Draft of Law of Patient‘s Rights

Draft of Law of Patient's Rights

Drafted 30 July 1991, revised at the Third Members Assembly,1st November 1993.


As is clearly stated in the Universal Declaration of Human Rights and the International Covenants on Human Rights everyone is entitled to living standards high enough to maintain the health and welfare of themselves and their family and to enjoy the highest attainable levels of both physical and spiritual conditions.
The Constitution of Japan ordains that the highest degree of esteem must be placed on the right to life, liberty and the pursuit of happiness and confirms that all Japanese people are entitled to maintain the minimum standards of wholesome and cultured living. Furthermore the Constitution declares that the Japanese government has a duty to promote social welfare and security and public health in all spheres of people's daily life.
Medical care should ensure the rights of people to live in good health.
Above all, medical care must respect human dignity and, as well as being scientific and safe, it must respect the wishes of the patients and be as transparent as possible.
Although an economic power in the world, Japan is still not in a position to enable its people to have a satisfactory standard of living in terms of medical care, welfare and health. To make matters worse Japanese people have a deeply rooted distrust of the domestic medical system, in spite of the high level of medical technology in some fields.
In order for Japan to establish a transparent medical care system and a humane welfare society, it is important to legally confirm Patients' Rights in the provision of medical care, and to establish the systematic respect for patients' rights to health and self determination.
Taking all the above into consideration we have drafted a fundamental law on Patients' Rights.

1 Fundamental rights in medical care
(a) Right to participate in medical care
Every person shall have the right to participate in all levels of medical care, from proposals about medical care policy planning to selecting sites for medical care.
(b) Rights to know and learn
Every person shall have the right to know and find out about the medical information necessary to properly understand his/her life, physical condition or health so as to be able to make the best choices.
(c) Right to receive optimum medical care
Every person shall have the right to receive the best medical care available regardless of his/her ability to pay fees or charges relating thereto.
(d) Right to equal medical care
Every person shall equally have the right to receive the best medical care available regardless of his/her political, social or economic standing, race, nationality, belief, age, sex or type of illness.
(e) Right of self-determination in medical intervention
Every person shall have the right to be fully informed in understandable language about the medical intervention he/she is going to receive and then freely to consent, choose or refuse treatment on the basis of his/her own will and acceptance.
2 Duties of Central and Local Government
(a) Duty to make the rights known and support patients
Both Central and Local government shall take the necessary measures including school education to make widely known the rights of patients set out in this law to nationals and local residents and to medical institutions and those engaged in medical care. In addition they shall support patients in the exercise of these rights.
(b) Duty to equip medical care facilities
Both Central and Local government shall provide the human and material resources to support the medical facilities necessary and sufficient for all nationals and local residents to receive the best possible medical care and shall take appropriate measures to improve the quality of medical care.
(c) Duty to strengthen the medical security system
Both Central and Local government shall ensure that nationals and local residents shall be able to receive the best available health care irrespective of their ability to pay fees or charges and shall strengthen the medical security system so that the medical care institutions and health care workers are able to provide the best possible services.
3 . Duties of Medical Institutions and Health Care Workers
(a) Duty to provide a genuine medical service
Medical institutions and health care workers shall respect the patient's dignity and right to good health, establish and protect the relation of trust with the patient and sincerely provide the best possible medical services.
(b) Duty to protect the rights of patients
Medical institutions and health care workers shall, taking into consideration the mental and physical condition of the patients, respect and protect their rights at all times.
(c) Duty of health care workers to study
All health care workers, doctors, dentists, nurses, pharmacists etc., shall have the ability and character as set out in the appropriate ethical standards and legal qualifications and shall have the duty to make every effort to continue to improve those standards.
4. The Rights of Patients
(a) Self Determination
A patient may consent, choose or refuse any medical intervention such as treatment, examination, prescription or operation following the sympathetic explanation, advice, cooperation and guidance from a doctor or health care worker.
(b) Right to receive explanations and reports
A patient shall be able to receive and fully understand from the doctor or other health care workers comprehensible reports and explanations about; the aims, methods, dangers, prognosis, and other possible treatments; the name and personal history of the person in charge of the medical intervention; and, the results of previous treatments and tests.
(c) Type and form of Informed Consent
(1) Patients and health care workers may request a written statement of explanation about and consent to a medical intervention.
(2)Where a patient is unable to understand the explanation of the medical intervention being offered or is incapable of consent, choice or refusal, such as in the case of a patient who is an infant or has lost consciousness, a representative will be appointed who will have the legal right to make decisions taking the best interests of the patient into account.
(d) Right to select or change medical institution and right not to be forced to stay in or be discharged from a hospital.
A patient may select the medical institution or change doctor but may not be forced to change doctor or stay in or leave hospital against his/her will.
A patient always has the right to receive the information necessary to change doctor.
(e) Right to a second opinion
A patient may, whenever it seems appropriate, request the opinion of another doctor in the same medical institution or a health care worker in another institution about the medical intervention being offered.
(f) Right to see and make a copy of one's medical records
A patient as well as being able to receive a summary of the course of the medical treatment from the medical institution or the health care workers, may also request to see his/her medical records held by the medical institution or ask for a copy of it.
(g) Right to receive certificates
A patient, or his surviving family in case of death, may request the institution or those in charge of the treatment for documentary certification of the diagnosis, prescription, operation, hospitalisation, progress and results of treatment, details of fees and payments, birth and death.
(h) Right to the confidentiality of personal information
The personal information about the progress of treatment held by medical institutions or health care workers shall not be disclosed to a third party without prior approval or for purposes other than treatment.
(i) Rights to receive treatment with comfortable facilities or at home and to continue a private life
A patient has the right to receive the best possible treatment with comfortable facilities or at home and as far as possible to take part in normal social life and carry on a normal private life.
(j) Freedom from unreasonable constraint and cruel treatment
A patient has the right to be protected against any unreasonable constraint and cruel treatment.
(k) Rights on experimental research and special treatments
A patient may refuse to take part in research or receive special treatment not normally available and may not be disadvantaged by such a refusal.
Where a patient does agree to take part in an experiment, research or receive special treatment, he/she shall receive a written and sufficient explanation about the aims, dangers, prognosis, the name of the researchers or medical workers in charge, their qualifications and personal histories. Also a patient shall provide written consent and may withdraw his/her consent at any time.
5. Systems to Protect Patients' Rights
(a) Systems to make patients' rights known
A patient may request the medical institution which is providing treatment to provide a written copy of the rights of patients.
Medical institutions must publicise within their institutions the concrete ways in which a patient may exercise the rights set out in this law.
(b) Patients' Rights Advocates (PRA)
All medical institutions over a certain size shall employ a PRA to deal exclusively with patients' rights. They will endeavour to deal as appropriate with the opinions and grievances of patients towards the medical institutions and health care workers.
Local governments must appoint PRAs to take charge of the protection of the rights of patients in medical institutions of less than a certain size within a certain area.
(c) Committee to Investigate Patients' Rights (CIPR)
A patient, his/her family, any person legally authorised to speak for the patient, any person legally obliged to protect the patient may apply to the CIPR for the recognition of a rights violation, or the realisation of the desired rights or the fair settlement of a dispute wherever a medical institution is or health care worker has violated a rights, or the decision of a PRA is considered unacceptable.
CIPRs shall be established at each level of local government larger than the town.
CIPRs shall be composed of patients (or groups of patients), local representatives, lawyers and health care workers provided that health care workers do not make up more than half of the membership of the committee.
The constitution and management of the CIPRs shall be determined by government ordinance.
(d) CIPR investigation procedures and the courts
The CIPR, where it is deemed necessary, will investigate requesting the medical institution or the health care workers to provide oral and written reports and submit the medical records etc. and will report on concrete measures to be taken or make public the nature of the rights violation.
A patient's petition to the CIPR and subsequent investigation shall not hinder the right to bring an action in a court of law.

6 . Penalties

(Whether it is appropriate to prescribe penalties under this law, and if so, what they should be is currently under consideration.)