas find this act to be a reasonable proposal.

Good, good. Another sensible proposal. Needless to say, it's been approved. Woo hoo! I'm the fourth delegate!

Patient's Rights Act
--snip--
OOC: Looks good. Perhaps we can include obtaining consent as a requisite for performing a medical procedure... nah, that'd be a thorny issue. :p Never mind. :)

I recommend changing the first line, or adding in one before it. Last time there were some complaints about the 'cynicism' of doing this 'for the sake of the economy'; at the same time, I don't think the line is likely to garner much support from those otherwise opposed.

'government interference' should be changed to 'undue government interference'; I don't think anyone would have a problem with the government interfering in the relationship between a patient and an abusive or incompetent doctor.

You vary between 'his', 'his or her', or 'their'. I recommend changing all such references to 'their'.

The emphasis on 'physician' throughout somewhat excludes the role of other medical professionals, such as nurses, midspouses, and emergency medical technicians. This is particularly relevant in the case of (II).

(I) is a bit unclear. Sometimes a patient and a doctor aren't going to want the same thing. Whose decision takes priority? I mean that rhetorically, because you do explain later on. I imagine the purpose is to make it clear the decision doesn't lie with insurers. But the clause seems a bit redundant.

In (II), what is the value of having a procedure approved 'by a major medical association'? To prevent extremely experimental procedures? And the final section might need to be reworded to 'legal for that person'. Gender reassignment surgery is legal in Quintessence of Dust, but only to adults. It could be argued that because the procedure is legal for some, your proposal would require us allowing it for all.

Also in (II), 'citizens of WA member nations' should probably become 'WA nationals'.

(III) doesn't parse: you need some punctuation between 'writing' and 'provided'. And any qualified caregiver should be permitted to give emergency aid without fear of countersuit, under the circumstances of (III)(i).

In (IV), thinking out loud, should an exclusion be added for violating others' medical confidentiality? For example, if a doctor treats a man for an STD, he cannot inform the man's girlfriend without his consent. If a week later, the girlfriend comes in with the STD, and is given 'full information', that should still exclude the information that it was likely contracted from her boyfriend.

Also (IV) should include 'risks and necessity of alternative procedures', particularly with regard to invasive options.

(VI) should be clarified to say that records stripped of personal details can be published. Surgeons might present 'case X'; and governments might issue statistics of epidemiological incidences.

(VII) isn't really viable, or at least 'discriminate' needs to be clarified a little. There would be numerous instances where such factors would be relevant, particularly as relate to inclusion in trials and studies. Perhaps 'the standard of care should not be affected by...except where such factors are relevant to the required course of action'.

Finally, I think it is worth adding that patients should be informed of their rights. Many will not know intuitively that they have the right to ask about their caregivers or the risks of certain procedures, for example.

Most of my suggestions being merely cosmetic, however, I have approved the proposal.

-- Samantha Benson
Quintessence of Dust, Delegate of Wysteria

The People's Democratic Republic of Yelda,

I agree almost entirely with the very-well written proposal of yours. I will certainly vote FOR it if it becomes a resolution.

However, there is one thing bugging me.

You mention the costs. I'm not sure about you, but I think the health service should be free. Although I do suppose other nations may not want this and we can add this in as something seperate.

I would also like to thank you for raising this topic. If it doesn't get passed, it will come into force in Fulmaria anyway.

Regards,
The Kingdom of Fulmaria

OOC comparison to the NSUN resolution (over which one of my nations actually left the NSUN) _

You're now allowing more doctors than just the patients' "attending" ones, such as the experts who'd actually carry out the most difficult operations, a say in matters: Good.

You're now letting the authorities obtain medical records, as long as they can get a warrant for this: Good.

You're still excluding whoever might have to fund the treatments if a nation's doctors don't require all of their patients to pay in advance, such as governments or charities or insurance companies or hospital administrations, from the decision-making process: Bad. They should have some right to set priorities, given their responsibility for providing the cash... Even leaving aside the argument that "he who pays the piper calls the tune", it's a sad-but-true fact that they're unlikely to have unlimited budgets available... and they might well have other legitimate demands on their funds (especially in the case of governments...) too.

You're still forbidding discrimination on the grounds of nationality without setting any mechanism in place for letting whoever funds the treatment (if a nation's doctors don't require all of their patients to pay in advance) recover the costs afterwards from either the patients themselves --before those go back home -- or from either side's national government: Bad. This is likely to result in medical services in the more advanced WA member nations (although probably not Bears Armed...) having to treat "health tourists" from (less advanced nations / non-WA nations where medical treatment isn't a right / nations where medical treatment has to be paid for in advance) without their budgets receiving any compensation for doing so...
(I've got a first draft, somewhere in my notes, for a proposal on the recovery of [legitimate] debts across national borders: Maybe I'll dig that out, although it isn't very relevant to BA, and see whether anybody wants to adopt the basic idea...)

After sending a draft of this resolution to Holiest Party Secretary Schaurbrien, the USSC is interested in full support this draft if it indeed ever becomes a proposal.

Our only issue lies with Clause IV of Article III:

(IV) Patients have the right to be given full and accurate information about the nature of their illnesses, diagnostic procedures, the proposed treatment and the costs involved.

In most cases the USSC would agree with this. The USSC is determined to extend the goodwill of Catholic Charity to persecuted minorities in other lands and grant them asylum, but when doing so, we require them to submit a sealed-envelope medical exam as one of the requirements for residency. Why don't we allow them to know the results of this exam? So no attempts to forge paperwork are made which would allow someone with a dangerous disease to enter the USSC's borders. The USSC would like to reserve the right to this practice to protect the heath of both the permanent residents and citizens of Corlandian alike.

I'm not sure I see the point of II: having the right to a procedure doesn't guarantee the resources -- particularly the money -- to actually get it.

I'm not sure I see the point of II: having the right to a procedure doesn't guarantee the resources -- particularly the money -- to actually get it.

OOC: If this gives all people who happen to be in WA member nations the right to every treatment that any doctor says they should have then, as all WA member nations' governments are legally bound by WA resolutions, wouldn't the governments of those nations be legally obliged to pay for those treatments (in the absence of adequate funding from other sources) regardless of any other demands on their budgets?

OOC: If this gives all people who happen to be in WA member nations the right to every treatment that any doctor says they should have then, as all WA member nations' governments are legally bound by WA resolutions, wouldn't the governments of those nations be legally obliged to pay for those treatments (in the absence of adequate funding from other sources) regardless of any other demands on their budgets?

OOC: Not unless the resolution says so, which it (quite reasonably) doesn't. In my opinion, of course. Having the right to something doesn't equate to the ability to take advantage of it. Would you claim that if a person needed a medical procedure that was only available in Hippocratia, the Hippocratians would have to allow him into the country? That's why I'm leery of the language of rights; unsupported, they don't mean much.

I recommend changing the first line, or adding in one before it. Last time there were some complaints about the 'cynicism' of doing this 'for the sake of the economy'; at the same time, I don't think the line is likely to garner much support from those otherwise opposed.

'government interference' should be changed to 'undue government interference'; I don't think anyone would have a problem with the government interfering in the relationship between a patient and an abusive or incompetent doctor.

You vary between 'his', 'his or her', or 'their'. I recommend changing all such references to 'their'.

The emphasis on 'physician' throughout somewhat excludes the role of other medical professionals, such as nurses, midspouses, and emergency medical technicians. This is particularly relevant in the case of (II).

(I) is a bit unclear. Sometimes a patient and a doctor aren't going to want the same thing. Whose decision takes priority? I mean that rhetorically, because you do explain later on. I imagine the purpose is to make it clear the decision doesn't lie with insurers. But the clause seems a bit redundant.

In (II), what is the value of having a procedure approved 'by a major medical association'? To prevent extremely experimental procedures? And the final section might need to be reworded to 'legal for that person'. Gender reassignment surgery is legal in Quintessence of Dust, but only to adults. It could be argued that because the procedure is legal for some, your proposal would require us allowing it for all.

Also in (II), 'citizens of WA member nations' should probably become 'WA nationals'.

(III) doesn't parse: you need some punctuation between 'writing' and 'provided'. And any qualified caregiver should be permitted to give emergency aid without fear of countersuit, under the circumstances of (III)(i).

In (IV), thinking out loud, should an exclusion be added for violating others' medical confidentiality? For example, if a doctor treats a man for an STD, he cannot inform the man's girlfriend without his consent. If a week later, the girlfriend comes in with the STD, and is given 'full information', that should still exclude the information that it was likely contracted from her boyfriend.

Also (IV) should include 'risks and necessity of alternative procedures', particularly with regard to invasive options.

(VI) should be clarified to say that records stripped of personal details can be published. Surgeons might present 'case X'; and governments might issue statistics of epidemiological incidences.

(VII) isn't really viable, or at least 'discriminate' needs to be clarified a little. There would be numerous instances where such factors would be relevant, particularly as relate to inclusion in trials and studies. Perhaps 'the standard of care should not be affected by...except where such factors are relevant to the required course of action'.

Finally, I think it is worth adding that patients should be informed of their rights. Many will not know intuitively that they have the right to ask about their caregivers or the risks of certain procedures, for example.

Most of my suggestions being merely cosmetic, however, I have approved the proposal.

-- Samantha Benson
Quintessence of Dust, Delegate of Wysteria

Excellent, excellent suggestions Ms. Benson. All of that will be worked into the next draft. Thank you.

Aüþgæþ Spøtyiú
Ambassador

I'm not sure about you, but I think the health service should be free.
I really don't want to wade into the minefield of socialized medicine with this resolution. That's something to be dealt with in a different proposal.

Aüþgæþ Spøtyiú
Ambassador

OOC: Not unless the resolution says so, which it (quite reasonably) doesn't. In my opinion, of course. Having the right to something doesn't equate to the ability to take advantage of it. Would you claim that if a person needed a medical procedure that was only available in Hippocratia, the Hippocratians would have to allow him into the country?
OOC: If Hippocratia was a WA member then, considering the wording of this proposal (including its ban on discrimination on the basis of nationality), yes.

You're still excluding whoever might have to fund the treatments if a nation's doctors don't require all of their patients to pay in advance, such as governments or charities or insurance companies or hospital administrations, from the decision-making process: Bad. They should have some right to set priorities, given their responsibility for providing the cash... Even leaving aside the argument that "he who pays the piper calls the tune", it's a sad-but-true fact that they're unlikely to have unlimited budgets available... and they might well have other legitimate demands on their funds (especially in the case of governments...) too.
I'm not going to mandate, WA-wide, that insurance companies have a say in medical decisions. I might be able to word it so as to allow national governments to make that decision, if they choose to.

You're still forbidding discrimination on the grounds of nationality without setting any mechanism in place for letting whoever funds the treatment (if a nation's doctors don't require all of their patients to pay in advance) recover the costs afterwards from either the patients themselves --before those go back home -- or from either side's national government: Bad. This is likely to result in medical services in the more advanced WA member nations (although probably not Bears Armed...) having to treat "health tourists" from (less advanced nations / non-WA nations where medical treatment isn't a right / nations where medical treatment has to be paid for in advance) without their budgets receiving any compensation for doing so...
Hmmm. I'll look it over and see if there's some way to address this. I'm not trying to institute socialized medicine here, but I don't want to clutter up the text with a bunch of references to insurance and HMOs and methods of payment either.

Aüþgæþ Spøtyiú
Ambassador

OK, I'm going to put this on the back burner for now. I don't have time to work on two proposals simultaneously. I'll come back to it later, after the WAEU thing.

On a positive note, it's picking up approvals nicely on its own, without a TG campaign. I think there'll be widespread support for it when it's submitted for real.

BUMP

This has been re-submitted, with changes and with permission from the Yeldan delegation.

Patient's Rights Act

A resolution to improve worldwide human and civil rights.


Category: Human Rights


Strength: Significant


Proposed by: New Leicestershire

Description: BELIEVING that all persons have the right to participate in the assessment of their needs, the development of their treatment plans and to receive information concerning their condition and treatment;

ASSERTING that medical professionals must be able to provide these services without undue government interference in the doctor/patient relationship or corruption;

FURTHER ASSERTING that patients have the right to expect confidential treatment of all communications and records relating to their care;

The nations of the World Assembly declare that:

(I) Decisions concerning medical treatment, medical procedures and treatment options shall rest with the patient and any physicians or other medical professionals involved in their care.

(II) All citizens of all WA member nations and all WA nationals have the right to undergo any medical procedure that is deemed necessary and beneficial to the patient by their physician or other medical professional, such as nurses, midspouses, and emergency medical technicians, and is legal for that person in the nation where the procedure is performed..

(III) Patients may refuse treatment and such refusal shall be verbal or in writing, provided that such refusal does not endanger the health of others.
(i) A physician or any qualified caregiver may give emergency medical treatment without the patient’s consent if, because of the emergency circumstances, including the patient’s physical or mental state, it is not possible to obtain their consent.

(IV) Patients have the right to be given full and accurate information about the nature of their illnesses, diagnostic procedures, risks and necessity of alternative procedures, the proposed treatment and the costs involved, provided that such information does not violate the medical confidentiality of other persons.

(V) Patients have the right to be given full and accurate information about the persons and institutions directly and personally involved in their care as it relates to their care.

(VI) Personal medical records and the contents of such records, including consultations between patients and physicians, shall be held in the strictest confidentiality and shall not be made available to any third party without the consent of the patient, with the following exceptions:
(i)Records shall be released in response to a warrant, subpoena, or similar legal instrument issued by a court of jurisdiction.
(ii)Physicians may make the patients personal medical records and the contents of such records available to their colleagues and any healthcare professionals involved in the patients treatment for the purpose of providing medical care to the patient and for the purpose of epidemiological and morbidity study. Records entirely stripped of all personal details can be published.

(VII) The standard of care shall not be affected by religion, race, sex, nationality, country of birth, or other such grounds, except where such factors are relevant to the required course of action. Patients have the right to emergency medical treatment under circumstances requiring life-saving procedures.

(VIII) For the purposes of this legislation, "patient" may also refer to a legal guardian if the patient is under the age of majority, or is an adult unable to understand their rights under this Act.

(IX) Patients shall be fully informed of their rights under this Act, either verbally or in writing as applicable.

David Watts
Ambassador
The Dominion of New Leicestershire

On mature consideration, I'm a little wary of clause III. Does it allow for formal declarations that a patient is not competant to make decisions (OOC: such as sectioning under the Mental Health Act)? It strikes me that this area needs to be very carefully worded, otherwise it could be too easy to void the right to refusal.

On mature consideration, I'm a little wary of clause III. Does it allow for formal declarations that a patient is not competant to make decisions (OOC: such as sectioning under the Mental Health Act)? It strikes me that this area needs to be very carefully worded, otherwise it could be too easy to void the right to refusal.
This is only a test submission and I'm open to any and all suggestions. What alternative wording did you have in mind?

Also, now that I look at it I'm not happy with "Patients have the right to emergency medical treatment..." being placed in Article (VII). It really should have its own clause. So there's plenty of room for further improvement.

David Watts
Ambassador
The Dominion of New Leicestershire

This is only a test submission and I'm open to any and all suggestions. What alternative wording did you have in mind?

I haven't, at least not yet. I'll mull it over and see what I can think of.

(OOC: I wrote that in between poking a recalcitrant test system and writing something else, so I didn't have many neurons spare!)

I haven't, at least not yet. I'll mull it over and see what I can think of.

(OOC: I wrote that in between poking a recalcitrant test system and writing something else, so I didn't have many neurons spare!)
Article (III) deals primarily with emergency treatment, particularly (III), (i). What if I re-wrote it thus:

(III) Patients may refuse treatment and such refusal shall be verbal or in writing, provided that such refusal does not endanger the health of others.

(IV) Patients have the right to emergency medical treatment under circumstances requiring life-saving procedures.
(i) A physician or any qualified caregiver may give emergency medical treatment without the patient’s consent if, because of the emergency circumstances, including the patient’s physical or mental state, it is not possible to obtain their consent.
(ii) In non-emergency circumstances, treatment may be given without the patient's consent only in the presence of a legal instrument issued by a court of jurisdiction stating that the patient is not competent to make decisions.

Which would give us this:

BELIEVING that all persons have the right to participate in the assessment of their needs, the development of their treatment plans and to receive information concerning their condition and treatment;

ASSERTING that medical professionals must be able to provide these services without undue government interference in the doctor/patient relationship or corruption;

FURTHER ASSERTING that patients have the right to expect confidential treatment of all communications and records relating to their care;

The nations of the World Assembly declare that:

(I) Decisions concerning medical treatment, medical procedures and treatment options shall rest with the patient and any physicians or other medical professionals involved in their care.

(II) Patients have the right to emergency medical treatment under circumstances requiring life-saving procedures.
(i) A physician or any qualified caregiver may give emergency medical treatment without the patient’s consent if, because of the emergency circumstances, including the patient’s physical or mental state, it is not possible to obtain their consent.
(ii) In non-emergency circumstances, treatment may be given without the patient's consent only in the presence of a legal instrument issued by a court of jurisdiction stating that the patient is not competent to make decisions.

(III) All persons who are lawfully present within any WA member nation have the right to undergo any other medical procedure that is deemed necessary and beneficial to the patient by their physician or other medical professional, such as nurses, midspouses, and emergency medical technicians, is legal for that person in the nation where the procedure is performed, and for which confirmed funding is available.

(IV) Patients may refuse treatment and such refusal shall be verbal or in writing, provided that such refusal does not endanger the health of others.

(V) Patients have the right to be given full and accurate information about the nature of their illnesses, diagnostic procedures, risks and necessity of alternative procedures, the proposed treatment and the costs involved, provided that such information does not violate the medical confidentiality of other persons.

(VI) Patients have the right to be given full and accurate information about the persons and institutions directly and personally involved in their care as it relates to their care.

(VII) Personal medical records and the contents of such records, including consultations between patients and physicians, shall be held in the strictest confidentiality and shall not be made available to any third party without the consent of the patient, with the following exceptions:
(i) Records shall be released in response to a warrant, subpoena, or similar legal instrument issued by a court of jurisdiction.
(ii) Physicians may make the patients personal medical records and the contents of such records available to their colleagues and any healthcare professionals involved in the patients treatment for the purpose of providing medical care to the patient and for the purpose of epidemiological and morbidity study. Records entirely stripped of all personal details may be published.

(VIII) The standard of care shall not be affected by religion, race, sex, nationality, country of birth, or other such grounds, except where such factors are relevant to the required course of action.

(IX) For the purposes of this legislation, "patient" may also refer to a legal guardian if the patient is under the age of majority, or is an adult unable to understand their rights under this Act.

(X) Patients shall be fully informed of their rights under this Act, either verbally or in writing as applicable.

I'd suggest moving the clause about emergency treatment to directly before the current clause '(II)' ](II) All citizens of all WA member nations and all WA nationals have the right to undergo any medical procedure that is deemed necessary and beneficial to the patient by their physician or other medical professional, such as nurses, midspouses, and emergency medical technicians, and is legal for that person in the nation where the procedure is performed. and then inserting the word "other" into the latter clause in between "undergo any" & "medical procedure".
For one thing I think that thus makes sense anyway, and for another my earlier worries about taking potential financial contraints into consideration (instead of apparently requiring each WA nation to write its medical services a blank cheque) could then be addressed -- if you so chose -- by adding the words "and for which confirmed funding is available" at the end of the latter clause....

Re the term "All citizens of all WA member nations and all WA nationals", as the WA is not a 'nation' itself it clearly doesn't have any 'nationals' of its own: Presumably what you meant was "All citizens and other nationals of WA member nations"? Personally I'd suggest changing it to "All persons who are lawfully present within any WA member nation", both because I think that this looks slightly better (because of no longer having the words 'nationals' & 'nations' in such close proximity to each other) and to protect any visitors who are there with the nation's consent.

Looks good, mate.....a little to fluffy and feelgood for me, old boy, but not that bad. Since it stays away from socialized medicine, the Palentine enthusiastically gives its suppport. This is just perfect for me to solicit bribes....err....gifts for my vote.
Excelsior,
Sen. Horatio Sulla
(Now with 50% more unwholesomeness.)

I'd suggest moving the clause about emergency treatment to directly before the current clause '(II)' and then inserting the word "other" into the latter clause in between "undergo any" & "medical procedure".
For one thing I think that thus makes sense anyway, and for another my earlier worries about taking potential financial contraints into consideration (instead of apparently requiring each WA nation to write its medical services a blank cheque) could then be addressed -- if you so chose -- by adding the words "and for which confirmed funding is available" at the end of the latter clause....
OOC: *sigh* I'll do this, but only because I don't think it does any harm to word it that way. Nations that desire to provide socialized medicine could of course continue to do so. It won't affect emergency services, which I think should be provided to all persons as necessary, regardless of legal status.

I really don't understand though where you get the notion that this requires "each WA nation to write its medical services a blank cheque". The second amendment to the US Constitution grants citizens the right to bear arms. It doesn't then proceed to mandate that the federal government provide the citizenry with free firearms. You still have to buy your own guns. Likewise, the right to free speech doesn't imply that you have the right to have multi-page articles published in Time Magazine. Having the "right" to something doesn't automatically mean it is provided to you free of charge, or with no conditions.

Re the term "All citizens of all WA member nations and all WA nationals", as the WA is not a 'nation' itself it clearly doesn't have any 'nationals' of its own: Presumably what you meant was "All citizens and other nationals of WA member nations"? Personally I'd suggest changing it to "All persons who are lawfully present within any WA member nation", both because I think that this looks slightly better (because of no longer having the words 'nationals' & 'nations' in such close proximity to each other) and to protect any visitors who are there with the nation's consent.
Yeah, that part is poorly worded. I'll change it.

OOC: I really don't understand though where you get the notion that this requires "each WA nation to write its medical services a blank cheque". The second amendment to the US Constitution grants citizens the right to bear arms. It doesn't then proceed to mandate that the federal government provide the citizenry with free firearms. You still have to buy your own guns. Likewise, the right to free speech doesn't imply that you have the right to have multi-page articles published in Time Magazine. Having the "right" to something doesn't automatically mean it is provided to you free of charge, or with no conditions.
OOC: It's the "compliance is mandatory" aspect of WA legislation: If a proposal says that people within any WA nation have an absolute right to treatment, and the medical services within a given nation say that they require payment for this work, then if there's no other source of funding available in a particular case surely that nation's government would be out of compliance if it didn't provide the cash? Well, either that or force the medical services to do the work anyway without getting paid for it...

OOC: It's the "compliance is mandatory" aspect of WA legislation: If a proposal says that people within any WA nation have an absolute right to treatment, and the medical services within a given nation say that they require payment for this work, then if there's no other source of funding available in a particular case surely that nation's government would be out of compliance if it didn't provide the cash? Well, either that or force the medical services to do the work anyway without getting paid for it...
So if I pass a Right to Bear Arms resolution, all governments would be required to supply free firearms? Or a right to equal access in housing would mean free housing? Or a right to free speech would grant everyone their own TV show?

So if I pass a Right to Bear Arms resolution, all governments would be required to supply free firearms? Or a right to equal access in housing would mean free housing? Or a right to free speech would grant everyone their own TV show?
OOC: In my opinion? To choose one of the possibilities that you raise _

A 'Right To Bear Arms' resolution, if it specifically covered only the right to bear arms, would entitle people to bear arms if they had them and would oblige WA nations' goverments to remove any legal restrictions on that pracice but -- No -- it wouldn't actually require those WA governments to supply arms to their people: On the other hand, a resolution that said "Everybody in a WA nation MUST have a gun, and the right to bear it" would require the governments to supply arms to those people who couldn't afford to [or wouldn't choose to allocate the money to] purchase weaponry themselves.

And to me, this proposal, if it didn't mention the availability of funding as a possible limiting factor to the 'Right' involved, would still seem closer to the latter situation.
After all, as it's limited to procedures that are legal in the nation concerned, what additional rights would that clause give people if it doesn't mean that they don't have to be able to pay for the procedures themselves? Was it just meant as a "Bans unfair discrimination in the provision of medical procedures" ruling?

Bah! Now it's 240 characters too long.

You might want to shift II.ii down to be part of IV to avoid the appearance of ambiguity. You know how bad ambassadors are at spotting logical connections when the relevant clauses aren't right next to each other.

You might want to shift II.ii down to be part of IV to avoid the appearance of ambiguity. You know how bad ambassadors are at spotting logical connections when the relevant clauses aren't right next to each other.
That makes sense, yes. I don't know why I didn't put it there to begin with. Thanks!

Major rewrite. I believe it is under the character limit by 2. Please look it over carefully.

Patient's Rights Act

A resolution to improve worldwide human and civil rights.


Category: Human Rights


Strength: Significant


Proposed by: New Leicestershire

Description: The World Assembly, believing that all persons have the right to participate in the assessment of their medical needs, the development of their treatment plans and to receive information concerning their condition and treatment; asserting that medical professionals must be able to provide these services without undue government interference in the doctor/patient relationship; and further asserting that patients have the right to expect confidential treatment of all communications and records relating to their care;

Hereby declares that:

(I) Patients have the right to emergency medical treatment under circumstances requiring lifesaving procedures. A physician or qualified caregiver may provide treatment without the patient’s consent if, because of emergency circumstances, including the patient’s physical or mental state, it is not possible to obtain their consent.

(II) All persons who are lawfully present within any WA member nation have the right to undergo any non-emergency medical procedure deemed necessary and beneficial to the patient by their physician or other medical professional, is legal for that person in the nation where the procedure is performed, and for which confirmed funding is available.

(III) Patients have the right to be involved in decisions concerning their care and to be given full and accurate information about the nature of their illnesses, diagnostic procedures, risks and necessity of alternative procedures, the proposed treatment and the costs involved, provided that such information does not violate the medical confidentiality of other persons.

(IV) Patients may refuse treatment and such refusal shall be verbal or in writing, provided that such refusal does not endanger the health of others. In non-emergency circumstances, treatment may be given without the patient's consent only in the presence of a legal instrument issued by a court of jurisdiction stating that the patient is not competent to make decisions.

(V) Patients have the right to be given full and accurate information about the persons and institutions directly and personally involved in their care as it relates to their care.

(VI) Personal medical records and the contents of such records, including consultations between patients and physicians, shall be held in the strictest confidentiality and shall not be made available to any third party without the consent of the patient, with the following exceptions:
(i) Records shall be released in response to a warrant, subpoena, or similar legal instrument issued by a court of jurisdiction.
(ii) Physicians may make the patient's personal medical records and the contents of such records available to their colleagues and any healthcare professionals involved in the patient's treatment for the purpose of providing medical care to the patient and for the purpose of epidemiological and morbidity study. Records entirely stripped of all personal details may be published.

(VII) The standard of care shall not be affected by religion, race, sex, nationality, country of birth, or other such grounds, except where such factors are relevant to the required course of action.

(VIII) For the purposes of this legislation, "patient" may also refer to a legal guardian if the patient is under the age of majority, or is an adult unable to understand their rights under this Act.

(IX) Patients shall be fully informed of their rights under this Act, either verbally or in writing as applicable.

Does clause I allow for DNR orders and the like? I know that IV mostly deals with that, but it's not entirely clear how the two clauses interact.

Does clause I allow for DNR orders and the like? I know that IV mostly deals with that, but it's not entirely clear how the two clauses interact.
Hmmm. Probably need to work DNR orders into it somehow. I'll see if I can trim anything else and add some (probably minimal) wording to deal with that.

'I feel you could trim off the last part of Clause IX. I'm not sure for what reason 'verbally or in writing' was included, nor what it really adds. 'Patients shall be fully informed of their rights in a manner they can understand' is sufficient. (And, I feel you can exclude 'under this Act', because some nations may grant additional rights.)'

^
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Ok. I said the above before seeing that in Clause IV you have also used 'verbal or in writing'. Is there some significance of this I'm missing? To pick an extreme example, it is possible to communicate wishes in unusual ways (http://en.wikipedia.org/wiki/Jean-Dominique_Bauby#Memoir), that are not obviously less reliable than being verbalised or written.

A couple of extra things (I know you're tight for characters, I'm sorry):

I think the grammar in VI is subtly wrong. It should either be 'to the strictest confidentiality' or 'in the strictest confidence'.

Also, and this may not be a problem, but I'm a little confused by VI (ii): 'epidemiological and morbidity study' (I'm aware the inclusion of some of this language was actually at my suggestion). Those are two very different kinds of study. The first is of the order: '10,000 people in Xistan died of cancer of the Y last year'. The second is of the order: 'patient A died of cancer of the B'. The first is a tool for research and social policy; the latter for learning and legal purposes. That is, the former treats the case as one of a sample, the latter treats the case as a specific incident. But this might not matter, I'm not sure.

Finally, there is a parsing problem in II: there should be a 'which' before 'is legal'.

Otherwise, I commend you on the preparation of so comprehensive a piece of prospective legislation.

-- Samantha Benson
Congressional Liaison, Office of WA Affairs
Quintessence of Dust, Delegate of Wysteria

'I feel you could trim off the last part of Clause IX. I'm not sure for what reason 'verbally or in writing' was included, nor what it really adds. 'Patients shall be fully informed of their rights in a manner they can understand' is sufficient. (And, I feel you can exclude 'under this Act', because some nations may grant additional rights.)'

^
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Ok. I said the above before seeing that in Clause IV you have also used 'verbal or in writing'. Is there some significance of this I'm missing? To pick an extreme example, it is possible to communicate wishes in unusual ways (http://en.wikipedia.org/wiki/Jean-Dominique_Bauby#Memoir), that are not obviously less reliable than being verbalised or written.
You're right, verbally or in writing is not necessary and 'under this Act' can be dropped.

OOC: That's left over from the old PRA. I'm not sure why I used that, probably just thought it sounded good.

A couple of extra things (I know you're tight for characters, I'm sorry):

I think the grammar in VI is subtly wrong. It should either be 'to the strictest confidentiality' or 'in the strictest confidence'.
I will probably change it to 'in the strictest confidence'. Bear in mind that the original NSUN document that this is derived from was written by Yeldans and their command of English is tenuous at best.

Also, and this may not be a problem, but I'm a little confused by VI (ii): 'epidemiological and morbidity study' (I'm aware the inclusion of some of this language was actually at my suggestion). Those are two very different kinds of study. The first is of the order: '10,000 people in Xistan died of cancer of the Y last year'. The second is of the order: 'patient A died of cancer of the B'. The first is a tool for research and social policy; the latter for learning and legal purposes. That is, the former treats the case as one of a sample, the latter treats the case as a specific incident. But this might not matter, I'm not sure.
I wanted to use them as examples of situations in which records could be shared with colleagues or other institutions. I'll look it over and see if I can clarify the language a bit. It might be best to mention only morbidity studies since epidemiological studies would likely contain no personal data anyway.

Finally, there is a parsing problem in II: there should be a 'which' before 'is legal'.
That will be corrected.

Otherwise, I commend you on the preparation of so comprehensive a piece of prospective legislation.

-- Samantha Benson
Congressional Liaison, Office of WA Affairs
Quintessence of Dust, Delegate of Wysteria

Thank you for your comments and advice, which are always helpful.

David Watts
Ambassador
The Dominion of New Leicestershire

Does clause I allow for DNR orders and the like? I know that IV mostly deals with that, but it's not entirely clear how the two clauses interact.

Hmmm. Probably need to work DNR orders into it somehow. I'll see if I can trim anything else and add some (probably minimal) wording to deal with that.
I've been thinking about this. Do DNR orders generally cover emergency procedures? For instance, if a person is brought into the emergency room on a stretcher after a car wreck, is he likely to have a DNR order saying "if I'm in a wreck and bleeding to death, don't save me"?

I think the DNR orders you and I are thinking about usually involve terminally ill people or those who are already in hospital. I think those are already covered under Article IV.

I admit that I may be missing some aspect of this though, so correct me if I'm wrong.

David Watts
Ambassador
The Dominion of New Leicestershire

New draft including the changes suggested by Congressional Liaison Benson.

The World Assembly, believing that all persons have the right to participate in the assessment of their medical needs, the development of their treatment plans and to receive information concerning their condition and treatment; asserting that medical professionals must be able to provide these services without undue government interference in the doctor/patient relationship; and further asserting that patients have the right to expect confidential treatment of all communications and records relating to their care;

Hereby declares that:

(I) Patients have the right to emergency medical treatment under circumstances requiring lifesaving procedures. A physician or qualified caregiver may provide treatment without the patient’s consent if, because of emergency circumstances, including the patient’s physical or mental state, it is not possible to obtain their consent.

(II) All persons who are lawfully present within any WA member nation have the right to undergo any non-emergency medical procedure deemed necessary and beneficial to the patient by their physician or other medical professional, which is legal for that person in the nation where the procedure is performed, and for which confirmed funding is available.

(III) Patients have the right to be involved in decisions concerning their care and to be given full and accurate information about the nature of their illnesses, diagnostic procedures, risks and necessity of alternative procedures, the proposed treatment and the costs involved, provided that such information does not violate the medical confidentiality of other persons.

(IV) Patients may refuse treatment, provided that such refusal does not endanger the health of others. In non-emergency circumstances, treatment may be given without the patient's consent only in the presence of a legal instrument issued by a court of jurisdiction stating that the patient is not competent to make decisions.

(V) Patients have the right to be given full and accurate information about the persons and institutions directly and personally involved in their care as it relates to their care.

(VI) Personal medical records and the contents of such records, including consultations between patients and physicians, shall be held in the strictest confidence and shall not be made available to any third party without the consent of the patient, with the following exceptions:
(i) Records shall be released in response to a warrant, subpoena, or similar legal instrument issued by a court of jurisdiction.
(ii) Physicians may make the patient's personal medical records and the contents of such records available to their colleagues and any healthcare professionals involved in the patient's treatment for the purpose of providing medical care to the patient and for other reasons such as morbidity study. Records entirely stripped of all personal details may be published.

(VII) The standard of care shall not be affected by religion, race, sex, nationality, country of birth, or other such grounds, except where such factors are medically relevant to the required course of action.

(VIII) For the purposes of this legislation, "patient" may also refer to a legal guardian if the patient is under the age of majority, or is an adult unable to understand their rights under this Act.

(IX) Patients shall be fully informed of their rights in a manner they can understand.

That actually made the text a bit shorter and I thank the Quintessence of Dust delegation for their help in accomplishing this.

David Watts
Ambassador
The Dominion of New Leicestershire

I've been thinking about this. Do DNR orders generally cover emergency procedures? For instance, if a person is brought into the emergency room on a stretcher after a car wreck, is he likely to have a DNR order saying "if I'm in a wreck and bleeding to death, don't save me"?
Extensive viewing of archival material (i.e. old episodes of ER) suggests that this can happen, and is next to impossible for emergency medical personnel to know about in time. It's probably worth leaving alone, then.

(VII) The standard of care shall not be affected by religion, race, sex, nationality, country of birth, or other such grounds, except where such factors are relevant to the required course of action.
Perhaps "medically relevant", just to make it harder to weasel around this?

Extensive viewing of archival material (i.e. old episodes of ER) suggests that this can happen, and is next to impossible for emergency medical personnel to know about in time. It's probably worth leaving alone, then.
Agreed. I think I'll leave that as is.


Perhaps "medically relevant", just to make it harder to weasel around this?
Good idea. I'll edit that in.

David Watts
Ambassador
The Dominion of New Leicestershire

I think that accommodates all of our suggestions; I can't think of anything to add.

-- Sam Benson

ASSERTING that medical professionals must be able to provide these services without government interference in the doctor/patient relationship or corruption;

I believe the "or corruption" part is well-meaning, but utterly useless. If the government is to decide if the relationship was tainted with corruption, then this cluase is, in fact, utterly useless. Because the government is WHAT IS corrupt. The government will not punish itself for being corrupt under this piece of legislation, then - unless the World Assembly does so (or general pressure from the international community), or: part of the government is in fact NOT corrupt, and that part of the government can (and will) stop the other part from corruption. Think of this what you will.

(i)Records shall be released in response to a warrant, subpoena, or similar legal instrument issued by a court of jurisdiction.[./quote]

See: related posts in the current resolution at vote thread. How would you like your medical records to be spilled in court? However, you just cannot ask the patient for their permission - for if it does not suite (temporary spelling loss there, no spellchecker either) them than they will not give their consent. Maybe, if the jury rules it important or something like that, then it will be given in court? There needs to be some sort of other wording there to imply that it is not open.

[quote](ii)Physicians may make the patients personal medical records and the contents of such records available to their colleagues and any healthcare professionals involved in the patients treatment for the purpose of providing medical care to the patient and for the purpose of epidemiological and morbidity study.

NOOO!!! I insist that this passage be changed. If this passage is not changed, I will most likely vote AGAINST this resolution. What if the patient does not want their information passed along for studies and the like? Ask the patient for their consent for their information to be passed along. Please.

Overall, a fine proposal, except for the flaws I have pointed out. Please correct them!

<snip>

Before I respond to any of that...Look Up There! About 4 posts above you!

There's a newer version of the proposal. The one you're commenting on is about 7 months old.

I've submitted this with a minimal TG campaign. If it it makes quorum, great. If it doesn't I'll try again after the New Year.

Quorum Reached: In Queue! (Many thanks to Kungpaomao)

I will make a new At Vote thread since this one starts off with an ancient version of the text.