Eubios Journal of Asian and International Bioethics - Eubios Ethics ...

44 Eubios Journal of Asian and International Bioethics 22 (January 2012)
as expression of something, which everyone
fundamentally and logically expects from a HCW in
general.(6) Patients’ duties varied from the prima facie
duty of compliance by adhering to the treatment
prescriptions to duties of truthfulness and to seek and
access healthcare responsibly (1, 7).
Convenience sampling was adapted. Since there has
been no study of the sort in the region we the calculated
sample size of 269 was based on average 50%
prevalence and 90% confidence level. Three trained
research officers were asked to interview the participants
of the event.
Data was double entered and analyzed in SPSS v.16.
Descriptive statistics were calculated. Later, scoring for
duties and rights questions was done, according to the
responses given by the participants. Each correct
question had a value of one mark. There were no marks
deducted from wrong answers. Rights were scored from
1 to 5 and duties were scored from 0 to 4, depending on
the minimum and maximum number of correct questions
answered by the participants. Fiftieth percentile was
taken as a reference to judge the level of awareness and
knowledge. Outcome variable was taken as number of
correct answers and the score of the participants.
Institutional permission from the event organizers, Dow
University of Health Sciences was taken before data
collection. Each individual participant was asked to give
verbal consent before the five minute interview.
Results
The median age with IQR of the study population was
28±14 years. Characteristics of the study participants is
given in Table 1.
There were five questions pertaining to patient’s rights
in our questionnaire. Out of 269 people, 200 (74%) knew
that they have the right over your doctor’s advice or
decision. Majority, 190 (71%) believed that their doctor
will always make the best decision for them. Similarly 195
(73%) thought that their doctor would not take any
harmful decision. Inquiring about their knowledge on their
doctor’s ethical and legal boundaries, 211 (78%)
assumed that their physicians can not disclose their
disease status to a third person. Opinions on favoritism
concerning class, creed, gender or religion, by doctors
had 167(62%) showing concerns.
There were four questions asked to check the level of
awareness of the patients towards their duties. As a
patient, 251 (93%) agreed that they respected and
followed their doctor’s advice. Few 18 (7%) subjectively
reported non-compliance. Though, 102 (38%) reported
following treatment regimes of minimal of two doctors
simultaneously for the same disease. Most, 250 (93%)
agreed to share complete information with their
physicians, however 19 (7%) had opposite opinions. Two
hundred and thirty six (88%) were aware of an
employee’s right for health coverage and recommended
that all employees irrespective of their job rank should
have medical coverage.
Scoring of the level of awareness and knowledge is
shown in Figures 1 and 2. Data showed that 50 th
percentile of the scoring regarding rights and duties was
4 and 2, respectively. The majority, 213 (79%)
participants scored below the 50 th percentile on questions
regarding their rights. Few, 95 (35%) scored 4 out of 5.
Similarly, 166 (62%) of them scored below 50 th percentile
regarding their duties. Almost half, 127 (47%) scored
high with score 3 out of 4.
Discussion
Our findings summarize that the residents of Karachi
belonging to upper and middle socioeconomic classes
are less aware of their rights but comparatively well
aware of their duties.
Human life and health has the utmost importance in
human rights (6). It has been reported that people of
developing countries are unaware of their medical rights
(8, 9). We also found only 20% of our study participants
scoring above the cut off. Remaining needs to be
empowered and informed of their birth and civil right to
appropriate medical care. This may reflect the wide
differences among people from developing countries
belonging to different cities and towns. Ironically, our
people are not empowered by any means to know their
rights. Neither their school curriculum nor the
philanthropist of our society has ever attempted to
explain the rights to the citizens. Government has limited
role in developing and safeguarding the healthcare
system of Pakistan.
One has to be cautious about the topics such as rights
in healthcare as they can be misleading or damaging.
Smith M. explains how it is so to conclude that as the
world is evolving and having its effect on the doctorpatient
relationship, it is of pivotal importance to maintain
a balance of rights and responsibilities in healthcare (10)
.Often separate frameworks need to be designed
according to the sub-specialties involved to prevent
injustice (11). In today’s world of advance technology it is
even more important for the people to know of their rights
to refuse and accept treatment options. Market driven
decisions are often risky for the patients if not for the
pharmaceutical, institute or the HCWs involved (12).
Most of our respondents (71%) assumed that doctors can
not harm them and would always decide the best for
them. The patients should however keep a watch out for
unethical doctors in the area. More than half (62%) did
not believe that HCWs would think about class, creed,
gender or religion while making clinical decisions for their
patients. It shows that the theories of paternalistic still run
in mind of our society and the people trust any
authoritative person with their important life decisions.
This reflects the general culture in our region. In our data
set, 74% were aware of their rights over their physicians’
recommendations for treatment. This aspect is a
satisfactory element and can help us to be a budding
point to teach the rest of the healthcare rights to the
people of Karachi.
On the opposite end, the study participants were well
informed of their duties. Though original research and
literature is scanty regarding patients’ duties, however
duties of the HCW are mentioned in the literature (1).
Few have studied the patients’ duties in depth. Resnik
argues that patients have a moral duty of compliance and
have a duty to protect the health of others. Patients do
not have the right to refuse treatment if this act of nonadherence
would threat other people (1, 7). This adds to