Proposition 50K1642

Projet de loi relatif aux droits du patient.

General information ¶

Submitted by

Groen Open Vld Vooruit PS | SP Ecolo MR Verhofstadt Ⅰ

Submission date

Feb. 19, 2002

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

patient's rights

Voting ¶

Voted to adopt

Groen Ecolo PS | SP Open Vld MR

Voted to reject

FN

Abstained from voting

CD&V LE N-VA VB

Party dissidents ¶

• Ferdy Willems (N-VA) voted to adopt.
• Richard Fournaux (MR) abstained from voting.

Contact form ¶

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Discussion ¶

July 15, 2002 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, Mrs. Minister, colleagues, first of all, I would like to thank the services of the House for the work they have done during the discussion of this important bill. We must have determined that it was not always clear what amendment was being made. Thanks to the smooth reporting of the services, everything was always on its feet. We are very grateful to them for this.

In this explanation, I will limit myself to what was discussed in the general discussion. For the article-by-article discussion, I refer to the written report because all these points have been the subject of extensive discussion.

To date, there is no specific, separate law on the individual rights of the patient. This bill was initiated in the Government Agreement of 1999. Working groups were established with representatives of the Cabinet of the Minister and the Healthcare Board. This work resulted in a concept note. There followed hearings. They resulted in adjustments and adjustments. All this resulted in the present draft law.

I will summarize the individual patient’s rights: the right to quality services, the professional’s free choice, the right to information, the right to consent, the right to access the patient’s dossier, the right to protection of privacy and the right to lodge complaints.

The CD&V group has constantly urged to approach the problem from the concept of "medical care contract" that was developed in our bill, which, in our opinion, would provide a better definition and description of the scope of application. My group also pointed out the absence of a provision on the main liability of hospitals and called for a more comprehensive development of the right of complaint.

On behalf of the MR, Mr. Seghin argued that the law involves numerous risks such as the codification of rules in a domain where one cannot or should not think black and white, a principle that may interfere with the interests of the patient. At this moment there is a certain lack of transparency in the doctor-patient relationship. According to Mr. Seghin, the bill for conflicting confrontations between the two could worry. It is difficult and dangerous to subject medical operations to rules of civil law. He also noted that although the design is consistent with deontology, it transcends the reality of medical duty doctrine and common practice. He also regretted the lack of a regulation on medical liability.

Mrs. Gilkinet is happy with the design. According to her, the bill achieves the goal of simplicity and readability. In this way, it provides a guarantee of security. The patient relationship can be deepened.

Mrs Avontroodt also supports the objectives of the draft law. It points out, within the framework of the professional’s free choice, that the relationship between a patient and, for example, the supervisory physician is of a different order. She emphasizes that the design is not intended to reinforce a right to the best possible existing therapy for the benefit of the patient. The validation of the right of access should not impair the quality of the medical dossier, on the contrary.

Mr Mayeur stated that he is in favor of the granting of rights, but does not find the following elements in the text: access to care for all and protection of the medical practice. In the latter, he notes that the draft law is only relevant if it would be accompanied by a draft law to protect the professional. He also questioned the responsibility of hospitals. They also have to take a part of the responsibility.

Mr Vandeurzen concludes this by pointing out the importance of the legislation on liability. He regrets that the bill does not impose rights regarding the relationship between the patient and the care institution. Regarding the Ombudsman’s role, he considers that the fictitious separation between administrative tasks and individual medical operations is a downturn compared to the current situation. He further states that the law on the rights of patients should come into force before the law on euthanasia and points out that the arbitrary decision has different formal requirements and other effects in both laws.

Mrs Avontroodt considers that the provisions on the arbitration are fundamental and that they may result in significant legal consequences.

Mr Valkeniers believes that the patient’s request should not always be fully taken into account. In doing so, it is necessary to verify in what state of mind the patient wrote the decision of will. He also believes that both the law and the medical deontology require a doctor to treat his patient, regardless of the content of the will.

Mr Vandeurzen is of the opinion that the representation of will-being patients is improved by this bill.

Finally, Mrs Avontroodt points out the limitations. It concerns representation regarding decisions on medical operations, but it is not excluded that the arrangement will also be accepted with respect to institutions, even before the conclusion of the cooperation agreements.

Mr. Speaker, Mrs. Minister, colleagues, briefly summarized that the accents that were especially discussed in the general discussion came from each group. They, of course, found their reflection in the article-by-article discussion, in which some articles were even amended. To this I will limit the report of our work. I also refer to the written report.

Our own approach is the following. I think everyone will agree with me when I say that this bill has actually experienced a very long maturing process. In the previous legislature, several attempts have been made to submit and discuss legislative proposals. It is also clear that this bill relies on a number of elements from those bills and also from the previously submitted bill of the then Minister Marcel Colla. In that sense, we can say that this is a complete draft with clearly structured and elaborate provisions.

This does not include the fact that, in our view, there are, of course, still a number of difficulties, including the lack of a clearer regulation on central liability. The explanation states that the law must be simple and clear. Indeed, the provisions show that the Minister sought to avoid an inflation of duties and that it did not intend to provide for all derogations from the rule.

The disadvantage of this concisity is that the reader for a complete and more correct interpretation often needs to consult the Memory of Explanation. In addition, we sometimes find additional provisions in the explanation that are no longer included in the legislation itself. One has, of course, made a weighing and one may wonder whether completeness should go for clarity. Therefore, it seemed appropriate to supplement and clarify the legislation in a number of areas. So that has happened.

I give two examples. The provision of the right to free choice of the professional provides only for a limitation under the law The explanation speaks, however, of an additional limitation that was indeed mentioned in the original text, but is no longer explicitly included. This refers to the possible restriction in the freedom of choice in the case of health care provision in a healthcare institution, a restriction due to the organization and functioning of the healthcare institution concerned. Such restriction, in our opinion, does not fall under the denominator of restriction under the law. Furthermore, the same reasoning applies not only within a healthcare provider, but also in the control medicine and the audit assignment of advising physicians.

I give another example. Organ removal, as well as medical-scientific research, is excluded from the scope of the law. To understand this, however, one must read the explanation. These exclusions are by no means self-evident to us and should be the subject of a more thorough debate. If one would agree, it would have to be explicitly included in the law.

During the article-by-article discussion, we paid a lot of attention to the handling of complaints. One of the objectives of the patient rights legislation is to ensure that patients know how to handle their complaints. In order to address this, Article 11 establishes the function of the Ombudsman. It is created, but too little is developed. The King shall be given a list of powers concerning the conditions to be met by the Ombudsman. The principles of independence, professional secrecy, expertise, legal protection and the regulation of organization, operation, financing, procedural regulation and territory description shall be determined in a royal decree. This article should also be read together with Article 17. The Ombudsman’s function should be seen as a standard of recognition for hospitals. However, the State Council points out that the federal legislator is not competent in terms of recognition standards and therefore cannot impose such an obligation. The communities are competent in the field of hospital care for, among other things, recognition. The question then arises how the creation will be forced. The Minister says that this is not a problem as long as the Ombudsman’s function is limited to complaints about the patient-professional relationship.

Article 11 is inadequate because complaints related to unfriendly accommodation, waiting lists, cannot or should not be handled. In addition, the article does not provide clarity as to whether or not the decision of the Ombudsman’s office is binding. The Memory of Explanation stipulates that the patient is given the opportunity, that his complaint is received and that therefore mediation is taken. The State Council therefore recommended that this be clearly included in the text of the draft. What about complaints concerning outpatient practitioners? This would also include Ombudsman functions, but those are not included in the draft. The Federal Commission, which is established by Article 16, is provided for a Ombudsman function only in the absence of the Federal Commission.

It could serve. Currently, the treatment of such complaints is usually done through hospital funds. You may ask yourself whether this is the right place to address these complaints. The committee should act as a point of contact for Ombudsman functions. At the same time, it will also be able to handle complaints relating to the functioning of the Ombudsman’s functions without, however, being an appeal body for individual complaints submitted to the Ombudsman’s function of a hospital.

The Ombudsman’s function, as described in Article 16, will be a kind of safety net. However, there is no regulation on who should take the initiative to establish regional ombudsman functions, what conditions they must meet and how they should be financed. Furthermore, the ratio between the ombudsman functions in hospitals and the committee is not regulated in Article 16. The problem of competence also causes the federal regulated ombudsman’s function, for example, to be unable to express opinions on complaints relating to the administrative organization of the hospital, as we have already cited. How will this Ombudsman Committee be composed? A role will be played by representatives from the health funds. Private insurance companies are no longer mentioned here.

Finally, one may wonder how this Ombudsman’s function will relate to the body that will be created within the framework of objective responsibility to deal with complaints about medical accidents. It is also not regulated who can express the complaint, whether the patient can be assisted by, for example, a trust person and whether the file at the Ombudsman’s function with the patient’s consent will be able to be accessed by third parties.

In short, since the draft remains so vague about the Ombudsman functions referred to in Article 11, there is concern that it will take a long time before these Ombudsman functions will actually exist. The effect must still be done through the announced royal decree. Thus, through the law, a federal ombudsman’s service will be established that will handle complaints from patients in the absence of competent ombudsman functions. The future will have to show it, but if this federal ombudsman service arrives earlier than the ombudsman functions referred to in Article 11, this is not a good thing. A federal ombudsman service cannot, in the absence of understanding of local or regional problems, intervene equally efficiently in the mediation of complaints. The centralization of patient complaints is contrary to the intention of stimulating communication within the relationship of patient practitioner. The alleged overload of the Federal Ombudsman Service will only strengthen the bureaucratic handling.

The complaint handling process developed in our proposal creates more clarity on a number of aspects. We assume that in every hospital a Ombudsman should be appointed. The Ombudsman’s tasks include, among other things, informing patients about their rights, recording complaints about acts in or the operation of the hospital, mediating complaints and, if this fails, informing the patient about the available means and about the bodies to which he can address his complaints. In our proposal, the administrator provides the Ombudsman with the necessary resources to carry out his duties. It brings the existence of the Ombudsman to the attention of the patient. The Ombudsman is also appointed by the administrator after the advice of the Medical Board. Any interested party may submit a complaint to an Ombudsman within two years after the patient has been discharged from the hospital. With the written consent of the patient, he has access to the medical record in the presence of, for example, a chief physician. We do not find these elements in the description of the Ombudsman’s function as we would like to see it happen. I would then like to draw attention to the determination of the scope of the law. The scope of the design is wide. Some say it is too wide. Both therapeutic and administrative relationships between physician and patient can be included in the scope of the design.

However, the scope of application is also limited. The institutional aspect cannot be recovered. This gap could have been filled by accepting the concept of "medical care contract". We defended the medical care contract, which is mentioned in our bill, during the discussion. In the case of a medical care contract, an agreement is established: a natural person or a legal person, the healthcare provider, undertakes to perform medical acts in relation to the care applicant. These acts are then all diagnostic, preventive and curative acts, which are also mentioned in Articles 2 and 3 of Royal Decree No. 78 of 10 November 1967. These are not assessments of the state of health, which are commissioned by insurance institutions or the Occupational Medical Inspection.

However, in the explanation two exceptions are mentioned that we would rather have been included in the text itself. We have submitted an amendment on this. Unfortunately it was not accepted. I give the example of removing an organ from a living donor and a fortiori from a deceased. The argument is double. On the one hand, there is no legal relationship between a doctor and a person receiving health care; on the other hand, there is already a specific legislation for that situation. We believe that during the procedure where the organ is removed, there is a concern for the health of the donor.

We also do not fully support the second argument. There are specific legislation, but it contains only limited provisions on the right to consent and information. It cannot be argued that the organ donation law provides for a comprehensive regulation of the donor’s rights. Furthermore, the argument of the already existing legislation can also be used for other sectors, such as for the control medicine practiced by the advisory physician of the hospital fund. The National Council of the Order of Physicians also finds this exception strange.

To the extent that medical-scientific research, the second exception, is accompanied by care for the health of the subject, the law, as regards the aspect of care, is applicable. We were in favour of a legal regulation of the rights of the subject. We remain in favour of this. The European Directive of 4 April 2001 must be transposed into Belgian law by 1 May 2003. Although the clinical trial requires a specific arrangement, the general rights of patients must also be respected in this area.

Our proposal was to limit the scope to therapeutic relationships. That seems more appropriate. The administrative relations arising from control medicine, examinations by advisory physicians and judicial expertise are therefore excluded.

In addition, however, the scope of application should be expanded with medical experiments. For specific relationships between patient and practitioner, for example in medical experiments, the King should be empowered to provide for derogations. It should be able to provide for exceptions to the application of certain articles and, where necessary, to impose stricter conditions.

A separate regime for medical experiments, by the way, is contrary to the purpose of the draft, in particular in the legislation to counter the fragmentation in the field of patient rights. Their

Until then, a number of approaches from our group, which, in a way of speaking, are a complement to what we have already put forward in the general discussion and in the committee. We give this bill a good heart and we have ourselves been working on it for a long time. However, we have had to conclude that, on two points, the scheme on the joint liability of hospitals is not sufficiently clear and shows a number of weaknesses. Mr Vandeurzen will undoubtedly continue to address this later. This does not improve the position of the patient. Sometimes it even weakens. We regret that this has not been clearly resolved through an amendment in the committee. Their

Furthermore, we regret that the Ombudsman’s function has yet to be fully developed through the announced Royal Decree. For all these reasons, I feel the personal regret that we cannot wish you a full compliment with a good piece of work. We have waited for a long time. We will, however, have to abstain from voting because we would much rather have seen these two very special points better settled. So far, my report and immediately also the clarification of the attitude of our group.

Mr. Speaker, Mrs. Minister, dear colleagues, the text of the law on the rights of the patient was expected, in particular by the patients themselves and the associations of patients. On principle, we can only approve of the fact of affirming in law the rights of individuals in the care system and thus clarifying what had so far been dealt with only in the code of ethics or by the case-law.

But what is also expected, and ⁇ especially patients, is that the legislator comes to help those who are victims of medical accidents, for which the text that is submitted to our vote today does not say a word.

The complexity of the procedures, the lack of compensation for the accident without fault in civil law create uncertainty, not only for the victims, but also for health professionals. by

This aspect of accountability is lacking and it is really very regrettable, because without this device, the law will not be able to reassure victims of medical accidents and health professionals, concerned about the judicialization of their activity. You yourself, Madam the Minister, and the Prime Minister are committed here even to the fact that the bill on accountability will be deposited and discussed in parliament next autumn. by

I don’t think this is enough to reassure both patients and providers. This destabilization in the medical sector and in the professional practitioners in particular does not seem to be desirable, although they have been subjected, for several months, to constant pressures related to the management of the healthcare budget. by

If the vote and the entry into force of the legal provisions relating to accountability should actually be a reality within a few months, it would be better to postpone the entry into force of the legislation relating to patient rights to that date.

The Government will then be able to organize the awareness and information campaign necessary for the proper understanding of these two laws by avoiding the errors of understanding that will occur in patients on the occasion of the entry into force of this law, of which it will be explained that it does not regulate medical liability. The CDH group therefore submitted an amendment aimed at postponing the entry into force of the provisions of this law to the time of entry into force of the provisions of the law on medical liability.

Returning to the content of the text of the law submitted to us, I can repeat that we share the general philosophy of the bill, but the development of a regulation concerning the rights of the patient can only be considered in an perspective of balancing the rights and duties of each at the heart of a relationship based essentially on trust. That’s why on a number of principles defined in the government bill, we can’t sign our agreement because we think they risk undermining the very foundation of the patient/care provider relationship.

With regard to the scope of the law, we continue to ask ourselves questions about the scope of this scope. by

Applying to any relationship between patient and care provider, at the request of the patient or not, the bill covers all medical relationships of whatever nature. by

The bill provides for the same legal protection for the patient without distinguishing between situations in which he is in a therapeutic relationship with the caregiver and situations in which patients and caregivers are in an administrative relationship. However, this equal treatment of both types of legal relationships is not desirable and is hardly achievable.

Thus, the free choice of the patient and the right to consent go against the very logic of control medicine. In addition, the protection of the patient, in the context of relations of administrative law with health professionals, is governed by other legislation such as the Charter of the Social Insured, the Act on Health Insurance and the Act on the Federal Ombudsman.

More specifically with regard to control medicine, ⁇ by mutual counseling doctors, the following difficulties may arise.

The protection of the social insured in the context of its relations with the counseling physician is currently ensured by the Charter of the social insured. On the basis of this Charter, the counseling physician has, for example, the duty to inform the social insured about the decisions he makes. This is the information necessary for the interested party to ensure the recognition or maintenance of their rights. The right of access to the medical record is, on the other hand, regulated within the framework of the Law on Privacy and the Law on the Cross-Banque. by

In the context of control medicine, there is in principle no free choice as to the provider. Does the free choice provided under this law mean that a member will be able to choose which control doctor will intervene in the control procedure? In the affirmative, this will pose enormous organizational problems and weaken the control procedure very sharply because this free choice is by essence contradictory to the control function.

When it comes to access to the medical record, it sometimes contains more information than is necessary for administrative decisions. What information should be provided by the consulting doctor? Furthermore, access to the personal data of the medical record is currently regulated by the law on the bank-cross-cross.

How will he handle the procedure for complaints submitted to the Patient Rights Mediation function and those submitted to the Federal Ombudsman? Complaints relating to decisions or behaviors of insurance agencies fall within the competence of the Federal Ombudsman. Will two types of procedures be allowed?

Here too, we again submitted an amendment aimed at correcting Article 3.

With regard to anticipated wishes, we also make reservations with regard to the provision of Article 8, which stipulates that if the patient has notified in writing at the time when he was still able to exercise his rights that he refuses a particular treatment, that refusal must be respected.

We really think this provision is dangerous and too restrictive. The situation between the moment when one manifests one’s will and the moment when one is in a condition of receiving care can be completely incomparable and this for several reasons, for example: - because the medical science has evolved, that the treatments designated at the moment of the manifestation of the will are no longer comparable to those practiced at the moment when the patient needs them; - because the family situation has evolved.

Furthermore, should the autonomy of the person not be confronted with the right of his or her relatives to be able to participate in this decision? We recommend, and have submitted an amendment in this regard, that in the case of the unconscious patient, the guidelines previously written by the patient should be considered as being taken into account by the practitioner in the decision-making process.

With regard to access to the medical record, we believe that the risks of deviations related to direct access to the medical record are important: - the risk of seeing the creation of a double file by the practitioner who will only transmit the "corrected" file to the patient, for fear of seeing the patient being alarmed by the medical information that he does not control; - difficulty realizing the distinction between the personal annotations of the practitioner and the content of the medical record; - the risk of seeing medical information immediately transmitted to the patient via direct access to his file, information misunderstood or misassembled by the patient. Since the patient cannot be "left alone" in front of a medical record, it is important to arrange during the consultation of the record a meeting between the patient and a trusted practitioner in order to deal with the anxiety aroused by information, this management of the anxiety being the first duty of the doctor. In addition to a complaint made against a provider, our amendment provides for indirect access to the medical record through a trusted person who will be a doctor mandated by the patient. This indirect access solution will guarantee the uniqueness of the file and prevent the removal of certain information such as personal notes from the file. This indirect access option should also allow to re-value the role of the family doctor who would be the ideal representative for this consultation except in the event that his own dossier is to be consulted. However, in the context of a complaint, the dossier must of course be communicated to the patient in its entirety.

In conclusion, although we find it legitimate to wish to settle patient rights in positive law, we fear that the application of the text presented to us today will introduce more complexity in the medical relations between the providers of care and the patient. The starting point of this project is based on the abstract and unlikely hypothesis of the infallibility of medicine and care services. But medicine, if it is to aim for maximum quality and effectiveness, remains also a matter of human beings with all the uncertainties and developments that this may imply. By trying to lock the patient/care provider relationship into excessive formalism and administration, by transferring on the providers the burden of proof that they have effectively exercised their art in respect of the rights of the patient, one risks leading to the opposite result of the expected effect. By pushing service providers to practice defensive medicine, it is ultimately the patient who will be hurt and for you as for me, this is not the aim sought.

Ms. Avontroodt, your committee has devoted 11 meetings to this bill.

Mr. Speaker, Mrs. Minister, colleagues, this is the plenary session of a bill to which many committee meetings were dedicated. A number of clarifications were given by both the members and the minister.

The content of this bill has raised a number of questions, mainly due to a certain emotion. After all, we had a little fear for the legalization of the relationship of trust between doctor and patient. Apart from this, we have always said that this corresponds to a contemporary, social evolution. Patients should be treated on an equal basis and the relationship between physician and patient should be based on equivalence. We can fully support this philosophy.

This is a bill that only regulates the rights of the patient. In everyday practice, however, one can also ask questions about the patient’s duties. Let me take as an example the information obligation. Before speaking, I reviewed a number of articles related to the right to information. However, it cannot be overlooked that there is also a certain information obligation.

I think of a patient’s dossier. The patient has the right to his file and he also has the right to clarify certain elements of his file so that he can gain a "second opinion". In this way, the next treating doctor may not have the complete information. These are only a few examples. However, I am convinced that this will be of extraordinary importance in the further examination and communication of this law. Patients and doctors should be informed on a very balanced basis.

In addition to that fear of legalization, our party was initially rather in favour of a charter of patient rights that would also have met with contemporary evolution. After all, there is a social evolution of equivalence in the treatment of patients which, however, would not lead to that jurisprudence. Our group will support this bill in its current form. This is a law that creates enforceable rights for patients.

Definitely a positive point in this law is that the various regulations have now been brought together in one legislative text. This will benefit the clarity, the viability and the accessibility of the various rights of the patient. We were not undividedly happy with the design and I illustrate that with the listing of some remaining troubles.

The first struggle for my group, as well as for our sister party and for the PS, is a good arrangement for liability insurance. It was announced that this would be treated simultaneously. You know that this was a breakthrough for us, and we are therefore waiting for a statement from the government or the Prime Minister to clarify some basic principles. This agreement has been made and we are waiting for this statement. This is not just any played hardness or any expressed concern from the professional practitioners, but ⁇ and above all inspired from the care to the quality of the care provision for the patient. Otherwise, you risk getting both undertreatment and overtreatment of certain patients at certain times. Both evolutions are not the object of this law or should not be the consequence of it, but when one questions the field something, one finds that this concern is alive. This cannot be the purpose of a law that wants to put the patient at the center. Their

Also legally, we think there are a number of difficulties. There is still a broad interpretation possibility in the hands of the professional practitioner. He must assess whether the trust person — the spouse, the cohabiting partner, the partner, and so on — really represents the patient’s interests. Fortunately, if there are two different opinions, the doctor can still act independently in the patient’s interest. This is a happy passage, because otherwise I find it a very large discretionary power for the professional practitioner if he should judge whether that representative really defends the interests of the patient. This is even more true since the representative receives all rights when the patient can no longer fulfill his rights. They have the same rights as the patient. I also think of the copy of the file. It is unimaginable that here the privacy of the deceased or of the unconscious patient is compromised under certain circumstances. I assume that in these cases the interest of the patient and the trust relationship doctor-patient can still provide the common sense to continue to act in the interest of the patient.

This creates a number of rights that may result in claims for damages.

We advocate a minimum of formalism. Therefore, we have questions about the standard forms that are threatened to arise. The right to consent must be included in the file. The trust person must be indicated in writing. If the latter subsequently no longer wishes to be a trust person, this must also be recorded in writing. One must provide information about all possible and impossible complications, and so on. All standard forms are required. However, it is this government that has pledged for administrative simplification. I now fear that the medical record, which was already very extensive for some patients or in some hospitals, will become even more extensive. The doctor, the nurse or the kinesiologist must be able to provide telkenmale the written proof that the patient has actually given his consent to be treated.

This is stated in the draft. I know that this was not your intention, nor that of Dr. Nys, who contributed to the text. But what is written, it is written. In the event of conflict or claims for damages — especially if there is no trust relationship at hospital admission — it is in my opinion unimaginable that healthcare providers will now better cover themselves to escape their responsibility by presenting the appropriate documents, so that they can be charged with nothing legally. This is not new, Mrs. Minister, we have also openly communicated this concern in the committee. In response to a number of questions, you answered that this was not the intention.

However, there are still questions about those situations where the patient has drawn up a document stipulating that he refuses a particular treatment. Under what circumstances can the doctor refrain from performing a particular act? After all, it is clear in the draft that "this does not discharge the doctor from providing quality services". Faced with a patient’s refusal, he must ensure that the latter can go to another healthcare provider, I suppose. However, how far does the responsibility of the professional concerned extend? This point will still need to be clearly expressed.

Then there is another very positive point that hopefully will lead to what you are aiming for, in particular that in the long run there would be a preventive effect from this law on the rights of patients. We support the Ombudsman function that you will launch in every hospital. I only hope that the independence of the Ombudsman’s function can be guaranteed and that there can be no so-called conflict of interest between the Ombudsman’s Office, the healthcare institution and the doctors. These are issues that we have discussed extensively in the committee. I repeat the positive effect on patients with the note that no false expectations should be created again. The Ombudsman’s function is established only to mediate in those rights and to protect those rights set out in the draft and should not be used to mediate terms such as claims for damages or other.

The big point that was extensively discussed in the committee is the other legislation, and I think here in the first place of what is applicable in insurance medicine. Other areas such as occupational medicine and preventive medicine are also widely covered here. The right to free choice cannot be guaranteed. In this regard, you yourself stated — which is also stated in the draft — that in the existence of another arrangement, it will take precedence. The same applies to euthanasia and the abortion law. These are laws that belong to the so-called lex specialis while here it is the lex generalis. These things remain outside. In fact, the legal basis is very clearly regulated in the specially designed laws and is not compromised here. The right to consent, the right to complete information and the right to free consent both refusal...

If you allow me, Mr. Speaker, I would like to ask Mrs. Speaker a relevant question. I would almost have to say: Do you no longer support today the thesis that your own party chairman, being Karel De Gucht, has welcomed note bene very recently in the weekend by saying that the entire problem of euthanasia should be fully incorporated into the bill concerning the rights of patients. You say here very clearly that there is a separate, specific legislation, as also Ms. Minister has correctly answered in the Committee on Public Health. Like many other colleagues, I have only taken note of what your party chairman has said this weekend. Therefore, I clearly ask you whether, with your very clear statement on this subject, you no longer endorse the thesis of your party chairman of the past weekend?

I only repeat what I said recently. This shall be without prejudice to the specific legislation made for this purpose in this Chamber. There is a law on euthanasia and there is a law on abortion. If this would be part of the general regulation, the specific legislation would not be necessary.

However, I agree — this can be read in the draft — that the person concerned or the patient has the right at all times to be involved in the decision on medical treatment at the end of life. This is clearly stated in the design. There is a right to information, there is a right to consent and there is a right to refusal. These matters clearly imply the right to be involved in decisions about medical action at the end of life.

This includes euthanasia.

There is euthanasia, but 05.07 for me this does not need to be a separate chapter in this law.

Mr. Speaker, I did not intend to speak at all, but colleague Valkeniers says that euthanasia belongs to the medical acts at the end of life. I thought we had a consensus — in dealing with the draft on euthanasia, with the specialists, recently in a question I asked the minister — that euthanasia does not belong to the medical acts. If it is clear to Mr Valkeniers that the draft law on the rights of patients also covers the euthanasia problem, then we are in a new discussion. I had understood from our conversation in the committee that euthanasia does not fall within the medical operations and therapeutic freedom.

Mr. President, Mr. Vandeurzen, the Order of Physicians of Flemish-Brabant once called me because I had declared on television that I had carried out euthanasia with one of my best friends. When I had presented the case to the Order of Physicians — I did not make a media view of it, as some might do — I was told that I had acted entirely deontologically according to the doctrine of duty, for it is the duty of the doctor to help the patient in the utmost possible way and to let him die in the most human way. That is our duty. It belongs to the duty teaching. Much of what is stated in this draft also belongs to the doctrine of duties, but I will submit my opinion on this later. I think you are mistaken. If even in the doctrine of duty it is stated that one must let the patient die in a dignified way, it also includes euthanasia.

Mr. Speaker, for the debate and for the subsequent interpretation of the legislative initiative it must be very clear — I hope the speaker will confirm that — that euthanasia, as it is now legally regulated, does not fall within the rights of patients or the definition of health care — as given in the draft law — and that it is also not a medical act. I do not understand why we should discuss this, since everyone has agreed on it so far. The Minister also made such statements. I am surprised that the debate is evolving in this direction, because that brings a whole new dimension to the discussion. I didn’t have the impression that they went so far during the discussion in the committee.

Mr. Speaker, colleagues, I can only confirm that the right to information, the right to free consent, the right to refuse and the right to be involved in the decisions taken at the end of life are fully incorporated in the legislative text. This bill does not regulate the euthanasia law.

I think this is clear. For euthanasia there is a lex specialis and this design is a lex generalis. That is clear, right?

I am very enthusiastic about the lex specialis and lex generalis. I’ve learned that once at the university, but it will very much envy me to know what the legal basis is to simply declare that it is always so.

Mr. Speaker, I do not look at you again, because I understand very well that you also assume that, as it is also included in the report, but the principle that a special law goes before a general law is just as true as the fact that a newer law has priority over an earlier law. That is your position, and the Minister has also stated that in the committee. Before the discussion, however, it would have been much clearer and simpler if it had been written: "Without prejudice to other specific provisions is...". In my opinion, this problem could have been better addressed legislatively.

I look again at the hidden smile of the Chairman of the Justice Committee.

The Attorney General will be involved here.

Mr. Speaker, I point out — and this discussion we have already conducted extensively in the committee — to other legislation, for example on the right to refuse vaccination in a situation of occupational risk. We have also cited that example and the Minister has responded that it will set up a number of working groups in this regard, which will create clarity.

This, of course, results in two different legislations: the right to refuse vaccination under this law and the obligation to be vaccinated under another law. Then it will be important – and the Minister has committed itself – that she will set up a number of working groups in this regard, which would address those conflicts of interest. It is obvious that they will be there, including in the field of insurance. In all honesty, I believe that the interests of the patient should always come first. In the example of vaccination, it is not so clear whose interests will prevail or which legislation will prevail. This will still have to be determined. Let us say that this is the challenge that this broad legislation has brought with it.

I would like to comment on the right to quality services. There is the right to refuse and the right to complete. After all, one remains obliged to provide a quality service to the patient, even if he refuses. It is obvious that this saves the other necessary care, although this may not always be guaranteed, for example in the outpatient sector. If the patient refuses to undergo a particular treatment, a doctor may not feel obliged or remain obliged to entrust the person concerned to another colleague for a quality service.

In my view, many matters still need to be clarified, although this paragraph — and that was discussed in the committee — could potentially be cost-inducing.

With regard to the right to information, our group is explicitly asking the party to include follow-up care. The right to information must be reciprocal. The patient should also follow his therapy faithfully, as it is prescribed. In the end, there is a mutual information obligation.

The VLD is very pleased that "patient collaboration" was added because this makes the relationship between the practitioner and the patient effectively equivalent. Hospitals are increasingly confronted with patients who have already undergone a lot of examinations but do not inform the new treating physician about this, ignoring potential risks or performing certain studies in an inadequate way. Such situations should be avoided.

The committee examined in detail the risks associated with the right to copy the file. The motivation obligation for the professional practitioner is broadly fulfilled. It will not always be obvious for the professional to justify why he refuses a copy to certain persons or trusted persons. Their

Mr. Speaker, colleagues, the VLD will approve this draft because it responds to the social evolution in question.

Mr. Speaker, I waited until Mrs. Avontroodt had arrived at the end of her speech to know whether she remains with her position linking the entry into force of this law to the liability insurance for healthcare providers. Until now, I have not heard the great statement you referred to and withdrew the amendment.

That can still come.

The final vote is in sight, Mr. Speaker.

This statement may come before the final vote.

Mr. Speaker, I ask Mrs. Avontroodt if she is aware of such a statement.

and no. Mr. Brouns, I remain with my position. However, I have full confidence that the government will make a satisfactory statement on this subject.

Mrs. Avontroodt, do you agree that the declaration must be made before the final vote?

Indeed indeed .

It is good to hear this again from your mouth.

Mr. Brouns, I am a man of trust and trust giving. Giving trust first and then gaining trust is the motto. I am one of those who give trust first.

Colleagues, I repeat that the VLD will approve this bill on the condition that — notice Mr Brouns, now follows the statement — the government works on a good regulation of liability. If we do not want to put the good health care that characterizes our country and which is based on the trust relationship caregiver-patient, and if we want to ensure that in the long run we should not have any fear, not only for jurisprudence but also not for the patient, then this responsibility is inevitable and absolutely necessary. The past was characterized by the paternalist relationship between doctor and patient. This situation is obsolete. We live in a different society where equality has its rights. However, we should not throw away the child with the bath water. The trust of a therapeutic relationship should not come on the slope. The patient should not be afraid of his doctor, but the doctor should ⁇ not be afraid of his patients.

Mr. Speaker, Mrs. Minister, dear colleagues, Belgium did not yet have a general law guaranteeing the rights of patients. This will be done now and we are obviously satisfied with it. The absence of legal protection, in some cases, the lack of information and transparency, sometimes the violation of basic rights of an individual are essential elements that must now be framed and regulated in a law that must protect the rights of the patient. The government agreement is therefore correctly translated here.

We have done this work during long sessions of the Health Committee, but also with hearings, on which I will return at the end of the speech. These hearings showed what the project contained and did not contain. Of course, we will have to take part in things.

What the project contains and that suits us, of course, is a transformation of the essential relationship between the patient and the caregiver, between the patient and the doctor. Patients, sick people are in a delicate situation and in a position of dependence on the providers of care. The feeling of insecurity or even the fear of the future that goes hand in hand with this situation is, in fact, the result of a lack of exchange of knowledge between the patient and the caregiver. Furthermore, the more advanced the medical science, already high-tech, develops, the greater the gap continues to grow between the patient and his doctor. One of the essential tasks that the democratic state must guarantee is to provide those who find themselves in such situations of vulnerability and dependence with the necessary safeguards, rights and legal certainty. by

This is important because of the sociological transformation of the population. Citizens are now better educated and have access to more information. Therefore, the healthcare provider can no longer have a paternalistic attitude towards the patient who knows much more than before. But in this bulk of information that circulates without always being correct, it is of good tone, of good use and even indispensable that the doctor can properly enlighten the patient in the midst of this bulk of information that concerns him directly or indirectly and that he discovers through the media of all kinds.

The creation of a legal framework explaining the rights of patients is therefore an obvious and universal goal. This is an important new right. Only in this way will the patient be able to fully participate in the healing process or medical follow-up. In other words, patients should be the central hub of any well-designed health policy.

What advantages does the law offer compared to the current situation? More transparency and simplicity through a specific law; a text of law that allows to consolidate the relationship of trust between the patient and the professional practitioner, with mutual rights and duties; the right to consult the patient; the representation of the patient in case of difficulties.

What are the individual rights enshrined in the bill? The right to quality services; the right to the free choice of the provider of care; the right to information on the state of health; the right to informed consent; the right to privacy; the right to mediation in complaints; the right to lodge a complaint with the competent mediation function, in particular in hospitals.

I would like to return to a few articles of this bill that I think require, on my part and for the PS group, clarifications. We want to mark our intentions and our interpretation of these different articles.

First of all, Article 3. During the review of this article, the role of the doctor-controller has been debated.

by Mr. Paque has spoken on this point recently. It is true that here, things will need to be clarified. No one has the freedom to choose their doctor. The law does not guarantee this. But what it guarantees compared to the doctor-controller is access to information. So the whole law does not apply, but part of the law will apply well to the relationship between the patient and the doctor-control of the insurance agencies or institutions or the INAMI. In fact, it is necessary to exclude, in part, doctors-control from the application of this law. This practice is governed by a royal decree. It is this royal decree that naturally prevails with regard to this practice, in particular the absence of free choice. But information, to take this example, is a guaranteed right, including with respect to the doctor-control through this bill.

Article 7 is, in essence, somewhat the basis of the information that is due to the patient, with Article 4 which insists on the contribution that the patient must make to the relationship with the doctor and for his therapeutic treatment. This is where the essential information is found. It is also stated in this article 7 that if the patient so wishes, another person, a trusted person may have access to this information. I would like to emphasize the both extraordinary and very positive nature of this provision but which may also eventually be delicate. by

This is extraordinary, it is indispensable. It is known, in many hospitals or doctor's offices, that sometimes it is necessary to go through a translator to explain the situation of a patient, when it comes to foreign patients, or by a parent to better explain the difficulty in which a patient is. It is not necessary, in view of what we have added to Article 9, that the information that would thus be given to the trusted person may be used for purposes other than those of informing the person as best as possible about his or her health status. Confidentiality, the fact that such information may not be disseminated elsewhere or to other persons than to the person directly concerned – which is also found in Article 9 – must also apply to Article 7 and to the trusted person who is designated to receive the information.

In Article 8, an important element was inserted, that of the financial repercussions of an intervention. In the absence of guaranteeing in this bill the accessibility of care, I will return to it, we guarantee at least the information in particular on the financial repercussions of an intervention. For example, the financial repercussions that are not only the cost of the operation but that can also be fees, moderator tickets, supplements requested from patients; these are the costs of the operation but possibly also the consequences induced by the operation if other medical interventions are needed and if a care follow-up should be made to that intervention. This is an important element that has been mentioned in Article 8.

However, I would like to raise not a doubt, we will join the project, but I would like to put tags in relation to what is contained in Article 8. Refusal of consent is an essential, indispensable right, it is the individual right that must prevail. It is a right that prevails in other laws of which we have talked about recently and which is also well framed in these two other laws, I speak of the law on abortion and the law on euthanasia. But it would nevertheless not be necessary that through this refusal of consent granted to the patient, and which is indispensable, one is in a situation where the doctor can be put at risk in the event of action. It should not be that in the case of an emergency, if there is doubt, the doubt cannot benefit the doctor. The doubt must benefit the doctor if he decides to intervene in particular in emergency cases or in other cases, I quote the case of emergencies because it is flagrant. With regard to the choice to treat the person, the value that must prevail when there is confusion, when there is doubt or when one does not know, it is this provision that must prevail, in particular with regard to the refusal of consent. A doctor should not be subject to the application of Article 422bis of the Criminal Code, which provides for sanctions in case of non-assistance to persons in danger. The medical actor, the doctor, must be protected against this possibility. A parent, for example, should not have the opportunity to prosecute a doctor who would have refrained from intervening because consent or absence of consent is not fully proven. Furthermore, it would not be necessary for a doctor to be prosecuted because he intervened while there was doubt. by

If this article is not sufficiently clear on this subject, there is therefore a risk of creating a situation of distrust while this bill in reality aims to establish a balanced patient-doctor relationship, based on trust, with the patient’s contribution to the therapeutic that must be granted to him. Therefore, labels must be placed clearly. Some examples were given in the report. I assume, Mr. Minister, that you will return to this during your speech. I repeat that the intention of the legislator is not to create confusion in the relationship between the doctor and the patient. On the contrary, he wants to strengthen confidence.

Now on to Article 9. Patient data must of course and scrupulously remain personal and confidential. Therefore, it should not be that, by their dissemination, these data can be used by an employer or an insurer. This risk is obviously impossible due to Article 9. In fact, we have added the words "this information is strictly personal and confidential" to clarify that no other person may use this information for other purposes. I think about employers and insurance companies.

In Article 10, we have introduced the “right to privacy”. This is an important notion. Some institutions still tend to regard the patient as an object of care. Our wish is that the patient is subject to care and that he participates in it. This right to privacy is fundamental. by

Finally, I come to Article 17. We have introduced a new article in the law on hospitals. It aims to involve the hospital in guaranteeing and organising these rights. This element is also important. by

The information must therefore be given to the patient by the institution itself, where possible, even if this should involve additional administrative work. This is a way to better ensure harmonious information for the patient, but also to relieve the practitioner. This article clearly specifies that it is the practitioner who is in contract with the institution and not the practitioner exercising his activity there on a private basis, the latter being then governed by other rules.

It is also important, Mrs. Minister, that in the context of the information campaign on this bill, you think of the institutions in such a way as to properly explain to them what they can or should do, in particular with regard to the display of tariffs. This task can be carried out by the administration of the institution rather than by the doctor. This also seems to be an essential element. The questions raised by the various developments lead to a reconsideration of the status of the patient in view, on the one hand, of the mutations that characterize the therapeutic relationship and, on the other hand, of the gaps in the legal framework existing so far. by

Although the doctor has long accumulated an authority of competence and morality, one witnesses — and it is well legitimate — a claim of equality of partners within the therapeutic relationship. It must find its point of balance in a harmonious complementarity between the respect for the right to information and to the understanding of his illness or state of health and the therapeutic freedom of the provider. This balance is essential. A therapeutic relationship based on a partnership model, however, requires more than a consent to the doctor’s decision; for example, it is for the patient to engage with full knowledge of the cause and to collaborate in the treatment. by

“This bill is not intended to threaten healthcare professionals or institutions, much less to consider their relations with patients in a purely legal perspective or to create disputes.” I would like to follow you on this point. I add that it is obviously in that spirit that the PS group has examined the bill and will vote on it. by

Our hope is that this bill is not a nest for disputes and that it allows us precisely to protect ourselves from those American drifts where the lawyers present in the waiting rooms of doctors wait for the error or the potential error to be able to intervene and eventually imagine a juicy trial against doctors or hospital institutions. We do not want this situation to translate through this law. Rather, this law must open a new era in which the patient will no longer be infantilized and where the doctor-patient relationship will be based on a trust basis.

I would like to conclude by citing two issues that were raised in the hearings and which are not met here. First of all, it is the problem of accessibility of care. It was right that the Intermutuellist College had insisted on this aspect of things during the hearings. Indeed, it is not through such a bill that access to care is guaranteed, but through a set of arrangements voted over the course of the year, and more specifically this year. However, it must be clear. This makes no sense if, on the other hand, access to care is not guaranteed for the whole population, including the most vulnerable or those who do not receive institutional support from their CPAS or other, those who are sometimes the most in difficulty being low-income people even though they live from their work. by

Then, the second element that is not included in this bill and for which I had submitted an amendment with Mrs. Avontroodt and Mr. Seghin, this is the problem of therapeutic aléas. We believe that the bill will only have relevance and force when we have voted on a draft on therapeutic hazards. That is the obvious! Patient rights cannot be guaranteed without, at the same time, guaranteeing that the practice of doctors is framed and protected in the patient’s interest. by

As Ms. Avontroodt said, I hope that we will have a firm statement before the vote on this matter. I don’t know if it will come from you, Mrs. Minister, or from another member of the government. What we expect is a firm commitment from the government on this issue and that will be able to strengthen the arrangement we are going to vote on today.

Protection of the practice of doctors is the only way to guarantee the rights of patients in the best possible way. This is the reason why we will vote on this bill. We are in a country where, fortunately, medicine is not practiced according to the American system. The difference is fundamental. We need to insist on the fact that we want a different medical practice, a different doctor/patient relationship than the one that is going on in the United States. This is what we are looking for and that is what makes Europe different. I think this is also a concern for your government.

Mr. Speaker, Mrs. Minister, colleagues, despite the risk of a repeat, I would like to point out that the present bill is the result of numerous extensive and intensive discussions. On the basis of a concept note, a number of hearings took place in January 2001. On the first day, experts in the field of medical law and bioethics, representatives of the different categories of healthcare providers and of the health funds, were heard. On the second day, patient and consumer organisations, representatives of healthcare institutions, the League for Human Rights, the Association for Medical Errors and the Federal Ombudsman were heard. Subsequently, written opinions were submitted, among other things, by the Commissioner for the Rights of the Child, the National Council of the Order of Physicians and insurance organizations. In short, all potential stakeholders gave their views and comments on that concept note. Taking into account these interventions and comments, the concept note was adapted to the draft law, which was eventually discussed extensively in the Public Health Committee for weeks and the final result of which is now for discussion.

While no one disputes that the patient is at the heart of health care, in that sector, however, it is more frequently discussed than with the patient. However, it is not because someone becomes sick or dependent that he should also renounce a number of important values in our democratic and civilized society, namely his autonomy, his participation and participation.

The policy agreement of July 1999 literally stated: “The right of the patient to clear and accessible information about the concerns presented or given to him and about his health status must be guaranteed. The patient’s complaints about the received care, should be better handled, with respect for human dignity.” Only a clear legislation on patient rights can form and make such rights enforceable. Sooner or later, ⁇ for a little thing or for a serious intervention or treatment, each of us and each of you will ever become a patient. Anyone who looks at the present bill from that perspective, i.e. as a patient, can find the guaranteed rights that now exist only obvious. Let me summarize: the right to quality services, the free choice of the healthcare provider and thus also a second opinion, to adapted information about your health status, the treatment, the consequences and the possible alternatives, to consent, which inherently includes the right to refuse, to access and copy of your dossier, to protect your privacy, to complaint mediation and to representation by a trust person.

Of course, some rights also inevitably have limitations. For example, those who go to a particular hospital see their choice de facto limited to the healthcare providers who work there. Whoever has to go to a control doctor, the jury has no free choice, because then, after all, a different legislation applies.

The participation of the patient is also required to ensure the rights. The Federal Advisory Committee on Patient Rights, which is to be established, in which patients, healthcare providers, hospitals and insurance institutions should be represented in a balanced manner, has, among other things, been tasked with continuous evaluation and adaptation of patient rights.

It will also act as a point of contact for complaint mediation in order to bring uniformity into effect. This law on patients’ rights aims at maximum prevention and does not aim at threatening the healthcare providers, nor a jurisprudence of the relationship between the care applicant and the healthcare provider, on the contrary.

The Ombudsman’s role, which healthcare facilities will now need to have in order to be recognised, will play a very important role in complaint mediation. In fact, care provision takes place mainly within a trust relationship between the patient and the caregiver. Even in the most ideal circumstances and despite knowledge and skills, healthcare can not be referred to as a commitment to results, but a commitment to effort. Sometimes something can go wrong. In the first instance, the complaint mediation service must provide a response, solution or advice. The system of complaint mediation applied in the Netherlands shows that 90% of complaints can be handled in an initial phase. If the complaint mediator fails to resolve the dispute, the patient will be informed of the further options for handling his complaint.

A scheme for compensation for damages resulting from the wrong behavior of a healthcare provider or not logically aligns with this law on the rights of patients. We therefore urge that the final details of that legal arrangement be settled as soon as possible. The AgalevEcolofraction has always emphasized the rights of patients. This law has our full support and we will approve it with conviction.

Mr. Speaker, Mrs. Minister, dear colleagues, the bill that is presented to us today aims to meet a series of basic rights of the patient. These rights already exist. They are indeed expressed in the code of ethics but, at present, they are not always regulated or codified. In practice, one can even say that in a limited number of cases, they are not always respected, unfortunately.

While these rights impose on the level of principles, they may, however, pose ethical or practical problems with regard to their application. It is also true that the codification of rules, even if it constitutes a legal advantage, can pose problems if it relates to a field that is not manichean. Let us pay attention to the fact that the targeted field, namely medicine, is largely out of the patient’s understanding, even if he is enlightened. It is unhealthy, and sometimes dangerous, to force the medical fact to civil rules. Furthermore, I am convinced that the added administrative burden is also likely to weigh heavily on medical practice. by

The right of the patient described in this draft is inspired by the 1994 Amsterdam Declaration, the jurisprudence regarding the obligation to inform the patient in advance and to seek his consent and the deontological provisions applicable to physicians. These rights apply not only to physicians, but also to other care providers covered by Royal Decree No. 78 relating to the art of healing, namely nurses, physical therapists, pharmacists, dentists, nurses, within the limits of their spheres of competence.

It should also be remembered that the rights of the patient are generally seven: - the right to a quality service; - the right to the free choice of the provider of care; - the right to information on the state of health; - the right to consent; - the right to the patient's file; - the right to the protection of privacy; - the right to mediation in complaints.

I would like to draw your attention very briefly to the achievements of our work in commission. First, through an amendment to Article 4, we introduced the notion of a general duty of patient collaboration. We consider that the right of the patient imposes on the doctor, insofar as each patient contributes to it. by

For example, we believe that patients should provide all the necessary information to the providers, so that they can guarantee them optimal care. It is true, in fact, that the provider also expects from his patient all the information that may have importance in the choices to be made. The obligation to inform and the right of the patient to information must lead to an open dialogue, an open dialogue, in which doctor and patient seek the best solution to the problems posed.

We also believe that if a practitioner considers that he does not have to communicate certain information to his patient, it is that he has good reasons and that therefore, one can never blame a practitioner for not having communicated all the information, if he can obviously justify reasons that motivated his decision and consulted another provider.

With regard to consent, it is important that the practitioner can fix the patient’s consent in writing and add it to the file. It is, in fact, the responsibility of the provider that is in question if the consent is subsequently challenged. On the other hand — and I insist — it would not be logical for the patient to refuse to confirm his consent in writing. The patient’s refusal to sign would then be equated to a refusal to consent. by

When, as provided in Article 8, § 4, a patient exercises his right to refuse or withdraw his consent, the doctor has the opportunity to release himself from his task, as set out in Articles 28 and 29 of the Code of Medical Deontology; then the doctor must obviously notify the patient, ensure continuity of care and provide all relevant information to the doctor who succeeds him.

In emergency cases, any necessary intervention should be carried out immediately by the practitioner in the interest of the patient. The urgency will very often involve an uncertainty regarding a refusal of consent. Let us not leave room for doubt. The practitioners must act in the patient’s interest, I repeat. They must intervene. There is no question of admitting, in one way or another, any form of assistance to suicide. It is not our responsibility to guarantee this. Mr. Minister, my group expects that you clarify very clearly the scope of this famous Article 8.

When it comes to access to the file, it will be mainly remembered that direct access to the file can only be made by the patient alone. It is therefore not possible for third parties to consult the dossier of a patient, with the exception, of course, of the trust person he has designated or of another practitioner. It is indeed unthinkable that third parties can consult a patient’s medical record and make some use of it. by

In this regard, we hope that the right to view personal notes through another provider will not be abused. It is indeed imperative to avoid that, for a malicious purpose, a patient calls on a provider that could be qualified as an appeal to get acquainted with his file and be ⁇ personal annotations of the doctor. by

In addition, the patient has the right to obtain a copy of his dossier. This right lies in the extension of the obligation of information and open communication, desired by the project.

We have, through an amendment, clarified that this copy is strictly personal and confidential. By thus emphasizing the character, it is avoided that the file is used for other purposes by third parties, in particular during an employment examination, the subscription of a loan, the conclusion of an insurance contract or a disaster settlement. by

Finally, we hope that the quality of the patient’s medical record will not suffer too much from the impact of this right of consultation. A federal "patient rights" commission will be set up to ensure general tasks, including a law enforcement monitoring mission. We will therefore be attentive to the future conclusions of this committee. by

Finally, a major achievement of our work consists in the insertion of a provision aimed at hospital institutions and their responsibility for compliance with this law. It was indeed indispensable to introduce this precision because it is not unnecessary to recall that problems arise also in these institutions with regard to the observance of the rights referred to, and ⁇ even more than for a practitioner taken individually. by

At their request, patients will also be able to receive information about existing legal relationships in a care structure. We have chosen to dedicate this right only to the patient’s request, because we believe that patients will prefer to be informed about care rather than about legal arrangements that may not be their primary concern.

Mr. Minister, like colleagues Mayeur and Avontroodt, I will conclude with the problem of therapeutic disorders. The MR group has been calling for a quick implementation of this bill for some time already. We believe that this is an indispensable corollary to the bill on patient rights. In addition, remember, it was discussed to deal with these two projects in parallel. Therefore, the government today gives us assurances regarding the basic principles to be included in a future project relating to medical liability insurance. We call for a quick and concrete implementation of this project. Patient law, on the one hand, and the professional liability insurance of service providers, on the other, are closely linked. This problem actually forms a whole.

Here, Mr. Speaker, Mr. Minister, Ladies and Gentlemen, are the various remarks I intended to make at this debate. And in order to say all this, I would like to point out that the MR group will support this bill.

Mr. Speaker, Mrs. Minister, colleagues, the SPA fully supports this draft on patient rights. This is for us the confirmation of an attempt that was indeed already undertaken during the previous legislature. Also then, a draft on this subject was already submitted by then-Minister Colla along with a number of other bills from colleagues. Unfortunately, this did not reach the final line. We sincerely hope that this bill will succeed.

We have three comments on this.

Mr. Speaker, I find it good that Mrs. De Meyer refers to the past, but then it must also be complete. Ms. De Meyer, you know why this bill did not reach the final line at the time. Your party colleague, then Minister Colla, did not want this. You must say this for the sake of honesty to history. He had the authority. There were legislative proposals. He had even submitted a bill, but he did not want to go beyond a charter. This is the correct attribution of the facts.

Mr. Brouns, that may be your opinion, but not mine.

One of the first remarks I would like to make regarding the financial information to the patient concerns Article 5 of the present draft on the rights of patients. We have advocated for an explicitization of Article 5 in the following sentence: "The patient has the right to quality services with respect for his human dignity and his self-determination and without any distinction on any grounds in relation to the professional practitioner." Therefore, it is stated: without any distinction on any ground. We wanted the express guarantee that no patient could ever be refused for purely financial reasons. After all, it is unacceptable for us that some practitioners refuse to provide medical care to people with low incomes or with payment difficulties. Healthcare is a fundamental right that should be accessible to everyone. For us, therefore, it is not possible that in practice, large advances are still required, that in practice patients are still branded because they are in financial difficulties. We must avoid at all costs falling into a situation where high-quality medical care would be accessible only to capitalists. On our question, the Minister made a clear statement that there can indeed be no such two-speed health care, especially within the framework of the philosophy of the maximum invoice which is also a battle point for our party.

Even in this context, the SP.A emphasized during the discussion that the patient should be informed before each admission of the full financial impact of the intervention, in particular on the fees, on the brake fees and supplements and on whether or not the professional practitioner is conventional. For us it is clear that when the patient needs to be treated by a non-conventional physician, he must ⁇ be informed about it, given the important financial consequences of this. However, the Hospital Act stipulates that the hospital administrator must take the necessary measures to enable patients to consult the lists containing both conventional and non-conventional hospital doctors. In practice, however, it shows that very few hospital patients really know which doctors are conventional and which are not. According to a survey by the Consumer Workshop, it would be about 10% of hospital patients. Therefore, the measure in question does not seem to ⁇ its purpose.

For us, it is therefore very important that the patient is informed about the consequences of whether the doctor is conventional or not. You have given us sufficient guarantees in this regard.

Our second comment during the discussions was about the rights of minor patients. The original text contained a rather empowering passage about minor patients. Our own bill included an age limit at a certain stage. In our original bill, we provided a derogation for a minor who was older than 14 and a review of whether or not his sexual life should undergo treatment. In that case, the minor could object to the disclosure of this information to the persons who exercise parental responsibility over him, unless the exercise of parental responsibility was of the opinion that the minor could not be considered to be able to reasonably assess his interests.

However, after discussion and informal advice from the Commissioner for the Rights of the Child, we found it better to no longer use age as a criterion, but rather the maturity of the minor. Through an amendment, we have therefore ensured that a minor who can be considered capable of a reasonable assessment of his interests can exercise the rights of the patient on an independent basis.

A third important note is about liability. Several colleagues have already talked about this. This law regulates the right to prior information and access to the patient dossier. The design ensures that on the basis of this information, the patient can give or not consent to a particular procedure. This is called informed consent. All these rights can also be exercised by a trust person. With any complaints, the patient can go to an ombudsman service, which primarily has a mediation function.

We regret that the central responsibility of the hospital, which, in my opinion, every one of us wanted, collided with the advice of the State Council. The central responsibility would have made it much easier for the patient. Their

In addition to the central liability, which is not regulated against our will in the bill, we also remain hungry in the field of objective liability in the case of a medical defect. If, after mediation, the Ombudsman’s service does not find a solution to the patient’s complaint, the patient remains with his complaint. From the patient’s point of view, we find it crucial that the corresponding law on liability is regulated urgently. After all, precisely in terms of compensation for damage due to a medical error, the patient is currently alone in the cold. The patient is often confronted with a much stronger counterpart. He faces a long and costly procedure to get his right. The system of objective liability should provide seamlessness in this regard. It would be unfortunate that patient rights remain an empty box for patients who are truly in misery and who are victims of a medical accident, because the liability scheme has not yet finished. Therefore, SP.A requires the absolute guarantee that the liability arrangement will be realized as soon as possible.

Mr. Speaker, Mrs. Minister, I am going around. Apart from these three important remarks, the SP.A group wants to fully support the draft on the rights of patients, which undoubtedly takes a further step in the de-education of the patient and constitutes a building block for a mature relationship between doctor and patient.

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker. For environmentalists, this project is important. He is expected by many patient associations and I dare to say also by many doctors with whom we have had frequent contacts as part of his examination. by

This bill has been examined very carefully. I’m not going to mention the many hours we spent here, but simply to trace the path. Indeed, we will remember the hearings we conducted on the preliminary bill and everyone will remember how much they allowed us to refine and clarify certain concepts. Today, we can say that the bill that is submitted to us meets the philosophy of the previous bill, deepening the place and participation of health care users in the health system. by

In the various texts relating to care, the participation of patients is a priority objective. While many accomplishments on the ground testify to this will, there are still many obstacles that persist today.

On the one hand, patients are increasingly organizing themselves into mutual aid or pressure groups to draw the attention of public authorities on a forgotten disease or, in the event of a medical problem, to demand information, more transparency or even compensation or even, to demand a broader financial accessibility to care. by

Alongside patients and medical services, mutual associations and trade unions are also involved in a discussion that has an increasingly widespread tendency. Doctors within GLEMs and one of their unions or the Order of Doctors are increasingly interrogated by these subjects and it is rare to see a week pass without the contribution of a text of reflections or recommendations on the subject. Several hospitals, in order to get closer to patients, to expand their observations in a more structured way, have already put in place a system of mediation. by

So it was time for Parliament to take the measure of this debate and legislate on this subject. On the parliamentary side, several bills were submitted, they were examined at the same time as the bill that is submitted to us today.

Our company is slowly but surely moving towards a greater representation of patients in healthcare systems, and I am delighted with this as I am personally convinced that our healthcare system will win. In this process, the bill we are examining today is a central step. by

But this evolution will not happen overnight. One of the things that struck me most during the review of the bill is the concerns that this debate raises on the part of some health professionals. If everyone testifies to his will to see the health system evolve towards a wider consideration of the aspirations of the patients, when one enters into the study of the problematic, one notices that this will collides with the different conceptions present, with the various experiences lived. by

Does a greater place for the patient risk changing the reports within health systems? Is there a risk of a wider excess of the health budget? Is there a risk of multiplying trials for medical errors or medical problems? Is there a risk of having to devote more and more time to medical consultation, to meeting groups of patients, to the defence in court? How can the patient appreciate his place in the health system when he knows nothing about the constraints to which professionals are subjected? How will he appreciate the information that the doctor is obliged to communicate to him, what will he do about it, etc? I pass because all these questions have been dealt with, reflected, thoroughly examined as part of the review of the bill. I assure you that we have spent several hours there.

This shows that we are in a complex reflection, and of course, politics must take a certain part in it, and that is what we are going to do today. However, it is on the ground that all this will happen. Therefore, it is important that actors also participate in the development of this new approach if we want to ⁇ a harmonious system around a new data, i.e. an increased place for patients in the healthcare system.

In order to do so, it was necessary to pass a law. Charts, there are today several; they have had their usefulness, that of making us move forward towards a better conceptualization, but they also have their limits, they are not binding and can leave certain areas in the blur. I think it was time to talk clearly about a whole series of points that are addressed in the bill.

The right to a quality service, the right to the free choice of the provider of care, the right to information on the state of health, the right to consent, the right to the patient’s file, the right to privacy protection, to mediation, to be represented, all these points should be specified in a clear and accessible way for the patient. They are so in the bill both with regard to adults as well as minors or older patients falling under the status of extended minority.

Another must-see point and addressed in the project, is the representation of patients in the mediation system set up and more specifically in the Federal Commission on Patient Rights. by

The patient/doctor relationship is something else than a matter of justice. Let us avoid analyzing our system only under the lump of medical error or medical failure. I haven’t talked much about this debate so far, but I would like to wait for a moment as there are parallels to the one we hold today.

It is certain that a large part of the reluctance of a part of the medical body, and more ⁇ of the doctors, to see the right of patients evolve belongs to a fear born of the debate "medical error / medical failure". Personally, and I am not the only one, when I address this problem, I prefer to refer to the notion of medical damage rather than the question of fault. I therefore strongly hope that in the continuity of the work we are doing today, we move towards a system called "without fault" with the creation of a fund for compensation for medical damage.

Our group welcomes the work done on the "patient rights" project. By adopting the text today, the House is taking an important step because this bill provides guarantees on two extremely important points. On the one hand, the voted text puts an end to the opacity and fragmentation of regulations, thereby enabling a better understanding and greater respect for the rights of patients: the right to a quality service, the free choice of care providers, information, consent, patient dossier, etc. This project offers us a clear, precise, accessible law that will help to avoid conflicts and consolidate the relationship of trust between patient and practitioner.

This point is extremely important for our group. I think it meets the wishes of many associations and health professionals.

On the other hand, we also believe that the final adoption of this text will give the necessary impetus for the completion of the bill on liability without fault. Several decisions have been made in the Council of Ministers and have already been addressed in this regard. It remains to be implemented as soon as possible and thus our satisfaction will be total.

Mr. Speaker, Mrs. Minister, colleagues, I will briefly join the evaluation that Mr. Brouns has made of this draft. I would like to draw your attention to a number of specific points and also ask for the Minister’s assessment of the exact scope of some points. Mr. Speaker, I will try to stick to the time you have suggested.

Colleagues, basically, it is absolutely positive that there is a design and that the rights of the patient are anchored in a law. This basic appreciation was also expressed by Mr. Brouns. The initiative and the text have undoubtedly the merit that this happens. I therefore have praise for all those who have contributed to the preparation, the Cabinet of the Minister and the external experts such as Professor Neys and colleague Brouns who ⁇ contributed. All praise for that. Their

My fear was already expressed by colleague Avontroodt in her presentation. In fact, one cannot say that one wants to provide rights for the patient on the one hand, while on the other one fears the jurisprudence. If one creates rights in a law, then there is partly a legalization of the relationship. I understand the resistance to such a legalization that lives out of practice in many people. I say in all honesty that I find it somewhat disappointing that in the discussion we have not always paid equal attention to the consequences of making a relationship that should be based on trust now the object of rights and corresponding duties. It also raises the question of what happens if these rights are not respected. This leads to the discussion of liability. I regret that in the discussion we have not always given sufficient attention to the consequences that such jurisprudence may have. For me, jurisprudence is inevitable if one wants to pour rights into a law. However, I think that then the necessary care should be applied to describe its consequences. In the committee I have sometimes heard too much about the interpretation and the scope of the present text, as should be shown in the Memory of Explanation and the report of our discussions. I would rather be inclined to be clearer than in the text of the law, or at least to close the door for certain interpretations that we do not want. Per ⁇ this is a legal misforming of me. Mrs. Minister, it has been repeatedly confirmed that this law is largely a codification of existing rights of the patient, based on international treaties and jurisprudence. As I suggested in the general discussion, I would have liked that we had included these references on a timely basis in the report so that, when there were discussions, one could find that this is a stick to an existing line rather than a new reversal in the legislation that will produce new jurisprudence. This has not always happened. We have spent quite a bit of time on Article 4 of the text, which stipulates that the professional practitioner must comply with the provisions of the law. Article 5 stipulates the right to quality services. Ms Avontroodt emphasized in her presentation that the question was repeatedly asked what is the scope of the provision that a patient is entitled to quality services that meet his needs. Should this need be assessed by the professional? Maybe so. To what extent does it take into account the patient’s desires and perception of quality life? To what extent can he influence medical action if we point out benefits that meet his needs? I am on that point in all honesty what remained on my hunger. The right to quality service is formulated as a right and gives the impression of being an absolute right.

However, the Minister has repeatedly confirmed that it is actually an effort commitment. The healthcare provider is expected to present itself as a careful, competent healthcare provider who delivers the care. Personally, I would have preferred that this too would be stated in the law rather than talking about a right to quality service. Their

I would like to draw your attention once again to Article 4, which introduces a sort of exception. This article provides that the practitioner is only obliged to respect the rights of the patient to the extent that the patient cooperates with them. This will be the gate along where all discussions will take place before the court. After the patient has completed the complaint procedure without a satisfactory solution he considers, he will turn to the court. In many cases, the practitioner will defend himself by referring to the fact that the patient has not provided sufficient cooperation. I find the creation of an exception a somewhat regrettable ambiguity in this law. What does this mean concretely? If the doctor tells the patient not to smoke and the patient still smokes, what are the consequences of this with regard to the obligations of the doctor? (Mrs. Yolande Avontroodt cries in agreement) I notice that Mrs. Avontroodt cries in agreement. This is an important signal. I’ve also heard her give examples of the fact that useless research is being conducted. At that time, a debate may arise about, among other things, the usefulness of those studies and their reimbursement. I personally consider this to be a debate that was too little sparked to be incorporated in just a few sentences in such an important law.

Let me give a last example. We have repeatedly discussed in the committee the right to refuse medical treatment. I think this is a completely legitimate right. What is the consequence of this? What are the repercussions? I invite my colleagues to read page 81 of the report. On that page is the Minister’s answer to the question about a patient who wants to end his life — it is immediately qualified as a bad example, but it is still a conceivable example — and the emergency service is brought in with a clear order stating that he refuses medical assistance. The doctors in our company in this case had the healthy reflex to say that that person should not simply receive no assistance. The Minister also made clear in her response that the patient has no right to oppose any attempt by a practitioner to save his life. There is also the right to refuse treatment. The confrontation between the two positions — the doctor with his vocation and deontology and the patient’s right to refuse treatment — is, in my opinion, not clearly clarified in the discussion.

I am pleased that we will soon receive an explanation on the objective liability scheme. You start from a strange reasoning when you first create a law in which you are not 100% sure of the correct contours of the scope of liability and then it only has in a second phase about the objective liability. I would rather have seen that we had discussed in detail the repercussions of this draft law on liability. In my opinion, this is the most obvious effect of the jurisprudence for which the healthcare providers are also the most denied. Only then could we have developed a system of objective liability.

My second concern concerns the hospital sector. In my opinion, we all agreed in the committee — which has also been shown in the hearings — that it is difficult to talk about operational rights of patients if one does not regulate the relationship of the patient and the respect of the rights of patients with regard to the healthcare facilities. This was also stated in the preliminary draft law. It is after discussion in the committee that the majority groups have submitted an amendment to reintroduce it in the final text. The government had previously removed this arrangement from the draft on the basis of the argument of the State Council which said that the federal legislature is not competent in this regard. I am sorry that there is a word in the text about "hospitals". In the original preliminary design, the problem of the patients in relation to the “health care services” was discussed.

The Minister has stated that compared to the other provisions, she could arrange that by royal decree. I would have found it more appropriate to regulate this problem from the perspective of the rights of the patient with regard to all health services and not specifically only with regard to hospitals. Their

The reason why the Minister was of the opinion that, despite the opinion of the Council of State, we are competent in this matter, I personally find it somewhat limited. We were all aware that it would not be easy to find a perspective to have any arguments that would allow us to declare our federal competence in this area, but to say that we are competent because it is in the hospital law, is still something peculiar. The judgment of the Arbitration Court referred to was precisely about the abolition of a provision in the Hospital Act, namely about the care circuits. To formulate the argument that we would be competent because this is regulated in the Hospital Law, I find no successful argument at all. If that ever needs to be triangulated, I hope that at the federal level we will find better arguments than that argument. Their

My first criticism was related to the fact that little was really explicitly spoken about the responsibility dimension of patient rights. We have not been able to technically confirm that these would be largely existing rights or that this would at all be an explicitation of existing international obligations. That was my first criticism. Their

My second criticism concerned the principle of hospitals and the arguments we use to declare ourselves yet competent. Their

My third point of criticism relates more specifically to the provision itself, which now requires hospitals to respect the rights of the patient. Again, in principle, I naturally agree that it is necessary to clarify the rights of the patient in relation to hospitals. However, there are still a few questions.

The article introduces a number of obligations for hospitals towards patients. The first obligation is the obligation to respect the patient’s rights. I think that seems logical. My question is, then, what are the repercussions, the practical consequences. Mr Mayeur referred in the committee to the obligation to disclose tariffs. Yes, but does that also relate to the right to privacy, to give an example? The infrastructure may be such that the hospital does not respect those rights. Does it also involve safely keeping a patient record? Is this also an obligation of the hospital arising from the new provision, article 17 novies? Personally, I think it would have been better to be a little more detailed about it and expressly name the practical consequences of it, also in relation to the responsibility of the healthcare provider himself. After all, it must also ensure the safe storage of a patient file, must also respect the right to privacy, must also publish tariffs. We will therefore face competitive obligations in that area. Their

The second obligation that has created the majority towards hospitals is the duty of surveillance.

You have taken the example of the right to privacy. The institution may guarantee the right to privacy in certain cases. The institutions that guarantee education may ensure that the teaching physician, accompanied by his students, does not necessarily appear in the room of the occupant who does not wish to be visited. The institution must be able to guarantee respect for privacy in the manner in which care is provided. It is not always the doctor who organizes his guard tour. This is done with the participation of the entire institution. Therefore, I do not find it abnormal that the institution participates in this guarantee.

I assume that you do not contradict my position. You actually confirm that article 17 novies can indeed have a lot more implications for the sector than one might think at first sight. Therefore, it is a little regrettable that we cannot deal with this in more detail. After all, you give an example but there are numerous examples of situations in which the responsibility of the hospital can be invoked as a peculiar obligation.

Hence my question about the second duty, the duty of vigilance. The hospital must ensure that practitioners who are not employed as servants or officials respect the rights of the patient. This is a kind of commitment of effort, we understood from the discussion. The question then remains natural: should hospitals negotiate that in their general arrangement? I assume that the majority means that this is also a kind of permanent obligation. This means that there must be some kind of supervision, for example on respect for the patient’s free choice or on respect for the principle of inform consent or on the safe storage of the patient dossier. It is not always clear to me what that surveillance obligation as a competence or as a requirement of care due to the hospital will now imply. This is not so obvious. We also struggle with respect for therapeutic freedom and such principles more.

Again, my question is: how far does the commitment to effort now extend due to the hospital and why does it not apply to servants and statutory staff members? After all, this is not really clear to me either. I understand, of course, that one is responsible for those workers anyway, but I do not understand that those involved have no additional surveillance obligation.

My last point relating to that article also relates to the amendment I have submitted. The final part of Article 17 novies provides that the hospital shall be partially liable for the defects committed by the professional practitioners employed there, unless such liability has been excluded by having been able to provide the patient, at his request, with information showing that the hospital is not co-responsible. This information, of course, cannot be given to employees, I suppose, but to self-employed doctors or companies that are active in the hospital.

Therefore, I expressly ask the Minister the following question and have submitted an amendment to this effect in order to exclude any ambiguity. The information to be provided shall be the information that the King shall determine, after he has requested advice from the committee established by this Act. Unless I read it wrong, the law immediately comes into effect in its entirety and then, of course, a problem arises. After all, that hospital will not be able to provide this information, as determined by the King, since the King still has to determine that information, and before that even first must obtain the advice of a committee that is yet to be established on the basis of the law. Thus there arises a period during which the hospital would involuntarily be co-responsible, if a patient has a claim against a healthcare provider, in the absence of information determined by the King, which can be communicated to that patient. That is why I submitted this amendment. After all, I am afraid that without clarity on this point, a period of uncertainty can still arise.

These are technical remarks, as far as I am concerned, in the article on hospitals. All that does not take away that as regards the substance of the case, I of course the opinion part of many in the committee, that regulate patient rights without regulating the position of the patient in relation to the hospital, is not correct. Basically, it is obviously very good that we help the patient in his emancipation process, also provided with a number of rights, in order to come to a more equal relationship with the healthcare providers and healthcare facilities. This is a fundamental basic attitude that is of course shared by our group.

In the context of hospitals and other healthcare facilities, there is an increasing demand for a conversation — and I hope for a business conversation — about the relationship between healthcare providers and hospitals with regard to their mutual status. In the end, we are once again arranging a piece of it. I think the moment for a global conversation is coming. This will be the case for the next legislature. I thank you for your attention.

Mr. Speaker, Mrs. Minister, I do not have to tell you that I still wonder why a bill on patient rights is necessary. You know that I have always resisted the ever-new checks that people want to impose on doctors. I assume that I am a little older and that I belong to a different generation than most here. I also find that at the time as a general physician and later as a specialist I may have had more authority than the current physicians and that I had a better contact with my patients so that they could more easily obtain the explanation to which they were entitled. I have never had problems with the court, nor with the patients, both in terms of treatment, professional secrecy and honorary. However, if the majority wants to do so, I will give up. I can assume that young people might feel better protected by legislation on this subject. I put myself down.

However, I have another concern. We always talk about the rights of the patient, as if the patients have so few rights that would then be regularly violated. Nevertheless, we note that the majority of the population still has the most confidence in doctors and nurses. This means that there are likely to be far fewer cases than one wants to predict. There are many lawyers and lawyers present in the hall. We are constantly talking about the rights of patients. In my service, for many years, I have found that there are many more complaints about lawyers. Just a week ago, Mr. Van Hoorebeke, I read in the newspaper that the lawyers determine their fees purely arbitrarily. One can argue the argument of ‘journal talk’, but I assert exactly the same. The lawyers set their fees purely arbitrarily while the ours are regularly published in the media. Everyone knows the official fee when visiting the doctor. Mr. Van der Maelen, I don’t think you contradict me. Most doctors also stick to it. I don’t think the lawyers here can say with the same enthusiasm that most of them stick to a reasonable fee. What is the defense that remains? Then you have to go to the staff. I have experienced this in a case of interest defence. The Staffholder then says: Master so and so has indeed exaggerated, we will halve the honorary.

Once again, the debates take an important turn with Mr Valkeniers’ presentation. As we spotted the intentions following the VLD chairman: should we now conclude that you advocate for a similar approach of the legal profession as the doctors with a system of conventions and rates?

It would in any case be a testament of courage if the lawyers shrugged their hands and drafted a charter on the rights of the clients of a lawyer, which is protected nowhere, not even along the legal profession. I am involved in a trial that has been going on for 15 years.

I was recently sentenced to a fine of 320,000 francs for using a photograph for failing to pay for so-called copyrights. This was a photo taken in 1988. I was persecuted in 1996 by someone who now belongs to the chief executive of your party. I was sentenced for the first time in 1999 and in appeal in 2001 to a fine of 320,000 francs. I would like to tell you how the court and the lawyers work.

Mr. Vandeurzen, this is not a personal fact.

Mr Vandeurzen has no problem with this. The longer the case takes, the more advance one has to pay.

I had the impression that we would be the culprits again. Colleague, if you have been convicted for infringement of a copyright law, it is likely because you have dealt with and approved that law in Parliament — given your long presence here.

I have the impression that my recent conviction had something to do with the sympathy between the Minister of Justice and the judges.

I say that here. This is my last year that I am here. I need to blow my heart now.

I return to the clients of lawyers who do not enjoy any protection. I think you should all admit that you encounter such situations more than once in your service. I should not talk about lawyers in divorce. They say that the client will receive at least 80,000 francs of maintenance allowance, and so they ask for the first month of maintenance allowance as an advance. Then comes the process and the client receives 30,000 francs instead of 80,000 francs. I do not have to talk to you about it. I can tell you about this until tomorrow morning.

Now, I want to talk about this bill. We see a federal committee for patient rights being set up, which will register what. I hope that that committee will also register the disputes that give rise to a court case. I fear that the draft on patient rights could lead to more disputes before the court. Everyone is against me, but that is my personal opinion. There is also the responsibility of the doctors. That responsibility must come and we have been promised that the relevant law will be approved by the end of the year. It has even been promised that it will not involve additional costs for doctors and healthcare providers. The fund would be funded with funds from the national greenhouse. We will keep this promise to the government.

Mr. President, has Mr. Valkeniers made a statement here that the government will confirm so soon? Will the Fund be financed from national general resources and will it cost no more healthcare providers?

We expect the government to confirm this promise. Remember, there will come moments — if that promise is not kept — when we can point out to the government its responsibility and its promise.

I thought that those comments — which may sound different from others — were still relevant. I will approve the draft, like a good Democrat, although I still wonder if it was necessary.

July 15, 2002 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, I would like to point out that we have had a lot of extensive and quite thorough work in the committee. I would like to thank my colleagues for the general climate of cooperation and consultation. There was not always agreement on all points, but grosso modo the work was very positive.

I will devote my discourse in the plenary session to the most important points, as we will not exaggerate in detail the debates held in the committee.

The first point concerns the improvements that this design creates in relation to the existing situation. I will then immediately enter into a comment by colleague Vandeurzen concerning the relationship between what is truly entirely new and what has already been silently acquired. Their

During the work, it was often said that very many cases that were codified here effectively already had a basis in jurisprudence and in international treaties. I refer, for example, to the 1994 Amsterdam Declaration of the World Health Organization and the like. However, it is true that even in the documents related to codification, some points have become more clear, more sharply defined. Their

The whole system of representation is truly innovative, while there was nothing in that regard. In this regard, a completely new situation has arisen.

Let me briefly comment on the clarification. It may, in my opinion, be stated that now, with the delimitations contained in the legislative text, in the past due to a lack of knowledge and information, conflicts arose that can now be cleared, precisely because of the clear and clear text. Normally, clarity leads to fewer conflicts and unclearness leads to more conflicts.

In some cases, there is now a lack of any form of legal protection, referring to the less skilled patient, as well as to the fact that there was a large gap in order to properly clarify the entire representation.

Inzake het inzagerecht bestonden er tegenstrijdige uitspraken in ons recht: some texts verwezen naar rechstreeks, others naar onrechtstreeks inzagerecht. Say is no getrancheerd. Bovendien wordt er een duidelijke lijn getrokken in verband met bepaalde ronduit patiëntonvriendelijke bepalingen, meer bepaald in art. 95 of the Insurance Act. Therefore, we also have a committee for de Verzekeringen kunnen overtuigen. De Privacycommission en de Orde van de Geneesheren waren terzake duidelijk vragende partij. A serious problem raised by several speakers is what the effect of this codification will be in practice. Can we now determine whether more or less cases will be brought before the courts? It must be acknowledged that in general, the evolution of our society makes people carry more business before the courts, no matter what it is. This is a general trend we see in our current society. In the elaboration of this bill, we have realised several steps, not only by expressing a political will but also by creating appropriate instruments, to indicate that it is not a bill whose formulation would automatically lead to more matters before the courts. As certain elements are clarified compared to a case-law that currently does not always go in the same direction on identical issues, we have already considered that there should normally be fewer cases brought before the courts in this matter.

In addition, we will use two concrete tools. First, the information we announced about this project. By communicating, one can influence the perception of the population about motivation, the engine that presided over the establishment of this law. Then, in the very definition of the role to be played by the mediator, it is said textually in the law that one wants to first recreate the bonds of trust in case of conflict; then, there will be a mediation whose outcome is desired even if this is not settled in the immediate relationship between the patient and the doctor or another provider of care. Finally, there is, of course, the possibility of appearing in court. Regarding the situation of responsibility without fault — we will return to it later — the government solemnly confirms — this will be repeated in a few moments by the prime minister — that the draft on responsibility without fault will still be submitted to parliament this year. We absolutely want to fulfill this promise very concretely. Ten derde, uiteraard is het zó — in dat is al vaker gezegd — dat "the proof of the pudding is in the eating"; de feiten zullen bewijzen of us eleven effectief voornemens waarmaken in de zin zoals we betrachtten. In this is it well interesting to reference to the voorbeeld of the Netherlands. Daar kon worden vastgesteld dat tien jaar geleden een zeer gelijkaardig ontwerp van wet is aangenomen. Toen also was a number of occupational workers ervoor bevreesd dat daardoor onder meer de vertrouwensrelatie zou kunnen worden aangetast in dergelijke meer. The facts have, however, proven that it has not led to an increase in the rule of law, despite the fact that they have no rules in regard to foolless liability.

Without a flawless liability — a point that the current government is committed to in the most formal way — this has not led to an increase in court cases. This clearly shows that the philosophy of the law and the instruments created in the facts do indeed have an impact and that we ⁇ do not aim for an Americanization, something we absolutely do not want.

Several speakers addressed the issue of accessibility. I would like to emphasize that for the entire government the accessibility of health care is and remains a fundamental task. The government is aware that individual rights cannot solve these problems. Without guaranteed social access, many people cannot ⁇ their actual primary rights. Such a situation cannot be tolerated. In 2002, the government registered 14.4 billion euros in the RIZIV budget to guarantee solidarity and accessibility. The budget of Public Health as such adds 1.25 billion euros. The MAF is in the steigers. Also the present bill deals in various places with the information of the patient, which must be guaranteed so that he could know the financial consequences. Article 5 states very clearly that no distinction can be made between which types. There should be no discrimination, including in financial matters. Article 8(2) explicitly states that the patient must be informed in advance of the financial consequences at the time of admission. This has to do not only with the cost of the intervention but also with the possible supplements and everything related to it. Article 17 refers to Article 17 nonies of the Hospital Act, which clearly states that at the request of the patient, information must be provided in advance about the legal relationship in force within the hospital, so that he knows in what context he plays and can have information regarding the conventional and non-conventional doctors and the working hours of the doctors. I will later go deeper into the concrete question concerning the regulation and its development.

As regards the scope, we have been in the committee following the debate on Article 3 for a longer period of time staying stuck with the problem of the scope when it is not about direct therapeutic acts but about control medicine, mandatory preventive medicine and control medicine. I have pointed out that Article 3 contains a paragraph 2 which explicitly stipulates that a royal decree will lay down detailed rules concerning patient rights which must otherwise be applied in view of the statutory mandate of health care professionals in the mandatory forms of preventive medicine and control medicine. We are talking about work accidents, occupational diseases, disabled persons, child benefits, the tasks of the advising physicians and so on. As soon as the draft royal decree is available, I am willing to make them available to Parliament before I submit them to the Council of Ministers. This will allow Parliament to review those drafts and assess their exact scope. Around the question concerning the scope of Article 8, you would like to make a declaration sufficiently detailed because it seems to me in effect important to make the greatest clarity in this regard.

I would therefore like to confirm that Article 8 responds to the commonly accepted opinion that the valid consent of the informed patient is reclaimed for any medical intervention. In the absence of valid consent of the patient, medical intervention can be considered a crime. The doctor can therefore incur disciplinary and civil sanctions. This consent will be given in an explicit manner, and possibly written "at the request of the ...". This can be done at the request of the patient or the healthcare provider.

The first subparagraph of the first subparagraph of Article 8 does not stipulate that such consent must be given in writing. It is a faculty that is left to the choice of the patient and the provider of care. This consent shall be given in an explicit manner but, and this is paragraph 2 of the first paragraph, in order to avoid that the application of this generally accepted principle degenerates into administrative hassles and paperwork, when the consent of the patient previously sufficiently informed can be inferred from the attitude of the patient, this will also be acceptable. Because there is the situation of people who can no longer speak, who have had a brain problem and who can, through behaviors, mark their consent.We will not require the presence of someone else who should then translate in front of the doctor the behavior of the patient in question. This concept of non-verbal or tacit consent is also accepted and already applied today in healthcare without causing too many problems. The present project therefore corresponds to the assumption that a person goes to a doctor to receive help, of course.

In the same order of ideas, the project specifies that in order to refuse an intervention, the patient must indicate it explicitly and even in writing if the healthcare provider so desires. It is therefore important to emphasize that the patient who refuses an intervention does not thus automatically mark his desire to engage in a conflict with the therapist. The patient has a general right, namely to consent or not to an intervention. But the project respects the care provider’s right to protect against potential claims by requesting that the refusal be confirmed explicitly. If, for reasonable reasons, the doctor considers that the refusal comes from a patient who is no longer able to exercise his rights autonomously, he must address the patient’s representative. In the case of a refusal of treatment also by the authorized person, the doctor must deviate from it in the interest of the patient or to exclude a serious threat to his health and life, provided that this person cannot invoke the express will of the patient.

Let us now examine, in the light of these elements, Article 8, §4, last paragraph, also known as "pre-rejection". To be valid, this refusal must meet the following conditions. It must be formulated by someone who, at the time he expressed it, was in a position to exercise his rights.

Without the obligation of the law to indicate it, this condition includes two important elements.

First, the statement must be made by the interested party himself. In case of doubt, it cannot be considered to be his refusal. A patient who wishes to see his refusal respected must himself ensure that one cannot question the fact that he has just formulated the refusal himself. For this purpose, it can, for example, refer to a witness present at the time when the refusal was formulated, who received a copy of it and who can easily be contacted, such as the general physician.

Finally, the refusal must come from a person in a position to exercise his rights, that is, who has, at that time, the capacity. If the doctor has reasons to doubt, he should address a patient's representative. It must also be written. If this condition is combined with the previous one, it means that it must be written by the patient himself. A standard form therefore does not represent any value. A precise invention is refused. This means that the refusal of a resuscitation is clearly specified, the circumstances in which the intervention cannot take place, such as, for example, in the case of cardiac arrest. The simple refusal of a resuscitation should therefore not be interpreted as the refusal of a specific intervention, since the patient has not refused it when he was still able to do so.

Given the foregoing, it cannot be stipulated that a doctor who deals with such a written refusal should respect it. On the contrary, if he has good grounds to doubt the capacity of the person who formulated it, the identity of the person who formulated it, and if he has doubts about the possibility of seeing this written refusal applied because it is formulated in too vague terms, he must not respect it.

In case of emergency, things are very clear. In this case, Article 8 § 5 is applicable. The doctor is therefore obliged to provide any necessary treatment. In other cases, he has time to address a patient's representative.

We have been talking about the central responsibility of the hospital for a very long time.

Mr. Minister, I would like to return for a moment — this is important — to the example that I gave in a committee but which is not included in the report. This example relates to a Jehovah’s Witness, who refuses to allow his or her child or herself to receive a transfusion. This example has already been mentioned in jurisprudence. Indeed, some courts gave satisfaction to the doctor who had decided to act, to treat the patient and not to follow the will of the parents. I suppose this is exactly what you have just explained. The doctor therefore has authority in such circumstances and may decide not to follow the will, even written, of the patient, which matters being of course the survival of the individual. You confirm, in essence, that jurisprudence applies in this case and that the bill does not give a parent belonging to a sect — and my intention here is not to stigmatize a particular sect — the right not to help his child.

and no. Your interpretation is a bit overwhelmed. With regard to children, this law, as it is formulated, allows the caregiver to go beyond the opinion of the parent.

As regards children, the text explicitly provides that, in a normal situation, the will of the parents must be followed; however, if this will be contrary to the best interests of the child, the caregiver may not respect it. by

As for adults, when it comes to a Jehovah’s Witness who refuses to be transfused, thus putting his life at risk shortly, some cases of jurisprudence actually go in the direction you mention. But there are others, more numerous, where the will is expressed, verified and not questioned, and where the transfusion of blood is no longer the responsibility of the doctor, who, in addition, cannot be held responsible later.

I think that a crucial point is addressed here. However, you should answer the question of how the professional concerned should guarantee the right to quality services. The professional practitioner comes into a situation where the patient refuses treatment. Does the intervention in response to the patient’s wish for the refusal therefore respond to a quality service or is it considered that the doctor guarantees the quality service to the patient concerned in another way? I think this is a ⁇ crucial point, and I am pleased that Mr. Mayeur has repeated that example. In the future, however, this will become especially important in the case-law for patients who want to exercise their right to refuse, and for healthcare providers or professionals who can then completely escape their responsibilities.

I share the same concern. In my presentation I already said that this type of problem is very crucial. This should also be shown very clearly from all the documents that can support our discussions.

I would like to ask a concrete question on this. This is not a point on which there is a great disagreement between us. It is rather a matter of clarity and clarity.

You say that the doctor is not liable if he can prove, for example, that a Jehovah’s Witness, of whom this is widely known and who confirms this in writing in an unmistakable period, does not want a blood transfusion. However, I would like to reverse the matter. If the doctor gives treatment, does he make a medical mistake by treating without permission, knowing that there was no permission and that the refusal was clearly and clearly on paper? Is he responsible if he is treated? That is, of course, the other side of the medal.

I want to clearly use the example of an adult Jehovah’s Witness who refuses a blood transfusion. That is most likely for us a ⁇ incomprehensible attitude, inspired in him by clear religious rules, which he also wishes to adhere to. This is stated elsewhere in our bill. That provision clearly states that the patient’s religious and moral beliefs must be respected. Therefore, an adult Jehovah’s Witness has the right to refuse a blood transfusion. Based on the law, this right is granted to him. That does not mean that no other care can be given to that patient. Other care which, for example, relieves the pain, can be administered by the doctor. Radical action against the refusal of that blood transfusion can not be effective.

What is opposed to this? As regards liability in that file, the normal rules of liability that are already in force apply. The design does not add anything to this.

We are at the crossroads between the will of the patient and the responsibility of the doctor. by

In the law on euthanasia, a series of precautions has been surrounded, not only with regard to the period within which an early declaration retains its full validity, i.e. 5 years, but also with regard to the freedom both of the patient who requests euthanasia and who is free not to request it, and of the doctor who is free if the patient requests it, under certain conditions, to practice it or refuse to practice it. by

For me, the problem that arises in this case is related to this freedom of the doctor. In fact, what you institute is "assisted suicide", or then the words no longer mean anything and wrongly naming things participates in the misfortunes of the world, as Albert Camus rightly said. In this case, the doctor has no right to refuse to participate in the assisted suicide since if he refuses to participate in it, he can be convicted for non-compliance with the law. This poses a real problem. This is primarily what we wanted to emphasize. This situation will need to be clarified because otherwise we are facing a legal conflict situation from which civil society will not get out. by

The notion of the term, which was rightly imposed in the law on euthanasia, between the moment when the patient declares his will and the moment when this declaration is still applicable, does not exist in this draft. One might imagine, for example, that a Jehovah’s Witness who has made a statement this year, is, in ten years, in an emergency service in complete bleeding and that he absolutely needs a transfusion; because he would have declared this year that he would not want a transfusion, ten years later, the doctor would be obliged to let him die on the spot. This is unacceptable!

You mix several things. I am not talking about a prior rejection, but a direct rejection. You are referring here to a completely different situation that I have already answered, but I will return to it.

Mr. Speaker, Mrs. Minister, I think we are approaching the matter in a completely wrong way, in particular with regard to Jehovah’s Witnesses who refuse blood transfusions. An article of the draft law includes a regulation for emergency cases. The doctor acts as expected of him. If it is a foreseeable surgery that involves a lot of blood loss, then one can undergo an autotransfusion. It is then allowed fourteen days before the blood is drawn to be administered again later. For other situations, there are sufficient replacement products for blood, although they do not have the same function.

I will now give the example of another situation. In fact, I do not understand how, at the same time as the right to consent, one cannot de facto accept the right to refuse. I think one cannot do without the other. I will give the example of a kidney dialysis patient who, given his age and general condition, is not eligible for transplantation. If the patient consciously decides to stop going to dialysis, the doctor can only inform and try to persuade him. However, one cannot compel him manu militari to dialysis. The right to consent de facto includes the right to refuse.

Miss, do I understand the text correctly if I suggest that if, as a doctor, I am faced with a patient in need and if I would have had the time to consult the dossier and to make sure of the patient’s wish, I am mistaken if I have not consulted the dossier expressly stating the wish? If I can prove that in an emergency I did not have the time to consult the dossier and to make sure of the patient’s wish, am I then subject to the requirement to meet a person in need? According to my reading of the text, if I have sufficient time to consult the dossier, I serve to submit to the will of the patient and must act consistently according to it. Did I read the text correctly?

The question I raised is that of the legal certainty of the act or the absence of the doctor’s act. That is what matters. I agree that the patient has rights. But the act or the absence of act of the one who is supposed to help him must be protected. This is a fundamental element, otherwise the law will not be properly applied.

I fully agree with the reasoning of Mr. and Bacquelaine. In fact, the law says this: “If when he was still able to exercise the rights as set out in this law, the patient has made known, in writing, that he refuses his consent to a certain intervention of the professional practitioner, this refusal must be respected as long as the patient has not revoked it at a time when he is able to exercise his rights himself.” This means that unless an intervention is performed on an unconscious patient, who has previously writtenly refused this intervention, he will never be able to exercise his rights subsequently. Therefore, we submitted an amendment so that this refusal to intervene has only an indicative value for the practitioner who, in full legal certainty, will weigh the for and against of the intervention, in consultation with the patient’s environment. by

I would like to take the example presented by Mr. Bacquelaine: If a person today signs a document refusing a blood transfusion, but needs it five years later, it is possible that in the meantime changes will occur in his life, including a family burden or responsibilities towards relatives. Furthermore, relatives must be able to intervene and give their opinion so that the doctor can perform the act in question. They also have responsibilities towards their surroundings.

Let us try not to make an amalgamation. We were discussing the question asked by Mr. Mayeur, who mentioned the case of a conscious patient who refuses a blood transfusion because this act is contrary to his religious convictions. Generally, in such a case, the will of the patient is respected at the present time. But it is necessary to clearly distinguish the conscious patient from the unconscious patient.

If it is a conscious patient, other treatments are first given to relieve the illness but we will not carry out a blood transfusion. This is the thesis that is now being followed. The project under consideration does not revolutionize this situation at all.

But with regard to the unconscious patient, the care provider must carry out a thorough analysis of the situation. When he is faced with a prior refusal, he must check a whole series of elements: whether it was the person in question who formulated it and whether he was able to make such a decision at that time. If there is a doubt in this regard, the situation is special.

This means that in case of an emergency, it is the patient’s interest that prevails. It is clear! In other words, in an emergency where there is doubt, the doctor should try to save the patient. A number of conditions must be met, including the serious possibility, in a serious situation, for care providers to check the patient’s medical situation.

As for the question of responsibility, the care provider must ask the patient to communicate his consent or refusal in writing. If a conscious patient has formulated a refusal, it is clear that the doctor can no longer be worried afterwards.

I asked you the question before, I repeat it because you did not answer it. Article 422a of the Criminal Code for “non-assistance to anyone in danger”.

and yes!

I think it is important to ensure legal certainty for the medical body. I understand the philosophy of the bill. However, a doctor has the task of treating and healing the person who is presented to him. The situation of Jehovah’s Witnesses does not escape us. It seems unlikely to us that this community, respecting its philosophy, condemns some of its own to death by denying them care and blood transfusions. Will the attitude of Jehovah’s Witnesses be legitimized through this bill? by

Furthermore, what about a person who tries to commit suicide, who escapes from it and who, in writing, refuses any care and wishes to be let die? Is it considered that care should not be provided to this person? I admit the existence, through this bill, of a kind of obligation made to the doctor not to provide care. But how to reconcile this with Articles 422bis and 422ter of the Criminal Code, which require the doctor, in case of non-assistance to anyone in danger, to provide care to save life?

In this regard, two ethical conflicts may arise. I think that is a problem. As much as I can support the essence and philosophy of the bill, so much we must try, tomorrow, to avoid placing the doctors in an unbearable situation in relation to their oath.

As precisions are currently non-existent in the matter, doctors are ⁇ not safe, while the context created presents a clear codification. We could refer to other realities than Jehovah’s Witnesses, which have nothing to do with a situation in which a doctor is called. I think, for example, of the decision made by some people to no longer feed themselves as part of a prison. Even though it is known that the continuation of the hunger strike leads to death, it is forbidden to feed these people against their will. They must accept their decision.

Thatcher led a hunger striker to death with this kind of reasoning. I am not hiding my fears about this. There is obviously an ethical problem.

The fundamental principle of the right to refuse processing is an internationally recognised right. We are not talking about a request for assistance. The jurisprudence is increasingly moving in this direction.

Mr. Speaker, this is an exciting debate, but it strengthens me even more in my conviction, which I have subsequently put forward. If such a different view can still arise at this moment in this fundamental discussion or this law can still give rise to that interpretation, I am very concerned about the speed with which the Senate will also have to make a ruling. I would like to say to Mr. Eerdekens that on page 43 of the report — in so far as that report still means something — I have expressly asked the questions that Mr. Eerdekens now asks about the relationship between the provisions of the criminal court and the right to refuse treatment as now incorporated in the law. The Minister has answered the same as he has answered in the committee. None of the socialist group should now fall out of the air. This was the subject of the debate. It was then urged to support this. It also referred to the jurisprudence that would indeed confirm this position. I regret once again that this did not happen during the discussion in the committee.

I was surprised by the intervention of Mr. Valkeniers, the doctor, and by his plea concerning the number of lawyers. I wonder to what extent the Minister, by this project, does not open the way to enormous trials and enormous difficulties in the exercise of a profession which implies on the part of those who practice it an enormous responsibility and constant attention. by

To want to regulate everything, we will insecure a work of a very great humanity that is that of the doctor. I am upset that we get to such a drift because, Mrs. Minister, you want to constantly regulate everything that very often — and almost always — goes well. And you fall into this sin of the ecologists. You only dream of regulations; you dream of being integrist; you dream of taking the lesson. And you want to make sure that one must constantly go through regulations that you create from every room, while what people expect is the assurance that patients continue to be cared for by general and specialist doctors. Just trust the medical body and things will go well.

Mr. Speaker, I would like to ask a single question to Mr. Minister concerning, for example, an operation to be performed on a child. Let’s say that a surgeon believes that a child’s limb needs to be amputated and parents oppose it, because they think it’s premature or because they want to resort to other medicines. What happens in this case? What should the surgeon do?

This is clearly stated in Article 15, §1 of this project. It is expected that even if parents oppose an intervention — and this constitutes an innovation compared to the current situation — the doctor makes the choice in the patient’s interest. If parents say, “We don’t want amputation because we think it’s too difficult” and the doctor thinks it’s about safeguarding the child’s health, his choice will prevail.

How will he be able to prove it?

As is currently being done.

But will the doctor be better protected than before?

In my opinion, in such a situation, it will be better protected because this is clearly indicated, while until now, this point has not been settled. Belgium is the sixth European nation that is regulating things in this way.

Let me be surprised that such an interesting discussion must take place in a plenary session.

Ms. Herzet, in the problem you outline, the second opinion gets more and more in place. It is precisely through those discussions that doctors are also more likely to gain that second advice in order not to get conflict with the parents. This is a movement for the good. Which doctor has the truth in hand today? Second opinion is an enrichment.

Mrs. Minister, I do not remember that in the law on euthanasia we approved the aid in suicide. The example of the suicidal patient who ends up in the emergencies does not apply here. There the doctor must act as his conscience instructs him and the law obliges him to do so, otherwise you get trouble.

Mr. Speaker, my only comment from then on was that the general discussion here has been underway for hours now and that a number of things have been said very clearly. There are people who are just entering and they hear one element being pulled out of its context, causing the discussion to start again. That is the problem.

Mr. Speaker, I apologize, but that we are not denied the right to intervene in a plenary session, while we did not do so in a committee purely because we do not sit there. In this case, it will be necessary to insert in the Rules an article providing that only those who have intervened in the committee can still take the floor.

You are right, Mr Eerdekens. The report of a committee is drawn up in order to inform other members who are not members of the committee. There is free speech here, right?

Article 4 of the original draft spoke of a presumption of central responsibility for the hospital. As you know, we have not been able to maintain that by the advice of the State Council. However, an effort was made to go as far as possible. In this context, I would like to briefly address Mr Vandeurzen’s three questions.

He asked what the exact range of the first paragraph was. I would like to point out that in the draft it is stated that each hospital complies with the provisions within its legal capabilities. We know that there are several legal regulations. No matter how much you want, you can’t manage everything in one way. I give the example of the medical records, which he also mentioned. It has already been decided that medical records should be cared for. How exactly this will be arranged is not specified. Both doctors and hospitals have a part of the responsibility. This arrangement can be found in a number of general arrangements. The draft clearly states that the hospital monitors medical records for professional practitioners who do not have a statutory appointment or employment contract. This has a different dimension. When we talk about a contract, of course, Article 18 of the Law on the Employment Contract applies. The employer is actually responsible and responsible for what an employee does in his organization. For statutory staff members, the scheme is slightly different, but still largely inspired by it.

As I said in the committee, I want to make it clear that this is an effort commitment and not a result commitment. Therefore, one cannot impose it, but through general supervision one can ensure that attention is paid to it; one can make arrangements with the medical council et cetera.

He has criticized the fact that a hospital has to wait for a royal decision to be submitted first. The answer to this is that a hospital, of course, has the freedom to provide information about the general regime of the hospital. I would like to send a letter to the hospitals. In this, their attention would be focused on it. Moreover, it is in their own interest that they are not considered as centrally liable if the legal relations within the hospital do not allow that.

Finally, I confirm on behalf of the Government that we will indeed fulfill our promise of faultless liability. Premier Verhofstadt will immediately explain the various elements of the design related to it.

Mr. Speaker, as Ms. Aelvoet has already said, questions have been raised both in the committee and in the plenary session regarding the arrangements that the Government wishes to develop in connection with the medical responsibility. Monsieur le président, vous pouvez confirmer ici l'accord qui a été dégagé le 31 mai 2002 au sujet des lignes de forces d'un règlement relatif à la responsabilité médicale. The objective of the government is to translate these lines of the forces in an avant-project of the law before the end of the year, in such a way that the Parliament may put another statue at the beginning of the next year. In addition, I would like to point out that the purpose of the first draft law is to avoid the specific additional costs that may arise at the time of the introduction of a so-called no fault system for the compensation of damages related to health care in comparison with the damages currently paid by the insurance companies. The doctors also pay premiums for this. The introduction of such a no-fault system for compensation for damage related to healthcare should not result in a submission by the providers as a group. Mr. Valkeniers, for this reason, it is extremely important that an explosion of costs is avoided. We can best do this by, among other things, providing a clear definition of the damage eligible for compensation. We can also do so through a thorough preliminary study of the proposed remuneration system and the financial burden that would be associated with it. It is the intention of the government to carry out that thorough preliminary study when we come to the House with this draft. Costs can be kept as low as possible by simultaneously developing quality control and effective prevention mechanisms. These prevention mechanisms are always the best tool for reducing costs to a minimum. So, you want to confirm here that the government will come before the end of the year with an avant-project of the law on the medical responsibility in the conditions that I have enumerated.

Thank you well.

Mr. Speaker, of course, the Prime Minister makes an important statement that can motivate the majority to approve the rights of the patient. Mr. Prime Minister, you gave a small orientation of the draft. The question is, of course, whether the objective liability can be accumulated with the claims for the integral damage. You know this is one of the big discussions. If one chooses objective liability, is the concept of government of such nature that one can no longer claim for the whole of the damage? This is, of course, an essential question and I hope you can answer it. It is an orientative option, not a detail but essential. Is it a system that essentially excludes liability and must make a choice? Objective liability reduces the burden of proof. Otherwise, the ordinary liability procedure must be chosen. Is that the choice? Or is it cumulative? I would like to have a brief explanation from the Prime Minister.

Mr. Speaker, I discovered this matter through the plenary debate since I did not, like my colleagues, follow the work. I think Ms Aelvoet’s project is part of a good intention, but we can have concerns and fears about some of its aspects. Furthermore, the intervention of the Prime Minister allows, through medical responsibility, to address the whole problem. That said, we are about to vote on a project and we will, because we are in a majority for the worst and for the best. We will therefore vote for the proposal put forward by Ms Aelvoet, while feeling reassured by the statement of our prime minister because in the end, we don’t know very well where we are going.

Mr. Speaker, Mrs. Minister, I essentially share the questions and remarks that our friend Claude Eerdekens has just made and I find that he has the courage to say that we are in a majority for the worst and for the best. by

I have only one question to ask the minister, that is whether everything she has just said, she has said it in her own name or in the name of the government; that is the real problem. Because if it is on behalf of the government, I would still like to clarify that in a very legitimate way, beyond the bullshit that can occur, the medical body would have immense reasons to be ⁇ concerned tonight.

First of all, I would like to thank the Prime Minister for his statement. I think this is a statement that we have requested with various commission members. In part, this statement will also address the unrest and fear of legalization.

I have another question about the cryptic wording as if it would not involve any financial additional costs for the providers as a group. I assume that this will be answered in the preliminary study that the government has promised in this regard. It cannot be that a “shift” takes place from a given provider group to another group. I have some trouble with the cryptic description to include the additional costs in group.

I agree with the words of Mr. Eerdekens. We will approve this bill, but my group will remain vigilant when dealing with the next file.

I fully understand and share Mr. President’s concerns. by Eerdekens. That is why I ask him to support the amendment that I have submitted and which is precisely intended to make the entry into force of this law on the rights of the patient coincide with that on medical responsibility. This amendment was initially submitted by your colleague, Mr. Mayeur, and also supported by both MR colleagues and those of the VLD. This should only be a formality.

Mr. Speaker, I do not understand the reasoning of Mrs. Avontroodt as well as how a arrangement after the facts in the liability proceedings would prevent the jurisprudence. If the rights of the patient are included in a law, they are legalized. One creates rights and in this way one inevitably ends up in the discussion about responsibility. The more carelessly one defines those rights, the more discussions one will get about the extent of the liability. This is very logical. To say that a law at the end of the path stops the jurisprudence, that I do not understand.

Let me return to a fundamental question. The Prime Minister has given an orientation — for which a preliminary study needs to be carried out — of a bill concerning the responsibility of healthcare providers. I am not asking for the details, but for a fundamental option. Will the government choose a no-fault scheme, in which one can also claim full compensation through the classic scheme? Is this a cumulative choice? This is the whole concept, or the whole concept. I think the government has already made a choice.

I think this issue has already been discussed in the committee. It is evident that this is about the introduction of an objective liability scheme where it is no longer necessary to prove the error or a causal relationship in order to obtain compensation. This legal figure is also known in other parts of our law. For example, I think of the occupational accident insurance, where she has proven her validity.

This does not mean that the criminal aspect will be eliminated. If criminal offences have been committed, they will still be prosecuted and may eventually give rise to compensation.