The rights stated in the European Charter of Patients’ Rights have as main starting point the European Charter of Fundamental Rights, in particular the Article 35, but they are also linked to several international declarations and recommendations, issued by different subjects such as the World Health Organization and the Council of Europe. They regard organisational standards and technical parameters, as well as professional patterns and behaviours.  

1.The EU Charter of Fundamental Rights

  • The Charter of Fundamental Rights, which will represent the first “brick” in the European constitution, is the main reference point of the European Charter of Patients’ Rights. It affirms a series of inalienable, universal rights, which EU organs and Member States cannot limit, and individuals cannot waive. These rights transcend citizenship, attaching to a person as such. They exist even when national laws do not provide for their protection; the general articulation of these rights is enough to empower persons to claim that they be translated into concrete procedures and guarantees. According to Article 51, national laws will have to conform to the Nice Charter, but this shall not override national constitutions, which will be applied when they guarantee a higher level of protection (Article 53). In conclusion, the particular rights set forth in the Nice Charter are to be interpreted extensively, so that an appeal to the related general principles may cover any gaps in the individual provisions.
  • Article 35 of the Charter provides for a right to health protection as the “right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices”. Article 35 specifies that the Union must guarantee “a high level of protection of human health,” meaning health as both an individual and social good, as well as health care. This formula sets a guiding standard for the national governments: do not stop at the floor of the “minimum guaranteed standards” but aim for the highest level, notwithstanding differences in the capacity of the various systems to provide services.
  • In addition to Article 35, the Charter of Fundamental Rights contains many provisions that refer either directly or indirectly to patients’ rights, and are worth recalling: the inviolability of human dignity (article 1) and the right to life (article 2); the right to the integrity of the person (article 3); the right to security (article 6); the right to the protection of personal data (article 8); the right to non-discrimination (article 21); the right to cultural, religious and linguistic diversity (article 22); the rights of the child (article 24); the rights of the elderly (article 25); the right to fair and just working conditions (article 31); the right to social security and social assistance (article 34); the right to environmental protection (article 37); the right to consumer protection (article 38); the freedom of movement and of residence (article 45).


The EU Charter of Fundamental Rights

The European Parliament, the Council and the Commission have written the Charter of Fundamental Rights of the European Union (Nice, 7 December 2000).

The Charter claims that the peoples of Europe, in creating an ever-closer union among them, are resolved to share a peaceful future based on common values. Conscious of its spiritual and moral heritage, the Union is founded on the indivisible, universal values of human dignity, freedom, equality and solidarity; it is based on the principles of democracy and the rule of law. It places the individual at the heart of its activities, by establishing the citizenship of the Union and by creating an area of freedom, security and justice. The Union contributes to the preservation and to the development of these common values while respecting the diversity of the cultures and traditions of the peoples of Europe as well as the national identities of the Member States and the organization of their public authorities at national, regional and local levels; it seeks to promote balanced and sustainable development and ensures free movement of persons, services, goods and capital, and the freedom of establishment. To this end, it is necessary to strengthen the protection of fundamental rights by making those rights more visible in a Charter.
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2.Other international references

The fourteen rights are also linked to other international documents and declarations, emanating in particular from the WHO and the Council of Europe. As regards the WHO, the most relevant documents are the following:

- The Declaration on the Promotion of Patients’ Rights in Europe, endorsed in Amsterdam in 1994;

- The Ljubljana Charter on Reforming Health Care, endorsed in 1996;

- The Jakarta Declaration on Health Promotion into the 21st Century, endorsed in 1997.

As regards the Council of Europe, one must recall in particular the 1997 Convention on Human Rights and Biomedicine, as well as Recommendation Rec(2000)5 for the development of institutions for citizen and patient participation in the decision-making process affecting health care.  All these documents consider citizens’ health care rights to derive from fundamental rights and they form, therefore, part of the same process as the present Charter. 


The Declaration on the Promotion of Patients' Rights in Europe

The Declaration on the Promotion of Patients' Rights in Europe constitutes a common European framework for action and includes the principles stated by the Amsterdam Consultation aiming at promoting the rights of patients in the health care context. This Declaration should be interpreted as an enhanced entitlement for citizens and patients in improving partnership in the process of care with health care providers and health services managers. (Amsterdam, 28-30 March 1994).

The European Consultation on the Rights of Patients, under the auspices of the WHO Regional Office for Europe (WHO/EURO), and hosted by the Government of the Netherlands, was attended by 60 people from 36 Member States. The purpose was to define principles and strategies for promoting the rights of patients, within the context of the health care reform process under way in most countries. After the Consultation, with the support of the Government of the Netherlands and other institutions in European countries, technical experts in the field drafted The Declaration on the Promotion of Patients' Rights.
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The Ljubljana Charter on Reforming Health Care

The Ljubljana Charter was drafted by the World Health Organization in the European Region (18 June 1996).

The purpose of this Charter was to articulate a set of principles which are an integral part of current health care systems or which could improve health care in all the Member States of the World Health Organization in the European Region. These principles emerge from the experience of countries implementing health care reforms and from the European health for all targets, especially those related to health care systems.   This Charter addresses health care reforms in the specific context of Europe and is centered on the principle that health care should lead to better health and quality of life for people. The improvements in the health status of the population are an indicator of development in the society. Health services are important, but they are not the only sector influencing peoples’ wellbeing: other sectors also have a contribution to make and responsibility to bear in health, and intersectorality must therefore be an essential feature of health care reform.
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Jakarta Declaration on Leading Health Promotion into the 21st Century

The Jakarta Declaration on Leading Health Promotion into the 21st Century is the name of an international agreement that was signed at the World Health Organization's 1997 Fourth International Conference on Health Promotion held in Jakarta (21-25 July 1997).

The “Fourth International Conference on Health Promotion: New Players for a New Era - Leading Health Promotion into the 21st Century” came at a critical moment in the development of international strategies for health. The Conference was the first to be held in a developing country, and the first to involve the private sector in supporting health promotion. It provided an opportunity to reflect on what has been learned about effective health promotion, to re-examine the determinants of health, and to identify the directions and strategies that must be adopted to address the challenges of promoting health in the 21st century. The participants in the Jakarta Conference presented this Declaration on action for health promotion into the next century. The Jakarta Declaration included the following five priorities for health promotion in the 21st century: promote social responsibility for health, increase investments for health development, consolidate and expand partnerships for health, increase community capacity and empower the individual, and secure an infrastructure for health promotion.
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Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine

The Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine was an international instrument which aimed to prohibit the misuse of innovations in biomedicine and to protect human dignity (Spain, 4 April 1997).

The Convention was the first legally binding international text designed to preserve human dignity, rights and freedoms, through a series of principles and prohibitions against the misuse of biological and medical advances. The Convention's starting point is that the interests of human beings must come before the interests of science or society. It lays down a series of principles and prohibitions concerning bioethics, medical research, consent, rights to private life and information, organ transplantation, public debate etc.

The treaty prohibits the use of techniques of medically assisted procreation to help choose the sex of a child, except where it would avoid a serious hereditary condition. The Convention sets out rules related to medical research by including detailed and precise conditions, especially for people who cannot give their consent. The Convention states the principle according to which a person has to give the necessary consent for treatment expressly, except in emergencies, and that such consent may be freely withdrawn at any time. The treatment of persons unable to give their consent, such as children and people with mental illnesses, may be carried out only if it could produce real and direct benefit to his or her health.
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Recommendation No. R (2000) 5 of the Committee of Ministers to member states on the development of structures for citizen and patient participation in the decision-making process affecting health care 

The Committee of Ministers, under the terms of Article 15.b of the Statute of the Council of Europe,

article 11 of the European Social Charter on the right to the protection of health, the Amsterdam Declaration on the Promotion of Patients’ Rights in Europe, the Ljubljana Charter on Reforming Health Care, endorsed by the WHO and the Jakarta Declaration on Leading Health Promotion into the 21st Century (1997) has developed this Recommendation No. R (2000) 5.

Recommendation No. R (2000) 5 respects the fundamental right of citizens in a free and democratic society to determine the goals and targets of the health care sector. It recognizes that a health care system should be patient-oriented and that citizens should necessarily participate in decisions regarding their health care. Moreover, it is necessary for each member state to help to broaden the public's general knowledge about health problems, promote healthy living, and disease prevention. Therefore, it recommends that the governments of member states: ensure that citizens’ participation should apply to all aspects of health care systems, at national, regional and local levels and should be observed by all health care system operators, including professionals, insurers and the authorities; take steps to reflect in their law the guidelines contained in the appendix to this recommendation; create legal structures and policies that support the promotion of citizens’ participation and patients' rights, if these do not already exist; adopt policies that create a supportive environment for the growth, in membership, orientation and tasks, of civic organizations of health care "users", if these do not already exist; support the widest possible dissemination of the recommendation and its explanatory memorandum, paying special attention to all individuals and organizations aiming at involvement in decision-making in health care.

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Beyond the documents mentioned and described above, there were already Charters throughout Europe that made significant references on the subject of patient's rights. Here below some examples:


Charter for Hospitalized Patients/Charte du Patient Hospitalisé

The Charter for Hospitalized Patients was introduced in France on 20 September 1974.

The Charter concentrates on the obligations incumbent upon health care establishments rather than on the rights of patients within them. The Charter was revised and a new version issued on 6 May 1995. This emphasized at the outset that public hospital services must be accessible to all, particularly the most vulnerable patients. In order to ascertain the level of their satisfaction with the health care services, patients are required to comment on their stays in health care establishments. A copy of the Charter must be given to every patient admitted for treatment in any health care establishment.

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United Kingdom’s Patient's Charter

The Patient's Charter was first started out as a United Kingdom government official document. It was originally introduced in 1991, under the then Conservative government, and was revised in 1997.

The Patients' Charter was an official document by the government that enlisted various Patients' Rights and Responsibilities along with the Code of Practice, followed by a medical personnel. It sets out a number of patient's rights for National Health Service patients, inspiring other nations to publish their patients' charter as well. The Charter sets out rights in service areas including general practice, hospital treatment, community treatment, ambulance, dental, optical, pharmaceutical and maternity care. The Patient's Charter puts the Citizen's Charter into practice in the NHS. It is helping the NHS to listen to and act on people's views and needs, set clear standards of service, and provide services which meet those standards. The Charter involves the fields of access to services, personal consideration and respect, providing information, registering with and changing doctors, health checks, drugs and medicines, and reducing waiting times.

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Czech Republic’s Code of Patients’ Rights in Health Institutions

The Charter was introduced in the Czech Republic by the Central Ethical Committee of the Ministry of Health (25 February 1992).

The Charter contains the following rights: right to informed consent, right to information concerning own health, rights regarding the medical records, right to privacy, right to complain and compensation.

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Ireland’s Charter of Rights for Hospital Patients 

The Charter was introduced in Ireland by the Department of Health (1994).

It outlined the rights of the hospital patient. Key points covered by the charter include: right to be admitted immediately to hospital in a medical emergency, right to be treated in a courteous manner at all times, right to receive visits from relatives and friends, right to be treated with respect for your religious and philosophical beliefs, right to your privacy being respected, right to information of your disease and treatment, right to complain about any aspect of the hospital service and to have the complaint investigated.
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Patient’s Charter of Malaysia

This Charter was introduced in Malaysia and was signed by the Federation of Malaysian Consumers Associations, the Malaysian Medical Association, the Malaysian Dental Association and the Malaysian Pharmaceutical Society (21 August 1995).

The document states that the Federation of Malaysian Consumers Associations (FOMCA) is committed to the protection of consumer rights and to consumer education; the Malaysian Medical Association (MMA) is committed to sustaining the professional standard of medical ethics as to education and directing public opinion on the problems of public health as affecting the community at large; the Malaysian Dental Association (MDA) is dedicated to supporting and promoting a high standard of ethics and professional conduct and to directing public opinion on dentistry and the problems of dental health; and the Malaysian Pharmaceutical Society (MPS) is committed to further the development of pharmacy, to enhancing the standards and ethics of the profession and to assisting in improving the health services in the country.

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The Patients’ Rights Charter of the Republic of South Africa

The Patients' Rights Charter in the Republic of South Africa was adopted by the Department of Health (1996).

For many decades the vast majority of the South African population has experienced either a denial or violation of fundamental human rights, including rights to health care services. To ensure the realization of the right of access to health care services as guaranteed in the Constitution of the Republic of South Africa, the Department of Health is committed to upholding, promoting and protecting this right and therefore proclaims this Patients' Rights Charter as a common standard for achieving the realization of this right.

This Charter is subject to the provisions of any law operating within the Republic of South Africa and to the financial means of the country. It claims the rights to: a healthy and safe environment, participation in decision-making, access to healthcare, knowledge of one’s health insurance/medical aid scheme, choice of health services, be treated by a named health care provider, confidentiality and privacy, informed consent, refusal of treatment, be referred for a second opinion, continuity of care, and complain about health services.
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Portugal’s Charter of Rights and Duties of Patients/Carta dos Direitos e Deveres dos Utentes

The Charter of Rights and Duties of Patients was introduced in Portugal in 1997.

The majority of the rights listed are also promoted by civil, criminal and traditional health care legislation. The Charter is based on a set of fundamental values ​​such as human dignity, equity, ethics and solidarity.

The knowledge of patients' rights and duties, also extended to all users of the health system, enhances their capacity for active intervention in the progressive improvement of care and services. This document assumes itself as an instrument of partnership in health, and not of confrontation, contributing to consecrate the primacy of the citizen, considering him as a central figure of the whole Health System and to develop a good relationship between patients and providers health care and, above all, encourage more active participation by the patient.

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Patients' rights in the European Union: Cross-border care as an example of the right to health care

This is an article published in the European Journal of Public Health (1 September 1997).

The rights of patients to receive health care in other member states of the European Union (EU) are dependent upon both individual rights and social rights. The problem is that these rights differ in character and the way they can be claimed. The right to health care falls under the category of social rights which require the state to provide the necessary health care services. Patients' rights to access to care are sometimes included in administrative regulations and in civil medical contract acts. European legislation and the jurisdiction of the Court of Justice of the European Communities played an important role in reinforcing the rights of patients to have access to health care in other member states. The conclusion is that, in the case of cross-border health care, a balance may be struck between the rights and criteria. This balance should create an equilibrium between general legal principles and national and international legislation.
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Patients’ Rights Charter of Poland

The Patients’ Rights Charter was introduced in Poland by the Ministry of Health (1998).

The Charter provides an overview of patients’ rights with reference to hospitals and outpatient clinics.

It presents throughout the whole Charter the following rights: patient's right to health benefits, patient's right to information, patient's right to privacy, patient's right to consent to health benefits, right to respect the patient's intimacy and dignity, patient's right to medical documentation, patient's right to opinion against a doctor's decision, patient's right to private and family life, patient's right to care, patient's right to store value items in deposit, and special patient’s rights on the collection and transplantation of cells, tissues and organs.

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Patients’ Charter of Hong Kong

The Patients’ Charter was introduced in Hong Kong in 1999.

The purpose of the Patients' Charter is to explain both your Rights and Responsibilities when you use the services of any of Hong Kong's public hospitals. Knowing and understanding your rights and responsibilities will make your relationship with health care providers a mutually beneficial one. The Charter sets out the ways in which the community and the hospitals work as partners in a positive and open relationship with a view to enhancing the effectiveness of the health care process. It consists of the: rights to medical treatment, rights to information, right to choices, right to privacy, and right to complaint.
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Charter of Patients 'Rights in The Slovak Republic/ Charta Práv Pacientov V Slovenskej Republike

The Charter of Patients' Rights in the Slovak Republic was adopted by the Government of the Slovak Republic (11 April 2001).

This Charter claims that, as defined by the World Health Organization, health is a state of complete physical, mental and social well-being and not just the absence of disease or disability. It states that health is one of the most important human values and that everyone is responsible for protecting and promoting their own health, but at the same time it is expected that society will provide the right conditions to do so.

Everyone has the right to a healthy living and healthy environment, to health protection, to health care and to adequate assistance in the event of illness, threat of illness or if the damage to health is permanent. It affirms that health recovery is a treatment process including rehabilitation (long-term health recovery).

The individual rights of patients in healthcare are based on the right of man to human dignity, self-determination and autonomy. Everyone should have the right of access to a standard healthcare that is in compliance with the legislation in force in the Slovak Republic and the current state of medical science.

The right to an adequate quality of healthcare means that the work of healthcare professionals must be of a high professional standard. Finally, the aim of health legislation is to ensure that legislation reflects these principles.
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Austria’s Agreement to Ensure Patient Rights (Patients’ Charter) /Vereinbarung zur Sicherstellung der Patientenrechte (Patientencharta)

The Charter was established in Austria by the federal government (1 September 2001).

The document offers the objective and the definition of the Patients’ Charter and then goes on to claim the rights and responsibilities of patients: right to treatment and care, right to respect for dignity and integrity, right to self-determination and information, right to documentation, special provisions for children, representing patients’ interests, and enforcement of claims for damages.

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Cyprus’ Charter on the Rights of Patients

The Charter on the Rights of Patients was produced in Cyprus by the NGO Patients’ Rights Movement (KIDDA) (2001).

This Charter aimed at filling a big gap in the effort to promote and protect the rights of patient-citizens. The Charter was compiled by a working group of distinguished citizens who had experience and had an in-depth knowledge of human rights and social problems and who were sensitive to the rights of patients. The Charter was drafted on the basis of relevant international documentation and in particular the “Declaration for the Promotion of the Rights of Patients in Europe” of the World Health Organization (March 1994). The main objectives of this Charter were: to make the citizens, the state, the doctors and in general all those offering health services more sensitive to the rights of the patients and to safeguard by legislation the rights contained in the Charter and to set up a mechanism to monitor respect for these rights. The Charter is a code of conduct for the state and all those who are involved one way or another in providing health services to a patient.
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