The rights of citizens and patients

There health is a fundamental right of every person and in Italy, this right is enshrined in the Constitution ("The Republic protects health as a fundamental right of the individual and in the interest of the community, and guarantees free care to the indigent", (Italian Constitution art. 32). To protect this right, the National Health Service (SSN) - through its structures, services and activities - pursues the promotion, maintenance and recovery of the physical and mental health of the entire population, according to the principles of Universality, Equality and Equity (Law 23 December 1978, n. 833).

Citizens, in their relationship with health services, are holders of specific rights. With the European Charter of Patients Rights, citizen and patient associations have identified a core set of fundamental rights.

Some of the rights indicated by the European Charter are reflected in the principles that underlie our NHS, while others have been indicated in regulations subsequently issued. Below is a first review of the rights of which it is important to be aware of the practical implications they have in the experience with health services.

It is the right of every citizen to use thehealth and social care assistance. The National Health Service (NHS) is required to provide all citizens - free of charge or upon payment of a participation fee (ticket) - with public resources collected through general taxation, a set of benefits and services, defined as essential levels of assistance (LEA). These benefits concern both prevention activities aimed at the community and individuals (vaccines, Screening, food safety, etc.), either health and social-health activities and services widespread throughout the area (general practitioner, pediatrician, specialist outpatient care, home health and social care, etc.), both thehospital care. The list of services included in the LEAs was updated in 2017 and finds its regulatory framework in Decree of the President of the Council of Ministers (DPCM) of 12 January 2017. 

In implementation of the Prime Ministerial Decree of 12 January 2017, the Decree of the Ministry of Health of 23 June 2023 (published in the Official Journal of 4 August 2023) updates the tariffs for outpatient specialist services and prosthetic assistance and defines the tariffs for the new services introduced with the LEAs in 2017, so that they are provided uniformly throughout the territory national.

It is the right of every citizen to be able access your medical records upon request at the facility in which he was hospitalized. The release of the copy of the medical record (preferably in electronic format) must take place within 7 days from the date of the request, while any additions can be provided within 30 days of the request (Law 8 March 2017, n. 24 – Art. 4 Data transparency). 

It is the right of every citizen to express his own opinion informed consent to any proposed diagnostic-therapeutic-rehabilitative treatment. No health treatment can be started or continued without the free and informed consent of the person concerned, with the exception of those conditions governed by specific legal provisions (e.g. compulsory vaccinations, psychiatric illnesses). Only after having been informed, in the context of a relationship of care and trust, in a complete, updated and understandable way is it possible to express a truly informed consent. Informed consent, in whatever form it is expressed (written, video-recorded, with communication devices for people with disabilities), is entered in the medical record and in the electronic health record (Article 32 of the Constitution and Law 22 December 2017, n. 219).

It is the right of every citizen who comes into contact with healthcare facilities and professionals protection of your privacy.This right guarantees complete confidentiality with respect to one's personal data and in particular with respect to one's sensitive data, ie relating to the state of health, acquired during contact with the structure or the professional. Furthermore, the acquired data must be processed for defined purposes. Each individual has the right to access their data, to obtain their rectification and in some cases, as required by the General Regulations for the protection of personal data, to request their cancellation (right to be forgotten) (General regulation for the protection of personal data n. 2016/679 – General Data Protection Regulation o GDPR; Legislative Decree 10 August 2018, n. 101).

It is the right of every citizen consult the wait in real time relating to visits and examinations provided in a public or private regime within structures affiliated with the NHS. The citizen can also ask the Health Directorate or the Hospital Medical Directorate to know his own position on the waiting list for hospitalization. In this regard, consult the National Waiting List Government Plan (PNGLA) 2019-2021. 

It is the right of every citizen safety of care, which is considered an integral part of the right to health and is pursued in the interest of the individual and the community. The right to safe care is also ensured thanks to all prevention activities and risk management associated with healthcare services and the appropriate use of resources. All health and socio-health personnel, whether belonging to public, private or freelance structures, will contribute to these prevention activities (Law 8 March 2017, n. 24).

With the Law 8 March 2017 n. 24, our country has an advanced regulatory system consistent with international standards regarding patient safety.

Law 24 also established theNational observatory of good practices on safety in healthcare at AGENAS, with the task of coordinating and promoting the implementation of the programs and the connection between the Regions and the various national actors involved (in addition to the Ministry, ISS, AIFA, AGENAS itself, Regions, Universities, professional associations, scientific societies, Citizens' Associations). The composition and functions of the Observatory have been regulated with the Ministerial Decree 29 September 2017.

It is the right of every citizen access pain management and palliative care,in order to protect the dignity and autonomy of the person as well as his health needs, avoiding suffering and pain. Citizens must be guaranteed an individual treatment program aimed at promoting quality of life at every stage of the disease, particularly in the terminal stage, through adequate health and social-welfare support, both for the sick person and the family (Law 15 March 2010 n. 38). 

It is the right of every citizen to express advance treatment provisions (DAT).With these provisions the citizen, of age and in full possession of his faculties, expresses his wishes on the "end of life" in the hypothesis in which the irreversible loss of the ability to understand and want occurs suddenly. In addition to the possibility of expressing these provisions, citizens have the right to identify a trusted person (trustee) who will take their place and represent them in relations with the doctor and health facilities (Law 22 December 2017, n. 219).

It is the right of every citizen to access the religious assistance service in the hospitalization facilities of the national health service. The competent ASL or the health management of the structure provide the Catholic religious assistance service, but upon request to the responsible body it is possible to activate the service also for other religious cults (Law 23 December 1978, n. 833 – Art.38).

It is every woman's right give birth anonymously,, maintaining maximum confidentiality and having the right to adequate and effective interventions from the moment he enters the hospital. The protection of anonymity is also guaranteed by the fact that the woman's name is not recorded in the birth certificate of the newborn. The law also protects the newborn, who remains in the hospital of birth so that the necessary assistance and legal protection is ensured (Decree of the President of the Republic 3 November 2000, n. 396, art. 30, paragraph 1).