Patient Rights

The premise of informed consent is that patients have a moral, legal, and ethical right to understand and agree with all aspects of their care, including all potential consequences of accepting or refusing care. Patients must have sufficient information to make decisions related to their healthcare that align with their values and preferences. The principle underlying informed consent is that a person has the right to decide what is done to their body. Outcomes associated with a procedure must be laid out to be understandable to the patient, outlining the risks and benefits the patient can anticipate after undergoing the procedure. With the ongoing advancement in medical care, treatments have become more complex, and so has fully inclusive, informed consent for these treatments. The use of technology and the involvement of multimodal therapies pose new challenges to the informed consent process. The four principles related to informed consent are defined as follows (American Medical Association [AMA], 2025b; Shah et al., 2024; Wagner, n.d.):

1. The individual must have the capacity to make the decision.
2. The healthcare provider must provide adequate information on the benefits and risks of a given procedure, test, or treatment, including the likelihood that the given benefits or risks will occur.
3. The individual must understand the information provided.
4. The individual's consent must be voluntary, with no coercion or duress applied.

Patients in healthcare facilities have the right to accurate and easily understandable information about their health plan, healthcare professionals, and healthcare facilities. If they speak another language or have physical or mental disabilities, appropriate information must be given to the patient to enable them to make informed decisions about their healthcare. Patient rights include knowledge concerning the following:

• The facility in which they receive care
  • The facility's policy on limiting and removing life-supporting care and interventions
  • Proficiency with various interventions and treatments
  • Certification status
  • Standard adherence and consumer satisfaction rankings, obtainable on the internet
  • The process for filing complaints
• Information on the health professionals providing their care
  • Provider’s name
  • Professional qualifications
  • Experience
  • Patient satisfaction ratings
  • Comprehension of their rights and obligations as healthcare consumers

Regulatory organizations require proof that each facility provides this to patients through direct observation and facility policies. Each facility has its own methods for ensuring patients know and understand their rights. Most facilities display patient rights at points of admission to the facility. Many facilities also include a description of patient rights in handbooks given to patients during the admission process. Facilities may also require that the patient, or their legally responsible guardian, sign a document stating they were provided with patient rights. It has become a common practice for facilities to display a copy of patient rights and responsibilities in communal areas where they are easily accessible to patients, family members, and visitors. Still, a written listing of patient rights may not be sufficient. The facility is responsible for ensuring that patients adequately understand their rights and can exercise them. All information presented to patients must be in a format that is easily understandable to them (OPM, n.d).

Facilities must recognize that although a patient may speak English fluently as a second language, it may not be their preferred language for communicating and understanding health care information. According to The Joint Commission, adverse medical events happen more often to those with less-than-optimal English proficiency (The Joint Commission, 2021). Patients for whom English is not their first language need to be asked what language they want to use when discussing their healthcare. Their choice needs to be documented and adhered to. When the patient does not speak English, it is advisable to use a professional interpreter, rather than a family member who may speak English, to translate. A qualified medical interpreter knows medical terminology, ethics, and how to maintain patient confidentiality. Medical interpreters have completed extensive training programs; many professional interpreters hold master's degrees. If possible, the best scenario is to match the patient with a professional interpreter with a similar cultural background. In many cultures, patients will find it difficult and embarrassing to discuss intimate healthcare details with those of the opposite sex. Clinicians need to consider this when utilizing professional interpreters. Data indicates that the United States has between 350 and 430 spoken languages, including over 150 Native American languages (Allen et al., 2020). This country is one of the leading linguistically diverse regions in the world (Dietrich & Hernandez, 2022). This data emphasizes healthcare providers and clinicians' challenges when communicating with patients. Family members may feel unduly pressured if asked to interpret and may have valid worries about their ability to do this; however, they may be hesitant to voice their concerns. This means that patients may require extra assistance if they do not speak English, have hearing problems, or psychological or physical challenges that impede their understanding. Instances of special assistance that may be needed include:

• Translators
• Specialists in sign language
• Case management services and social worker involvement
• Braille resources
• Magnifying glass or materials in a large font (U.S. Department of Health and Human Services, 2025b)

Patients have the right to choose their healthcare providers, including specialists, and to choose from a range of providers within their insurance network (OPM, n.d.). If they are dissatisfied with their care, they can switch to another provider. Patients also have the right to continuity of care. Patients should be able to expect that their physician will cooperate in coordinating medically indicated care with other health care professionals, and that the physician will not discontinue treating them when further treatment is medically indicated without giving them sufficient notice and reasonable assistance in making alternative arrangements for care (AMA, 2025a).

A patient and their healthcare insurance may not always agree on the necessity for emergency care. For example, a person develops sudden chest pain and goes to the Emergency Department because they think they have a heart attack. Tests reveal that the cause is heartburn, and the managed care plan refuses to cover the cost of the ER visit. The healthcare insurance stance is that they are not responsible for covering emergency care when the episode of illness is not life-threatening. These disagreements have resulted in healthcare facilities rejecting patients, refusing treatment, and transferring patients to other facilities. Now, healthcare companies have to utilize a standard definition of the requirements for ER care. This definition follows the example of a prudent layperson. Under the requirements of this definition, an individual requires ER care if they exhibit signs or symptoms that a rational NON-MEDICAL individual would believe to be an emergency. This definition of the actions of a prudent layperson is found in the Consumer Bill of Rights and Responsibilities, which was passed by Congress for Medicare and Medicaid in 1997 (U.S. Centers for Medicare & Medicaid Services, 2024b).

If a person develops severe pain, sustains an injury, or is struck with something that causes them to believe that their health is seriously threatened, then that person has the right to receive emergency care without the need for prior authorization or incurring a financial penalty. The patient also has the right to ask for a transfer to a different facility, assuming that such a transfer is medically feasible and that the other facility is willing to accept the patient (U.S. Centers for Medicare & Medicaid Services, 2024c).

The Emergency Medical Treatment and Active Labor Act (EMTALA) also safeguards the right to emergency medical treatment. This act prevents patient dumping and is commonly called the anti-dumping law. EMTALA was enacted in 1986 as a section of the Consolidated Omnibus Budget Reconciliation Act (COBRA). Under EMTALA, a facility must assess a patient who presents for medical care. The assessment must be sufficiently thorough to determine if the patient has a condition that requires emergency medical care. An appropriately qualified healthcare professional must do the assessment. It must be clearly stated that a triage exam does not qualify as a complete medical assessment and diagnosis. If it is determined by the medical professional that the person does not have an urgent health condition, the facility has no additional responsibility under EMTALA. However, if a condition requires urgent care, the facility is obliged to provide the care needed to stabilize the person. Care must be provided without consideration of the patient’s capacity to pay. Before stabilizing the patient, a transfer to another facility may only be undertaken if the second facility is better equipped to meet the patient’s needs. A facility cannot transfer an unstable patient based on financial considerations (U.S. Centers for Medicare & Medicaid Services, 2024c).

Annually, 4%-5% of hospitals in this country are accused of an EMTALA violation. It has been found that sizable, for-profit metropolitan facilities with a substantial Medicaid population and large emergency department patient numbers are most likely to incur violations. Hospitals and doctors that contravene EMTALA rules can be fined $50,000 for each breach, and this is not covered under malpractice insurance (Warby et al., 2023).

Patients have the right to take a leading role in making decisions about the type and quantity of treatment they will receive. To do this, they must have complete and accurate information. It is essential that a patient have detailed information about their diagnosis, treatment options, and prognosis (OPM, n.d). Healthcare professionals must review all treatment choices with patients, including not pursuing treatment. Patients must also be made aware of each treatment option's risks, benefits, and potential medical consequences.

Reviewing clinical information with a patient is an integral part of informed consent. Informed consent is an ongoing communication process between healthcare providers and patients. It allows the patient to make intelligent decisions about a proposed course of treatment; however, information is only beneficial to a patient when they can understand it. When reviewing diagnosis and treatment choices with the patient, the healthcare professional must make a concerted effort to minimize the use of medical jargon and terminology as much as possible. The services of a translator or interpreter may be required. If the patient would like a second opinion before deciding on their care, this should be facilitated. The procedure for obtaining informed consent must provide the patient with adequate opportunity to think through their options and diminish the likelihood of a pressure-induced decision (Moran, 2024).

Health literacy has recently become a primary healthcare focus and is crucial in obtaining informed consent. Health literacy has evolved from focusing solely on what the patient understands to emphasizing the clinician's responsibility to impart knowledge that is easily understood. However, data indicates that only 12% of adults in this country have competent health literacy, with around 36% having basic or below basic health literacy capabilities (International Medical Aid, 2024). Plain language has become a pivotal part of all healthcare communication. Simple language is not about 'dumbing down' healthcare information, but using words that are part of everyday speech. If medical terminology must be used, it is adequately defined and explained. Most people find healthcare services and treatment interventions difficult to understand. Clinicians should remember that in stressful situations, everyone, regardless of their level of education, can have difficulty comprehending what they are reading or hearing. Even healthcare providers who suddenly find themselves as the patient and need to make an informed decision may have difficulty comprehending the situation before them. The informed consent procedure must include the following components:

• Complete information about diagnosis and treatment
• A description of the proposed intervention
• Probable benefits and dangers
• Recuperation time
• Likelihood of success or possible outcomes
• Possible side effects of medication and treatment
• Costs, including what insurance may and may not cover
• Realistic alternatives to the suggested intervention (including dangers associated with the intervention, advantages, and side effects of these other options)
• Any restrictions associated with confidentiality

Obtaining informed consent is about more than obtaining a signature on paper. Ideally, an unhurried collaborative discussion that considers the patient's beliefs and culture. The clinician must verify that the patient understands the information provided. This should not be done by simply asking if the patient understands, since most patients will automatically answer yes. The best option is 'teach-back,' where the clinician asks the patient to repeat the information in their own words(Agency for Healthcare Research and Quality [AHRQ], 2024). The clinician needs to be careful how they phrase this request so that the patient is not 'put on the spot' and made to feel that they are being quizzed. The clinician can begin by saying, "I want to make sure that I have given you all the information needed for you to make a decision. Can you repeat back to me what you have heard?" A survey of patient preferences and evaluation found that patients had no objections to being asked questions concerning their understanding of the information provided (AHRQ, 2024).

After a patient has been provided with all relevant information, they agree to have the proposed treatment or to decline it. The clinician should anticipate questions the patient may hesitate to ask and provide the information. A good way to approach this is by saying, "Many patients who have to decide on treatment like yours often wonder about . . .". After all the information has been explained to the patient and their questions are addressed, the patient should be provided sufficient time to think about their decision and not asked to sign the consent form immediately. Except in an emergency, patient consent must be obtained before any treatment can begin. The medical record must include the patient’s signed consent or an explanation as to why the patient cannot provide consent. Apart from the right to refuse treatment, a patient may at any time withdraw their consent. In this event, the treatment must cease. When patients decline treatment or withdraw consent once treatment has started, they have the right to know the consequences of their decision. The healthcare professional must inform the patient of the possible medical and other outcomes resulting from a lack of treatment. Parents, guardians, family members, or others designated as the patient's representative must be provided with the same information if the patient cannot make an independent decision (AMA, 2025b).

Patients have the right to reasonable visual and auditory privacy. A private area must be provided for all healthcare interactions, examinations, and treatments. The patient has the right to receive and review their medical record. They also have the right to request that the healthcare provider correct any inaccuracies in the record and add any missing information. The medical records are shared only with providers who directly participate in the patient's care, regulatory personnel evaluating the quality of care provided in a facility, and other persons with legal or supervisory authority to examine records. Protected healthcare information (PHI) cannot be given to anyone without a legal right to see it. This latter group can include immediate family and other relatives if the patient or the patient’s surrogate has not given written permission for PHI to be shared with them. Only authorized staff should be allowed access to areas where medical records are stored. This same rule applies to access to electronic health records. The patient should be made aware whenever their PHI is disclosed. Patients may be prohibited from viewing specific information in circumstances where this information could be injurious to the patient or another individual, or could be inspected by an oversight committee.

The HIPAA (Health Insurance Portability and Accountability Act) privacy rule is a federal regulation that sets standards for patient privacy and confidentiality. It also sets severe civil and criminal penalties for people who violate a patient's privacy. To comply with HIPAA, organizations should ensure that protected patient information is only shared with people directly involved in the patient’s care. The patient's case must only be discussed with people who are directly involved. Particular attention should be taken when talking in communal spaces such as elevators, bathrooms, corridors, cafeterias, etc. No aspect of patient care should ever be discussed in public areas. Patient charts should not be left out where unauthorized persons might see or access them. Since many facilities use electronic patient records, clinicians must be aware of facility policies for 'locking' their computers whenever they are not in use. It is essential to observe the surroundings when discussing patient care (Tariq & Hackert, 2023; U.S. Department of Health and Human Services, 2025a).

The patient has the right to an impartial and speedy assessment of any grievance concerning any aspect of their encounter with the healthcare system. A patient complaint can cover a wide range of issues, including:

• Their healthcare plan
• Inadequate Facilities
• Conduct of healthcare professionals
• Long wait times before being seen by a healthcare professional

Several facilities have a Patient Care Representative on staff who deals with patient complaints and grievances. Many patient complaints can be easily remedied. For example, a patient complains about not getting what they requested on their dinner tray. An apology to the patient and a word with the person who oversees the preparation of the patient's meal tray should resolve this problem. Addressing a concern promptly gives the patient a sense of assurance that they are being well cared for by the facility. For more serious and pervasive problems, the patient may need to take their care to the facility's ethics committee. Patients have the right and expectation that matters concerning their end-of-life care should be handled with respect and understanding. The patient should be able to obtain a copy of their medical bill and an explanation of benefits, irrespective of the payment source.

Greater than 50% of patients who pursue legal action in a healthcare situation do so because of inadequate communication, lack of shared information between healthcare providers, hospital staff, and patients/families, and frustration with what they perceive as an unresponsive system. Grievance management is the responsibility of facility personnel. Prompt and efficient management of grievances from the onset prevents a problem from escalating and decreases the risk of negative legal consequences for the facility and staff. When a complaint requires more detailed intervention, a patient can exercise their right to file a grievance report. Grievance is an official complaint that may be either oral or written. If a patient wishes to file a grievance, the healthcare provider has to meet the following requirements:

• Explain the facilities' grievance procedure, including the name and contact information of the staff member who handles grievances.
• Inform the patient and family that they can file a grievance with state agencies, even if the patient has already used the facility's internal grievance procedure.
• Provide the patient and family with contact information for filing a grievance with the relevant state agency.

The healthcare facility is responsible for conducting an investigation into all grievances within a reasonable time frame and putting in place a plan of action to resolve the issue. A grievance related to patient safety, such as abuse or neglect, must be investigated immediately. The grievance procedure is finalized once the facility provides the patient with a written report of the investigation findings. This report should provide information on the facility's steps to investigate the grievance, their conclusions, and any further action that will be taken (OPM, n.d; U.S. Centers for Medicare & Medicaid Services, 2024b).

Towards the end of 2020, the United States Congress passed a bill, the No Surprises Act, which was signed into law by the President. This new law affords federal protection to people from surprise medical bills. The bill's provisions protect patients from liability for the cost of unforeseen, out-of-network medical expenses. Surprise medical bills are often incurred in medical emergencies, when there is no option but to receive care. They may also occur in non-emergency care when a patient at the in-network facility is provided care from a healthcare professional, such as anesthesia personnel, who is not part of the network and was not selected by the patient. The law mandates private health insurance companies to pay for surprise medical bills for emergencies, including air ambulances, and to provide coverage for care given by out-of-network providers at in-network facilities. The law also stipulates that non-network providers cannot bill patients for additional charges incurred.

Other stipulations of the bill include:

• Health plans are required to supply a prior explanation of benefits. Starting in 2022, people can ask for advance information regarding how treatments will be covered before they receive them.
• Health plans must maintain coverage between the continuation of healthcare coverage and the time a provider departs the network. Under the law, health insurance companies must inform patients when a provider or facility leaves the plan's network.
• Health plans are required to keep correct provider network directories. Health insurance companies must reply within one business day to questions from enrollees about the status of a provider or facility, whether they are in-network or not. The information provided to the consumer becomes binding on the insurance company.
• Health plans are mandated to release data on broker commissions. Persons enrolled in a healthcare plan have a right to be informed about the sum of direct and indirect reimbursement given to brokers for that enrollment (Kaiser Family Foundation, 2021).