Concept of patients' charters 'inadequate'

December 7, 2007

The concept of patients’ charters is inadequate and should be replaced with charters of health responsibilities, argues an expert in this week’s BMJ.

But even these raise ethical tensions, says Harald Schmidt, a research associate at LSE Health.

The British Medical Association (BMA) recently called for a charter setting out the responsibilities patients have within the National Health Service and what patients can expect from the NHS.

Although it lacked detail, it raised questions about the scope, specificity, and status of such a charter, says Schmidt. So he assessed how health responsibility initiatives in three countries have dealt with these questions and looks at the ethical tensions raised.

He examined the 2005 Scottish NHS’ patients’ charter: The NHS and You; book V of the 1988 German Sozialgesetzbuch (social security code), revised in 2007; and the Medicaid member agreement, implemented in West Virginia, United States, in 2007.

These documents all apply to publicly funded health programmes but set out responsibilities with varying degrees of specificity, legal status, and enforceability.

The documents all contain explicit health maintenance obligations, such as “Look after your own health and have a healthy lifestyle” (Scottish charter) and “I will do my best to stay healthy” (Medicaid agreement).

But Schmidt warns that, while it is easy to make appeals not to risk health, it is far more complicated to decide whether and to what extent people should be held responsible when things go wrong, especially when expensive treatment is required.

He urges clarity about such decisions, especially for documents with a binding status.

The documents also emphasise obligations to contribute to fair and efficient use of healthcare resources, but these may give rise to several problems, he adds.

For example, appeals to “only use emergency services in a real emergency” may lead people to not request treatment when they need it, or with delay, which may result in poorer overall health and higher costs for the healthcare system.

Similarly, emphasising the need to keep (or cancel) appointments may be unfair for patients who may have good reasons for missing appointments.

With rising healthcare costs, higher burdens of chronic diseases, and increasing evidence about the contribution of genetic and behavioural factors to disease, the issue of personal responsibility for health is here to stay, says Schmidt. There have already been concerns about the decision of some primary care trusts to require, for example, patients to lose weight or stop smoking before routine surgery.

The BMA’s proposal for a health responsibility charter, and similar initiatives towards spelling out “rights and responsibilities” as part of Lord Darzi’s current review of the NHS, offer unique opportunities to clarify which types of responsibilities are compatible with the ethos of the NHS, and which ones are not, he concludes.

Source: British Medical Journal

Explore further: Stuck in an opioids crisis, officials turn to acupuncture

Related Stories

Stuck in an opioids crisis, officials turn to acupuncture

February 20, 2018
Marine veteran Jeff Harris was among the first to sign up when the Providence VA hospital started offering acupuncture for chronic pain.

New genetic test can predict adverse reactions to epilepsy drug

January 26, 2018
A study led by researchers at RCSI (Royal College of Surgeons in Ireland) has identified a new genetic test that can be used to predict if a patient with epilepsy will develop an adverse reaction to a common anti-epileptic ...

Doctors already use phones to share clinical images of patients—legislation needs to catch up

January 9, 2018
Imagine this scenario: you're a recently graduated doctor working at a medical clinic in rural Australia. A person presents with a bite of what seems to be a poisonous spider—but you're not sure. You take a photo of the ...

Yoga in the workplace can reduce back pain and sickness absence

December 8, 2017
Back pain is the single leading cause of disability in the world. In the US, four out of every five people experience back pain at some point in their life. In the UK, back pain is one of the most common reasons for visits ...

Florida wants to remove virus-excreting wild monkeys

January 10, 2018
Wildlife managers in Florida say they want to remove roaming monkeys from the state in light of a new study published Wednesday that finds some of the animals are excreting a virus that can be dangerous to humans.

Canadian provinces need to adopt a patient charter of rights

April 23, 2012
Canadian provinces should adopt a patient charter of rights with independent enforcement as part of the move to patient-centred care, argues an analysis article in CMAJ (Canadian Medical Association Journal).

Recommended for you

Best of Last Year—The top Medical Xpress articles of 2017

December 20, 2017
It was a good year for medical research as a team at the German center for Neurodegenerative Diseases, Magdeburg, found that dancing can reverse the signs of aging in the brain. Any exercise helps, the team found, but dancing ...

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.