The Law of 24 July 2014 consolidates the rights and obligations of patients in a single law, thereby allowing for greater consistency and transparency in the relations between patients and healthcare providers. This law focuses on:
- the importance of the information due to patients by health providers;
- improving the extent to which patients' wishes are taken into account in the delivery of care, including the possibility of appointing a trusted person or support person;
- the generalisation of and access to the patient's medical file;
- the creation of a National Health Information and Mediation Service (Service national d’information et de médiation) on 1 January 2015.
Mutual respect, dignity and loyalty
Patients have the right to the protection of their privacy, confidentiality, and dignity, and to respect for their religious and philosophical convictions.
By providing, in accordance with their abilities, information that is relevant for their care, and consenting to and cooperating in the latter, patients play a part in ensuring that they receive the best possible healthcare.
Access to quality healthcare
Depending on their state of health, patients have equal access to healthcare. This care is provided efficiently and in line with scientific data and legally prescribed quality and safety standards.
In addition, healthcare should be organised in a way that guarantees continuity of care in all circumstances.
Freedom to choose healthcare providers
Subject to the organisational imperatives inherent in the delivery of healthcare, each patient has the right to freely choose the healthcare provider they wish to receive care from. They may change their mind at any time.
For all medical procedures delivered in a hospital setting, their choice is limited to the healthcare providers accredited by the establishment.
Refusal to provide healthcare to patients
A healthcare provider may refuse to provide care to a patient for personal or professional reasons. They may refuse to provide any care when they believe they are not in a position to do so appropriately.
Differences in treatment may be legitimate when founded on objectively justifiable reasons. Consequently, for example, when a patient's state of health does not justify the use of certain treatments, the healthcare provider cannot be accused of discrimination if their action is based on objective medical reasons.
At the patient's request, the healthcare provider will help the patient find a another provider that is capable of providing the required care. Providers are duty-bound to provide:
- urgent first-aid care to the extent of their capabilities;
- continuity of care in all circumstances.
The refusal to provide healthcare may not, in any case, be based on discriminatory considerations. When a patient can present factual grounds for supposing that they have been discriminated against, it is up to the healthcare provider to justify their refusal by providing objective non-discriminatory reasons for their decision. In practice, it is in healthcare providers' best interest to record the objective non-discriminatory reasons for their refusal to provide care in the patient's medical file.
Right to assistance
Patients have the right to be assisted in their healthcare-related formalities and decisions by a third party of their choosing, who may or may not be a healthcare professional. Any such person chosen by the patient to support and assist them are called support persons.
To the extent desired by the patient, the support person is integrated in the healthcare process and, if requested by an adult patient, the obligation to patient confidentiality may be waived in their regard.
The identity of a support person is noted in the patient file. The healthcare professional may however at any time freely decide to speak with the patient without the support person being present.
Patients' right to information regarding their state of health
Healthcare professionals must notify their patients in advance of the services that they are responsible for providing and inform them of their state of health and the probable assessment thereof. Such information must be provided to the patient in clear and understandable language; it is generally communicated verbally and, where applicable, can be communicated in writing.
Decisions concerning a patient's health are taken jointly by the patient and their healthcare professionals. Care for patients having the necessary capacity can only be delivered with their prior informed and enlightened consent, after they have been adequately informed. In addition, patients may refuse or withdraw their consent at any time.
Advance notification refers to the essential information characterising the proposed healthcare, including adequate information on the objectives and foreseeable consequences of the care, its benefits and possibly urgency, generally known risks or frequent and/or serious events associated with the care, assessed in light of the patient's specific profile, as well as any possible therapeutic alternatives or options that may be envisioned, and the foreseeable consequences in the case of a refusal.
Advance notification also entails, at the patient's request, providing an estimate of the overall cost for the proposed treatment and conditions for coverage. Also, at the patient's request, such notification may include information on the availability, quality and safety of the proposed healthcare, including the number of procedures carried out by the provider, the rate of complications, the foreseeable duration of a hospital stay, if any, the authorisation or registration status of the healthcare provider, and the provider's professional liability insurance coverage.
The right 'not to know' and therapeutic privilege
Patients may sometimes wish not to be informed of a diagnosis, prognosis or any other information in connection with their state of health or its probable evolution. If this is the case, their wishes must be respected, unless the non-communication of such information to the patient could cause serious harm to the patient's health or to that of a third-party. The patient's wish not to be informed should be recorded in their the patient file.
Exceptionally, doctors may decide not to communicate information that could manifestly cause serious harm to the their patients' health. In that case, the patient's doctor would first discuss the matter with a colleague and, in so far as possible, with the patient's person of trust. They would then record an explicit reason in the patient file.
To ensure the best possible healthcare, the patient should provide, to the best of their ability, any information that is relevant for their care, and generally cooperate with their healthcare providers in respect of the latter. During their treatment, patients are expected to respect the rights of healthcare providers and other patients.
Freedom to choose a person of trust
All adult patients who have the capacity to give their consent, but who may no longer be able to express their wishes and receive information necessary for taking a decision related to their health, may appoint a person of trust. The appointment must be in writing, and dated and signed by the patient.
Patients unable to express their wishes
If the patient is temporarily or permanently unable to express their wishes, the healthcare provider will attempt to determine the patient's supposed wishes. To do so, the healthcare provider can refer to the patient's appointed person of trust, or to any other person who is likely to be aware of the patient's wishes.
If, in a medical emergency, a patient is unable to take decisions concerning their health, and their wishes could not be established, the health care provider may, in the interest of the patient, immediately take any emergency medical measures dictated by the situation.
The rights of patients who are unemancipated minors may be exercised by their parents or by any other person who is their legal representative.
If an unemancipated minor patient possesses sufficient judgement to reasonably assess their interests, their physician, or any other healthcare provider responsible for their care, may allow them to exercise their rights in connection with their health in an independent manner. Legislators felt that it was preferable not to set a precise legal level, but to let doctors decide whether the patient is sufficiently mature.
If the minor patient's life or health is in serious and immediate danger, their physician may take any medical measures required by the situation. Where necessary, such emergency measures may be taken even if the minor's parents, or the person(s) with parental authority over the minor patient, refuse to consent to the measures in question. In that case, the doctor must send a report to the State prosecutor, within 3 working days, stating their reasons for the medical measures they decided to take.
All patients are entitled to a patient file that is carefully kept up-to-date. This file should provide a faithful and chronological record of the patient's state of health and its evolution over the course of their healthcare.
The holder of the patient file should provide safekeeping for the file for at least 10 years, starting from the end date of the healthcare.
Access to patient files and data on patients' health
Patients have the right to access their file, and all their health-related information, held by their doctor or any other medical body. They have the right to have the contents explained to them by the healthcare provider, and may also, for that purpose, be assisted by a support person.
If the patient file is consulted, or their health-related data is accessed, in the patient's absence, by a third-party individual who is not a healthcare professional acting in their capacity as such, that individual must be able to produce a written approval to do so, dated and signed by the patient. Consulting a patient's file is the patient's absence must be exceptional.
Furthermore, patients may obtain a full copy of their patient file, and demand that it be forwarded to the healthcare provider of their choice.
Except when the patient's state of health requires more urgent access, the holder of the patient file is expected to respond to such demands within no more than 15 working days of receiving the demand.
Confidentiality and professional secrecy
Two or more healthcare professionals may exchange information related to the same patient receiving healthcare in order to ensure the continuity of their care or determine the best possible treatment, unless the duly informed patient is opposed to their doing so. The duly informed patient may refuse, at any time, to allow their information to be communicated to one or more healthcare professionals. However, the healthcare professional who initiated the healthcare service(s) remains entitled to access the contents of the file related to the service(s) that they provided.
With the patient's consent, healthcare professionals may also provide persons close to the patient with any information that is deemed indispensable for them to intervene in the patient's best interest. The patient's consent is not required if, in the case of a serious diagnosis or prognosis, the patient is unable to express their wishes and had not previously expressed their objection to the lifting of the obligation of medical confidentiality.
Persons of trust, and support persons assisting patients in their relations with healthcare professionals, who fail to preserve the confidentiality of the patient's information face the risk of sanctions.