Implementation of Patient's Rights Charter: a Report from Ministry of Health and Medical Education, Iran.

At the aim of explaining the rights of health care recipients and upgrading ethical observance in the field of treatment-the most important field of health care-, the Patient's Rights Charter was declared by Ministry of Health and Medical Education to all medical universities in September 2009. This paper provides a report of strategic planning for implementation of Patient's Rights Charter and a summary of other projects.

Introduction

Physical, mental, spiritual and social health are considered as the most important dimensions of individuals and according to the article 29 constitution of Iran its development is one of the most important commitments of Iranian government (1). Accordingly the Ministry of Health and Medical Education (MOH), Iran takes the responsibility of providing proper health care for society.

Efficient health system needs active participation and relationship between health care providers and health care recipients. Health care centers should believe health care recipients, their families, physicians and other health care providers, respect them and their rights (2).

With this in mind and at the aim of explaining the rights of health care recipients and upgrading ethical observance in the field of treatment-the most important field of health care- Patient’s Rights Charter was compiled in three years. After approval by the Council of Policy Making of MOH, the Patient’s Rights Charter was declared to all medical universities in September 2009 (3).

This paper provides a brief report of strategic planning for implementation of Patient’s Rights Charter in addition to summary of other projects.

Process of strategic planning for implementation of Patient’s Rights Charter

One of the issues which were asked of the medical universities and the other related organizations to feedback the obstacles and solutions of implementation of each right of Patient’s Rights Charter. After awhile their comments were gathered and returned back to them. Then the executives sent back their comments and suggestions to the Council of Policy Making of the MOH. Those comments were collected into two parts; general and specific. The general part consisted of generalized views and the comments to each specific clause of the bill were considered as specific (4). In continuation teamwork in Medical Ethics and History of Medicine Research Center, codified the first draft of the strategies of the MOH for implementation of Patient’s Rights Charter. Then in July 2010 the draft was explained in a workshop in the meeting of the presidents of selected medical sciences universities, selected staff members of MOH, the invited experts in professional ethics and medical ethics. After reviewing, the final strategies were defined and announced by MOH.

Codifying Iranian Code of Medical Ethics at the aim of determining framework of medical professionalism

Codifying the Comprehensive Document of Pharmacy Ethics including the code of ethics of pharmaceutical, and medical supplies industries, distributors, pharmacies and their affiliated centers

Codifying Nursing Code of Ethics

Designing specific informed consents to promote informed consent process

Establishing the national and academic Hospital Ethics committees under supervision of the higher council of medical ethics at the aim of supervising, monitoring, and evaluating hospital ethics committees

Necessitating ethical evaluation of all rules and regulations of health care system especially hospitals and clinics according to the observance of patients rights and principles of medical ethics by the Higher Council of Medical Ethics

Re-evaluating disciplinary regulations of medical profession by considering ethical violations

Following ethical evaluation of the regulations of insurance companies based on physician- patients relationship

Re-evaluating the regulations of archiving medical documents in hospitals based on patients privacy and confidentiality

Designing communication skills courses based on patients rights for physicians, nurses, students, residents, hospital staffs, etc.

Re-evaluating medical ethics curriculum for undergraduate students

Emphasizing on professionalism and medical ethics in continuous medical education programs.

Comprehensive society informing activities for all beneficiaries including patients, physicians, and nurses by educational movies, posters, pamphlets, and lectures (The rights of health care providers and recipients should be considered in parallel).

Establishing palliative care clinics in large hospitals at the aim of patients welfare

Considering patients rights observance in hospital ranking

Establishing educational courses in palliative care for health care providers

Attention to the patients interests in designing physical space of health care centers at the aim of establishing a proper relationship between internal and external elements

Establishing information centers in order to promote health care accessibility

Strategies of the Ministry of Health and Medical Education for implementation of Patient’s Rights Charter

Now the affiliated institutions to the above mentioned strategies especially the Higher Council of Medical Ethics of Ministry of Health and Medical Education are following the issue. It has to be noted that in some instances the goal was achieved such as Nursing Code of Ethics and some other issues such as designing specific informed consent forms, Iranian Act of Medical Ethics, etc are on the way.

A brief report of some strategies for implementation of Patient’s Rights Charter Codifying Iranian Code of Medical Ethics

Iranian Code of Medical Ethics is codifying in Medical Ethics and History of Medicine Research Center of the Tehran University of Medical Sciences from 2006 on. Firstly the last code of American Medical Association was considered as a baseline and a hundred and fifty topics were selected. Secondly the expert working group prepared the first draft of the code according to national and Islamic believes and values. Group discussion by expert panels composed the second draft after more than thirty meetings. The second draft consists of more than fifty topics. The expert panels included academic members of the departments of medical ethics, clinicians, lawyers, and PhD students.

Thirdly the draft was assessed by the department of medical ethics and education of Academy of Medical Sciences and participation of MOH, Medical Council, and medical associations. After final evaluation, the code will be published.

Comprehensive Document of Pharmacy Ethics

Complexity in health care and science development require more pharmacists contributions in patients care which is the basis of revolution in pharmacy profession (5–7). From the other point the high amount of money transfer in pharmacy system has created a business dimension for pharmacy. More contribution of pharmacists in health care and also trading make ethical challenges in pharmacy profession inevitable (8). Pharmacists are facing with ethical dilemmas in their everyday work which necessitates providing ethical guidelines as well as upgrading their ethical knowledge (9–11). Teaching pharmacy ethics has been initiated in faculty of pharmacies less than a decade ago, so most of the pharmacists who are working as technical managers are not aware of ethical challenges and the way of solving ethical problems. Furthermore economical obstacles mostly affect their ethical decision making. In order to provide an ethical framework for Iranian pharmacists working in different fields of their profession the Medical Ethics and History of Medicine Research Center codified and compiled the Comprehensive Document of Pharmacy Ethics based on the principles of bioethics and professionalism. It consists of five codes and guidelines including pharmacists’ code of ethics, code of ethics for manufacturers, code of ethics for drug importer companies, code of ethics for drug distributors and code of ethics for policy makers. The document finally was approved by High Council of Ethics of Ministry of Health in July 2012 and will be published in the near future.

Specific informed consent forms

The principles and dimensions of informed consent show its influence on every level and stage of treatment.

In spite of general agreement about providing enough information and getting informed consent; it seems that its implementation is far different qualitatively and quantitatively. Although informing patients depends on their knowledge but providing acceptable standards of medical profession may help.

In this regard the specific informed consent forms were drafted based on available resources and each form was evaluated by expert consultation. After all the re-assessed forms as a collection was delivered to the executives of health system for further evaluation. The Higher Council of Medical Ethics will double check those forms.

Establishing the Hospital Ethics committees

In parallel with other countries Tehran University of Medical Sciences appointed hospital ethics committees as official part of university ethics committees to provide ethical guides and recommendations for hospital executives as well as ethical consultations. Tehran University of Medical Sciences is pioneer in activating/re-activating hospital ethics committees. In a higher level of performance hospital ethics committee can develop a committee at the university level in the near future the same as our research ethics committees which are operating at different levels including research centers, departments, faculties and university.. The responsibilities of these committees are described in four levels as below:

Proving educational services for physicians, hospital staff, nurses in medical ethics issues

Providing consultation services for health care providers and recipients

Policy making and ethical evaluation of policies and regulations of hospitals based on patients rights

Ethical assessment of human studies in special circumstances

According to, hospital medical ethics committees were activated. Hopefully these committees will begin new practices in the field of clinical ethics.

Re-evaluating medical ethics curriculum for undergraduate students

Undergraduate students should be familiar with medical ethics principles and solve patient’s problems accordingly. In order to upgrade students’ ethical knowledge in the different levels and make it practical and standardizing health care services, the curriculum was re-assessed in several experts meetings and finally 33 topics was chosen for residents which were approved by the Higher Council of Medical Ethics of MOH.

Outlook

It has to be noted that most of the mentioned strategies have advanced. The Higher Council of Medical Ethics as the higher institution for policy making intends to support researches and applicable plans based on the mentioned strategies. It seems that in spite of several obstacles and difficulties in providing the best health care services, it is possible to qualitatively upgrade patient’s right status by paying enough attention, and proper short term teachings. From the other side there is the hope that realization of those strategies provides a new evolution in observing patients rights, although achieving the high level of patient’s rights components needs utilization of human and financial resources as well as re-assessing present regulations.

Ethical considerations

Ethical issues (Including plagiarism, Informed Consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc) have been completely observed by the authors.