Patient rights is an umbrella concept describing the totality of the fundamental rights and freedoms held by individuals in the course of receiving health services. By virtue of these rights the individual receives care in a manner compatible with human dignity, has his or her personal data protected, is properly informed about the process, is able to participate in decisions concerning treatment, and enjoys a secure position vis-à-vis service providers.
The function of the concept is to regulate the relationship between the patient and those providing health services and to redress the imbalance between the parties’ positions. To that end, the Patient Rights Regulation, which gathers patient rights under a single instrument, entered into force in 1998. The Regulation governs a range of matters, from informing the patient and the consent to be given to medical examination, to the rules the patient is expected to observe and the applicable application procedures.
The Concept of Patient Rights
Patient rights denote the entirety of the rights held by an individual throughout the period in which he or she receives health services, together with the principles that serve to protect those rights. A person receiving health services is not merely a subject being treated; he or she is an informed and active participant in the process. The essence of this approach is to move the individual out of the position of a passive recipient of services and to give him or her a say in decisions concerning his or her own health. These rights are intended to place health services on an ethical and legal footing and thereby to raise the quality of care.
The Patient Rights Regulation, which entered into force in 1998, defines patient rights as follows:
Patient Rights Regulation
“It denotes the rights which individuals in need of benefiting from health services hold simply by virtue of being human, and which are secured by the Constitution of the Republic of Türkiye, international agreements, statutes and other legislation.”
As the definition makes clear, these rights are not reserved solely to those who are in actual need of health services; they are recognised as a universal category of rights attaching to the quality of being human. Protected by the Constitution, international agreements and other legislative provisions, these rights constitute a framework that all institutions providing health services, and their staff, are obliged to observe.
Principal Rights Set Out in the Regulation
Patient rights encompass a broad bundle of rights relating to the process of receiving health services. In Türkiye this field is governed by the Patient Rights Regulation of 1998, which sets out in detail the rights held by the patient while receiving services. The core rights contained in the Regulation are examined below.
The Right to Benefit from Health Services
Governed by Articles 6 to 14 of the Regulation, this right secures access to health services and comprises the following sub-headings:
- Benefiting on a just and equitable basis: no discrimination may be made against anyone in accessing services; everyone has an equal right to benefit from them.
- Requesting information about the service: the patient may request information concerning the health service to be provided to him or her.
- Choice and change of institution: the patient has the opportunity to determine, and where necessary to change, the health institution and the physician by whom the treatment will be carried out.
- Identifying and changing personnel: the patient may learn the identity of the health personnel who will provide the service, choose them, and request that they be changed.
- Requesting that the order of priority be established: the patient may request that the order of priority be determined when benefiting from the service.
- Diagnosis, treatment and care consistent with medical requirements: the patient’s diagnosis and treatment process must be conducted in accordance with the requirements of medicine.
- Requesting medical diligence: the patient may request that the requisite diligence be shown throughout the treatment.
The Right to Obtain Information on One’s Health Status
Set out in Articles 15 to 20 of the Regulation, this right covers the patient’s access to information concerning his or her own health status. In this framework the patient may examine his or her own medical records and request that those records be corrected. The patient also has the power to prohibit the transfer of information to third parties. The information must be given in language the patient is able to grasp, in a plain and clear manner leaving no room for doubt.
The Right to Respect for Privacy
Governed by Article 21 of the Regulation, this right ensures that the patient’s health status and treatment are handled in confidence. The principal matters falling within its scope are as follows:
- Procedures relating to examination, diagnosis and treatment are carried out in confidence.
- Assessments concerning the patient’s health status are kept confidential.
- It is a matter of principle that there be no interference with the person’s private and family life.
- Information relating to health expenditure remains confidential.
- A relative of the patient may be permitted to be present during treatment.
The Right Not to Be Subjected to Medical Examination Without Consent
Set out in Article 22 of the Regulation, this right expresses the principle that no medical intervention may be carried out without the patient’s consent. Consent is required for every procedure directed at the person’s body. An exceptional situation is nevertheless provided for:
- Where there is a possibility that evidence of an offence is present on the body, an intervention may be carried out on the basis of a judicial decision or, in cases where delay would be prejudicial, at the request of the public prosecutor.
The Right to Require That Information Be Kept Confidential
This right, contained in Article 23 of the Regulation, secures the confidentiality of information belonging to the patient. Information obtained in the course of providing the health service may not be disclosed to third parties save in cases required by statute.
The Right to Require That Safety Be Ensured
Governed by Article 37 of the Regulation, this right is intended to ensure the safety of patients and their relatives on premises where health services are provided. Institutions providing the service are under an obligation to ensure patients’ safety.
The Right to Fulfil Religious Obligations and to Benefit from Religious Services
Article 38 of the Regulation covers the patient’s ability to fulfil his or her religious obligations and to benefit from religious services. Health institutions are obliged to provide services directed at meeting these needs so far as their means allow.
The Right to Require Respect for Human Values
Article 39 of the Regulation guarantees that the patient receives health services in conditions befitting human dignity and compatible with the values of his or her personality. This right imposes on all health personnel an obligation to behave courteously and respectfully towards patients and their relatives.
The Right of Application, Complaint and Legal Action
This right, contained in Article 42 of the Regulation, governs the avenues available where patient rights are infringed. In the event of an infringement the patient may lodge a complaint and also has the opportunity to bring an action.
This body of rights is intended to establish a balance between the patient and service providers and to ensure that the individual receives safe and effective health services consistent with human dignity.
The Course to Follow Where Patient Rights Are Not Observed
Where patient rights are not applied at all, or are applied incorrectly, certain mechanisms are available to the patient or a relative. The process begins with an application within the hospital and proceeds in stages, so that it may be taken to the judicial authorities where necessary. These steps are explained in turn below.
Application to the Patient Communication Unit
Under Article 42 of the Patient Rights Regulation, Patient Communication Units have been established within every health institution for the purpose of protecting patient rights. This unit is the first instance of application for a patient, or a relative, who takes the view that rights have been infringed.
Steps of the application:
- Approaching the health personnel concerned first: a person who considers that his or her right has been infringed should first convey the situation to the health personnel concerned and request that the rights recognised in the Regulation be applied.
- Applying to the unit by petition: where no result is obtained from the personnel, an application should be made to the institution’s Patient Communication Unit by written petition or electronically.
The process conducted by the unit:
Upon the applications reaching it, the Patient Communication Unit carries out the following:
- It examines the practices capable of giving rise to the infringement.
- Where it considers it necessary, it proposes that corrective action be taken.
- It allows the health institution concerned time to implement those measures and notifies the Provincial Health Directorate of the steps taken.
- It renders its decision within 30 days following the date on which the application reached it and notifies the decision both to the patient and to the health personnel concerned.
The Provincial Health Directorate and Patient Rights Board Stage
Where no result is obtained before the Patient Communication Unit, the file is transferred to the Patient Rights Board operating within the Provincial Health Directorate. The Board’s procedure is subject to the following principles:
- It reaches a decision within 30 days from the date on which the file is referred to it.
- The decision rendered is served both on the applicant and on the health institution concerned.
- Summaries of decisions are published on the website of the provincial health directorate without names being stated.
- Where a decision finding an infringement is rendered, written notification is served on the health personnel and the institution concerned.
Where two or more infringement decisions have been rendered in the preceding six-month period, the file relating to the health personnel concerned is sent to the Health Professions Board.
Recourse to the Courts
In some incidents an infringement of patient rights may be intertwined with medical errors of a more serious nature. In such cases the patient may pursue civil proceedings with a claim for damages arising from malpractice. A person subjected to a faulty intervention may seek both civil and criminal sanctions. The available avenues are as follows:
- Bringing an action for damages: in cases of faulty medical intervention, pecuniary and non-pecuniary damages may be sought on the ground of malpractice. It is appropriate to obtain legal advice in this process.
- Seeking criminal sanctions: where the physician’s gross negligence or intentional conduct gives rise to criminal liability, criminal proceedings may be pursued.
Confidentiality and the Limits of Competence
- Files dealt with by the Patient Communication Unit and the Patient Rights Board are kept confidential; no information may be transferred to third parties.
- Applications founded on an allegation of medical error are assessed not by the Patient Communication Unit or the Patient Rights Board but by the judicial authorities.
Making the necessary applications in due form where a right has been infringed is the principal instrument for ensuring that providers of health services discharge their legal and ethical obligations.
For detailed information on the steps that may be taken and the application procedures where patient rights are infringed, our notes bearing the following titles may be consulted:
- Action for Damages on Account of Medical Error (Malpractice)
- Criminal Proceedings on Account of Medical Error (Malpractice)
- Action for Damages on Account of a Faulty Aesthetic Operation
- Liability in Damages for Faulty Medical Interventions Carried Out in Private Hospitals
- Liability in Damages for Faulty Medical Interventions Carried Out in State Hospitals
- Liability in Damages for Faulty Medical Interventions Carried Out in University Hospitals
Independent Legal Assessment
The problem most frequently encountered in the application of patient rights stems not from the existence of the rights but from how they are to be exercised. The administrative avenue and the judicial avenue are not alternatives to one another; the Patient Rights Board may make a finding of infringement, but it has no power to award damages. The records generated in the Board’s file may, however, carry evidential value in an action for damages brought subsequently. For that reason we recommend that the administrative application not be neglected, even where an action is contemplated.
The second critical point is documentation. Matters such as whether the duty to inform was discharged, the scope of the consent, and when the request for access to medical records was submitted come to sit at the centre of the dispute at later stages.
In preparing a concrete application, we recommend that attention be paid to the following headings:
- Stating clearly in the application which provision of the Regulation the alleged infringement is founded upon
- Obtaining medical records and reports in due form before the administrative stage has even begun
- Monitoring the thirty-day decision periods prescribed for the Patient Communication Unit and the Patient Rights Board
- Distinguishing at the outset whether the incident is purely an infringement of rights or at the same time amounts to malpractice
- Where a claim for damages is contemplated, monitoring the statute of limitations independently of the administrative process
Independent Legal provides advisory services and conducts litigation in the field of health law, from administrative applications concerning infringements of patient rights to actions for damages arising from medical malpractice.
This note has been prepared for general information purposes. In order to avoid any loss of rights, it is advisable to obtain legal support in the field of health law before taking any step.