policy brief KD .pdf

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Kim Dahan
HarvardX PH555X – Improving Global Health: Focusing on Quality and Safety
Final paper assignment: Policy brief

Creating and implementing a

Universal Declaration of Patients’ Rights
How to improve medical care worldwide focusing on patients’ rights?

During the class, we have explored many ways of improving quality and safety of care.
It appears that one way of positively impacting all six components of quality healthcare (safety,
effectiveness, efficiency, timeliness, patient-centeredness and equity) would be to create
extensive and precise rights for patients. This would encourage medical institutions, as well as
legislators, to define better standards for quality, which would contribute to improving health
systems worldwide.
In order to examine the relevance of a potential Universal Declaration of Patients’
Rights (UDPR), we first present France’s Hospitalized Person’s Charter, in order to assess the
effect of such a declaration on a national scale. Secondly, we argue that Quality Healthcare
must become a “stand-alone” goal as part of the Sustainable Development Goals of the global
post-2015 development agenda. Lastly, we make the case for the creation of a UDPR, propose
some guidelines for its elaboration, as well as suggestions for its content.

Case study: the Hospitalized Person’s Charter in France
• History
In the 1970s, the French government launched a new “movement for the humanization
of hospitals”.1 In 1974, a “Charter for hospitalized diseased people”2 was implemented, which
consisted of internal guidelines and mostly viewed the patient as passive, as opposed to a
bearer of rights. The real turning point occurred in 1995, when French Health Minister
Simone Veil stated: “A hospitalized person is not just a sick person. It is first and foremost a
person with rights and duties”.3
In 2006, the Hospitalized Person’s Charter was created.4 It guarantees extensive rights
for patients, in accordance with eleven principles:
Ø Universal access to care;
Ø Quality of reception, treatment and care;
Ø Right to access reliable information;
Ø Requirement of the free and informed consent of the patient in order to perform a
medical act;
Ø Requirement of the specific consent of the patient to participate in biomedical

See the report of Bernard Ducamin for the French Health Ministry, 1970.
See Circulaire du 20 septembre 1974 relative à la Charte du malade hospitalisé.
See Circulaire DGS/DH n° 95-22 du 6 mai 1995 relative aux droits des patients hospitalisés et comportant une
charte du patient hospitalisé.
See Circulaire DHOS/E1/DGS/SD1B/SD1C/SD4A no 2006-90 du 2 mars 2006 relative aux droits des personnes
hospitalisées et comportant une charte de la personne hospitalisée + Translation of a summary from the
American hospital in Paris.


Freedom to leave the institution at any time;
Right to be treated with consideration and respect;
Respect of the privacy of the patient;
Right to access health information directly;
Right to be heard by the institution to express grievances and to request compensation
for harm.

• Implementation and impact
The implementation of the Charter has had many tangible effects: for instance, it is
mandatory for the Charter to be displayed in hospitals, and for patients to be made aware of it.
In addition, in order to ensure the quality of reception of patients and the respect of all beliefs,
hospitals have had to hire multilingual personnel, as well as multi-confessional chaplains.
Procedures to express grievances have also been made more transparent, and the whole
compensation system has been revised.
• Obstacles and limitations
The Charter is only limited to public hospitals, and therefore does not apply to private
clinics and ambulatory medicine. This prevents the principles from becoming nationally
recognized as rights; moreover, the legal status of such a Charter is inferior to the
Constitution or even to laws, which reduces its scope.
Furthermore, the Charter is still relatively unknown from the general public, and so it
may not always be enforced. One may also argue that the Charter is not ambitious enough,
and that more binding rights should be added to it.

Including Health in the Post-2015 Development Agenda
• Health in the Millennium Development Goals
The Millennium Development Goals (MDGs)5 have been established in 2000 by the
United Nations, following the adoption of the United Nations Millennium declaration by the
World Millennium Summit. They set eight development goals, which cover eighteen specific
targets to be achieved by the year 2015. Although some of these targets are both hard to
achieve and to measure, and despite some failures, the MDGs have mostly been a success:
since 2000, the world has witnessed an unprecedented acceleration of the poverty reduction.
Although health concerns are integrated in some goals and targets, notably in
“reducing child mortality”, “improving maternal health” and “combatting HIV/AIDS, malaria,
and other diseases”,6 improving global health is not defined as a “stand-alone goal” of the
• Health in the Sustainable Development Goals of the post-2015 development agenda
The United Nations are currently working on a post-2015 development agenda, and are
preparing some new Sustainable Development Goals,7 a process which was agreed upon at
the Rio+20 Conference in 2012. We believe that Improving Global Health should be defined
as a stand-alone goal, with its own set of targets, in addition to being integrated in the frame
of other, more specific goals. Indeed, this would put a particular focus on the improvement of

See http://www.undp.org/mdg
Goals 4, 5 and 6.
See http://sustainabledevelopment.un.org/?menu=1300

global health. The main angle of realization of this new goal could be defined as patients’
rights, such as universal access to care, transparency of information, respect and
consideration of the patient and freedom to request compensation in case of wrongdoing.
A lot of measurable targets could be determined: level of education of medical
personnel, staffing ratios, hospital mortality rate, ratio of successful medical acts according to
patients’ income, etc.

Towards a Universal Declaration of Patients’ Rights
• Relevance of a UDPR
A Universal Declaration of Patients’ Rights, similarly to the Universal Declaration of
Human Rights (UDHR) or other universal declarations, would promote quality healthcare
worldwide and encourage every nation to treat its patients in a better, more humane way.
Although the UDHR states the “right(…) to medical care” and the “right to security in the
event of(…) sickness”, 8 a dedicated Declaration would enable patients to enjoy more
substantial rights.
• Guidelines for the elaboration and implementation of a UDPR
The UDPR may be elaborated by one of several different international organizations,
for example the World Health Organization of the United Nations, or an international NGO
such as the Red Cross or Doctors Without Borders, and then be adopted by a resolution of
the UN General Assembly. It would then be applicable to all States, within the frame of legal
effect of international law.
• Suggestions for content
It is fundamental that relevant experts be consulted to prepare the UDPR. However, we
may suggest some fundamental principles that should appear in it:
Ø The right for each patient to be treated with dignity and respect;
Ø Universal access to medical care, in particular for the most needy, and regardless of
insurance coverage or legal situation;
Ø The right to be treated in safe and clean facilities;
Ø The right to be treated by appropriately trained medical personnel;
Ø The right to leave the institution at any time after having been informed of any risks,
unless otherwise provided for by the law;
Ø The right to access reliable information;
Ø The right to make grievances heard and to request compensation in the event of harm
resulting from negligence.

Medical care occurs mostly between a patient and its doctor, and might be perceived as
an individual matter; nevertheless, we believe that universal patients rights are a way of
improving the treatment of each patient all over the world.


See article 25 (1) http://www.un.org/en/documents/udhr/

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