Wednesday, 19 March 2014


The Magna Carta deals with ideals of democracy, limitation of power, equality and freedom under law.

Lord Denning described it as "the greatest constitutional document of all times – the foundation of the freedom of the individual against the arbitrary authority of the despot". Danny Danziger & John Gillingham, "1215: The Year of Magna Carta"(2004 paperback edition) p278

Tim Berners-Lee is the creator of the worldwide web. In celebration of the 25 anniversary of his creation this month, Berners-Lee called for the drawing up of a Magna Carta for the www.

The Magna Carta plan is in effect a ‘digital bill of rights’ – a statement of principles, B-L hopes will be supported by public institutions, government officials and corporations.

"Unless we have an open, neutral internet we can rely on without worrying about what's happening at the back door, we can't have open government, good democracy, good healthcare, connected communities and diversity of culture. It's not naive to think we can have that, but it is naive to think we can just sit back and get it."

So, a call to action!

Tim Berners-Lee

Bills of Rights have been popular ever since 1215 and the Magna Carta.

The best know Bill is the American Bill of Rights. Written in 1789, this is in fact made up of the first 10 amendments to the American Constitution. These amendments guarantee personal freedoms, limit the Federal Government’s powers and reserve some powers to the States and the public. In recent times, the most controversial amongst these freedoms is the freedom to bear arms. Originally this was designed to assuage fears by the States of a Federal takeover by forcer, but in recent times it has been used to justify individuals’ ownership of guns.

There are plenty of other Bills of Rights including Animals Bills of Rights and even a PhD students’ Bill of Rights, the latter talking of a right to a recognised expert and to an ethical role model.

It is however on Patients’ Bills of rights I wish to focus in this BLOG.

One of the fundamental problems with Bills of Rights is what to include and what to leave out. That is the reason so many countries, organisations and activities have failed to achieve what one would consider to be an obvious and good thing.

For example, the US Senate's 2001 attempt at a Bill had just the following eight broad rights for patients with health care plans:
·         have their medical decisions made by a doctor;
·         see a medical specialist;
·         go to the closest emergency room;
·         designate a pediatrician as a primary care doctor for their children;
·         keep the same doctor throughout their medical treatment;
·         obtain the prescription drugs their doctor prescribes;
·         access a fair and independent appeals process if care is denied; and
·         hold their health plan accountable for harm done.

The Bill was passed by the US Senate, amended the House of Representatives and failed when it returned to the Senate.
On the other hand Arizona State’s Scottsdale Healthcare has no fewer than 28 rights (and 16 responsibilities, the argument being that with rights come responsibilities).

The overarching patient Bill of Rights is in fact an oath taken by doctors: the Hippocratic Oath. In this the expectations of how the physician should practise can reasonably be taken to be the expectations of the patient of his or her treatment.

A 12th-century Byzantine manuscript of the Oath

The English translation of the original is:
To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art; and that by my teaching, I will impart a knowledge of this art to my own sons, and to my teacher's sons, and to disciples bound by an indenture and oath according to the medical laws, and no others.
I will prescribe regimens for the good of my patients according to my ability and my judgment and never harm to anyone.
I will give no deadly medicine to any one if asked, nor suggest any such counsel; and similarly I will not give a woman a pessary to cause an abortion.
But I will preserve the purity of my life and my arts.
I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.
In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or men, be they free or slaves.
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my life.

This has been modified many times over the centuries but most of the sentiments expressed in the original remain.

There has since 1948 been a Universal Declaration of Human Rights. It comprises 30 Articles based in general around:
-- Human rights are Universal, Indivisible, Interconnected and interrelated
-- With equality and without discrimination for all women and men, youth and children
-- Democracy must be a delivery system of human rights
--All must know, own, organize, plan and act guided by human rights as a way of life

The existence of such a Declaration, while by no means guaranteeing rights for all citizens of the world, allows its invocation in cases where such rights are threatened or subjugated.

Is there then a place for a Universal Bill of Rights or Declaration of Rights for patients as a successor to the Hippocratic Oath which is probably not enough to cover the complexities of a 21st century society and 21st century healthcare?

Yes, if the challenge of knowing what to include and what to leave out could be met and if a clear idea of in what circumstances and in what way it could be brought to bear could be decided.

A job for the ISQua Innovation and Systems Change Working Group perhaps?

Peter Carter
Chief Executive Officer
March 2014

No comments:

Post a Comment