Patient Responsibilities: Rights and Obligations, Medical Law

A lot has been said about the rights of the patient. Their violation is a rather relevant topic, especially for domestic medicine. But not everyone knows that there are also patient responsibilities. It is the patient - this is the legal status, in contrast to the term "sick". We also note that these responsibilities are not symbolic; they are directly spelled out in Russian law. What they include, what is fraught with violation, what sanctions may be - we will deal with all this further.

The legislative framework

Speaking about the rights and obligations of the patient, we will rely on the following legislative acts of the Russian Federation:

• Constitution of the state. Art. 45 and 46.
• Federal Law No. 323, adopted in November 2011, - "On the Basics of Health Care in the Russian Federation." Art. thirty.
• Federal Law No. 1499-1, adopted in June 1991, - "On Health Insurance in the Russian Federation." The final variation of the law is the 1993 version. Art. 6 and 15.
• Federal Law No. 2, adopted in January 1996, is On Consumer Rights Protection. Art. 17, 44-46.
• Federal Law No. 4866-1, adopted in April 1993, - "On Appealing against Decisions and Actions Violating the Rights of Citizens in the Judicial System of the Russian Federation."

It should be noted that the fundamental document in our case on the rights and obligations of the patient is Law No. 323. We will analyze it in detail.

Rights under Federal Law No. 323

The rights and obligations of the patient are one of the areas covered by the law "On the Basics of Health Care in Russia".

The full list of patient rights, according to the Federal Law, is as follows:

• The right to a respectful and humane attitude on the part of doctors and other health workers, staff.
• Conducting both examination and treatment in appropriate conditions, consistent with current sanitary and hygienic standards.
• The right to a medical consultation, the opportunity to consult another specialist.
• Relief of severe pain caused by therapy, surgery, etc.
• The right to preserve medical confidentiality about the procedure, treatment, general history.
• Own written consent to medical intervention, as well as informing doctors about this possibility.
• The right to refuse medical care.
• Obtaining full information about the state of one’s own health, rights and obligations of the patient and the doctor.
• Using a full package of medical services as part of the current program of medical voluntary insurance.
• The right to compensation to him (the patient) for damage caused to health by health workers. But only if the guilt of the doctors will be proved in court.

Note that the rights and obligations of patients and health workers will be directly related. What does it mean? Patient rights are the duties of the doctor, and vice versa.

We continue to analyze the legislative act.

Obligations under the Federal Law No. 323

And now we list the responsibilities of the patient:

• Observe the internal routine of the medical institution where he (the patient) is examined or treated.
• Take care of your health. What does approval mean? Do not commit actions that could be harmful to your health - both your own and other patients of the medical institution.
• Respect the rights of doctors, caregivers, and other patients.
• Inform the treating specialist about their misunderstanding / incomplete understanding of the meaning of the upcoming medical intervention.
• Follow the rules of conduct prescribed for patients in this facility. In particular, to be on time for the appointed procedures, examinations. If it is not possible to visit or be late, you must promptly warn your doctor or nursing staff (nurse) about this fact.
• Follow the instructions of the attending specialist. Report on contacting another doctor for help, stopping the prescribed treatment.

And again, the responsibilities of the patient and the doctor are connected. The rights of a medical institution will directly flow from the duties of its patients.

Classification of duties

Now let's move on to more general cases. All patient responsibilities can be divided into three categories:

• Provided by the Russian Civil Code. These will be the basic duties of any citizen as a customer, a consumer of a service in our country.
• Obligations provided by the law "On Protection of Consumer Rights". Here it is considered that the consumer of any service should. In particular, medical.
• Obligations stipulated precisely by Federal Law No. 323 concerning the protection of the health of Russian citizens. Here the patient is considered only as a consumer of medical services.

And now it makes sense to become more familiar with the most important responsibilities of the patient.

Duty to take care of your own health

This is the key duty of any patient in the Russian Federation. Clause 1 of Art. 27 Federal Law No. 323 "On Health Protection in the Russian Federation."

Taking care of your health is a declarative norm that illustrates the humanity of the legal system. Therefore, no sanctions for violation of this obligation are not prescribed.

Medical examinations: legal framework

Talking about the rights and obligations of patients in medical law, one can not help touching upon such topics as medical examination, medical examinations. This preventive measure is also considered a patient's duty. However, the obligation does not apply to all Russian citizens - only to certain categories of workers.

Now imagine the legislative acts regulating this issue:

• Articles 76 and 213 of the Russian Labor Code.
• Federal Law No. 273 (2012 version) - "On Education in the Russian Federation". Section 48.
• Federal Law No. 3132-1 (1992 version) - “On the Status of Judges in Russia”. Section 4.1.
• Federal Law No. 35 (version of 2005) - "On the Electric Power Industry in the Russian Federation". Section 28.
• Federal Law No. 52 (1999 version) - "On the epidemiological, sanitary welfare in the Russian Federation." Section 34, paragraph 4.

Now briefly present the content of the prescribed legislative acts.

Who is required to undergo medical examinations?

We note again that this patient’s duty in the Russian Federation is selective. It applies only to the following categories of persons:

• Workers employed in hazardous industries, workers whose activities are associated with hazardous working conditions for life and health.
• Workers in the food industry, trade, catering.
• Persons whose labor activity is connected with any type of transport.
• Workers at the waterworks.
• Specialists employed in children's and medical institutions.
• Working in the judiciary.
• Workers in the field of electricity.

The above legislative acts prescribe for these categories mandatory preliminary medical examinations (to confirm the fact of professional suitability), as well as periodic annual medical examinations.

The following particulars are indicated:

• An additional obligation of a teacher is to undergo an extraordinary medical examination in the direction of his employer.
• Those working in the electric power industry are required to undergo pre-shift medical examinations aimed at identifying the fact of the use of alcohol, psychotropic or narcotic substances.

If a patient who belongs to one of the categories indicated in the list refuses to undergo a medical examination, he is not allowed to work. He can return to work only after a satisfactory passage of this preventive examination - if it confirms his suitability.

Duties of Sufferers of Dangerous Diseases

A very important topic in the general story about the duties of the patient and the professional role of the doctor. Here we will rely on the Decree of the Russian Government No. 715 (2004) - "The list of socially significant diseases, pathologies that are socially dangerous."

It follows from this legislative act that citizens suffering from at least one disease from the List are required to:

• Get a medical examination.
• Engage in the full treatment of pathology according to the recommendations of your doctor.
• To prevent relapse, exacerbation by taking preventive measures.

The List includes the following diseases:

• HIV
• Hepatitis B and C.
• Tuberculosis.
• Diphtheria and so on. (total of 15 items).

Treatment Obligations

We examined the concept and general description of the patient's responsibilities, but it should be noted that many, when talking about patients, still mean only those people who are currently undergoing treatment. Let us specifically determine the debt of these persons:

• Follow treatment regimen. Even if he prescribes their temporary disability.
• Do not violate the internal regulations of a particular medical institution (Section 3, Article 27 of the Federal Law No. 323).
• The obligation to comply with the doctor’s recommendations, take prescribed medications, undergo prescribed procedures, provide complete and exhaustive information about your state of health. In practice, this obligation is declarative in nature - no punishment awaits the patient if he forgets, say, to take the pills on time. Or replace an expensive medicine with a cheap analogue.
• The obligation to assist the medical organization in the proper and full execution of the medical services provided to it (the patient). The basis for such approval is the provisions on the work contract, which are prescribed in Art. 718 Civil Code.
• Comply with the treatment regimen, the patient’s rules of conduct, approved by internal acts (orders, orders, etc.) of the medical institution - polyclinic, hospital, etc.

What is treatment failure?

There is no clear interpretation of this phrase. To determine its essence, we will rely on the Order of the Ministry of Social Development and Health of the Russian Federation No. 624n (adopted in 2011) - "On the procedure for issuing disability certificates."

This act under violation of the treatment regimen defines the following actions / inaction:

• Unauthorized abandonment of the hospital.
• Travel to another administrative region without the permission of the attending physician.
• Untimely appearance at the appointed appointment.
• Going to work without closing a sheet of temporary disability.
• Refusal to undergo medical and social examination.
• Failure to attend the prescribed procedure for medical and social examination.
• Other violations.

All of the above, the attending doctor is entitled to note in the patient's temporary disability sheet.

If we go to medical practice, then non-compliance with the doctor’s prescriptions is usually as follows:

• Refusal to take prescribed drugs.
• Refusal of tests, other medical interventions.
• Failure to attend a routine medical examination.

Sanctions when applying for a temporary disability certificate

Punishment for violation of the patient’s duties may be imposed on a citizen when he or she is sick at work. It manifests itself in a decrease in the volume of temporary disability benefits.

In Russia, this sanction is regulated by Part 1 of Art. 8 Federal Law No. 255 (adopted in 2006) - "On Compulsory Social Security of a Citizen in the Event of Temporary Disability". A sufficient basis for applying the sanction is the following:

• Violation of a treatment regimen prescribed by a doctor during temporary incapacity for work without valid reasons.
• Failure to appear at the appointed medical examination, medical examination of a citizen in the absence of valid reasons.
• Injury or illness that occurred as a result of alcoholic, narcotic, toxic intoxication of the patient. Or his actions directly related to such a state.

There is one exception to all that has been said. The amount of temporary disability benefits is prohibited to reduce to persons if it (incapacity for work) is associated with an injury received at the workplace, an accident at work.

Denial of treatment - sanction?

Many patients are interested in: can a medical organization for some reason refuse them treatment? No, this is not possible under any violation of the patient's duties. The legal justification for such a statement is as follows:

• Civil Code of Russia, Art. 772. Reliance on the fact that the contract for the provision of medical services is public. A medical institution cannot but provide its services if it has the opportunity to provide them.
• The determination of the Constitutional Court No. 115-O (submitted in 2002).

Payment of medical services

The patient is obliged to pay for medical services voluntarily provided to him, if they are paid, at the cost that is prescribed in the contract concluded with him.

Additionally, the following is important:

• If the contract implies an advance payment, then failure to pay it on time will be regarded as a refusal to provide services.
• If the patient refuses to comply with the terms of the contract, he still must pay the medical organization actually incurred expenses.

There are no such areas where a person possesses only rights. Civil society always means having responsibilities. The medical field is no exception. The patient has the rights and obligations, the doctor, and the medical institution as a whole.