PATIENT RESPONSIBILITIES

American Medical Association

1993, updated 1998, 2000 and 2001

The American Medical Association's (AMA) Patient Responsibilities draws upon the recognition, articulated in the preceding Fundamental Elements of the Patient-Physician Relationship, that successful medical care depends upon a collaborative effort between physicians and patients. Originally published in July 1993 as Report 52 in the AMA Code of Medical Ethics: Reports of the Council on Ethical and Judicial Affairs, Patient Responsibilities expands upon the Fundamental Elements document by specifying the responsibilities of patients for their own health care. It has been updated three times since its creation in 1993.

The background section of the original report states: "Like patients' rights, patients' responsibilities are derived from the principle of autonomy.... With that exercise of self-governance and free choicecomes a number of responsibilities." The list of those patient responsibilities follows.

1. Good communication is essential to a successful physician-patient relationship. To the extent possible, patients have a responsibility to be truthful and to express their concerns clearly to their physicians.
2. Patients have a responsibility to provide a complete medical history, to the extent possible, including information about past illnesses, medications, hospitalizations, family history of illness and other matters relating to present health.
3. Patients have a responsibility to request information or clarification about their health status or treatment when they do not fully understand what has been described.
4. Once patients and physicians agree upon the goals of therapy, patients have a responsibility to cooperate with the treatment plan and to keep their agreed-upon appointments. Compliance with physician instructions is often essential to public and individual safety. Patients also have a responsibility to disclose whether previously agreed upon treatments are being followed and to indicate when they would like to reconsider the treatment plan.
5. Patients generally have a responsibility to meet their financial obligations with regard to medical care or to discuss financial hardships with their physicians. Patients should be cognizant of the costs associated with using a limited resource like health care and try to use medical resources judiciously.
6. Patients should discuss end of life decisions with their physicians and make their wishes known. Such a discussion might also include writing an advance directive.
7. Patients should be committed to health maintenance through health-enhancing behavior. Illness can often be prevented by a healthy lifestyle, and patients must take personal responsibility when they are able to avert the development of disease.
8. Patients should also have an active interest in the effects of their conduct on others and refrain from behavior that unreasonably places the health of others at risk. Patients should inquire as to the means and likelihood of infectious disease transmission and act upon that information which can best prevent further transmission.
9. Participation in medical education is to the mutual benefit of patients and the health care system. Patients are encouraged to participate in medical education by accepting care, under appropriate supervision, from medical students, residents, and other trainees. Consistent with the process of informed consent, the patient or the patient's surrogate decision maker is always free to refuse care from any member of the health care team.
10. Patients should discuss organ donation with their physicians and, if donation is desired, make applicable provisions. Patients who are part of an organ allocation system and await needed transplant should not try to go outside of or manipulate the system. A fair system of allocation should be answered with public trust and an awareness of limited resources.
11. Patients should not initiate or participate in fraudulent health care and should report illegal or unethical behavior by providers to the appropriate medical societies, licensing boards, or law enforcement authorities.