New Delhi: The Union health ministry has decided to implement a "charter of patients' rights" that includes, among others, the freedom for patients to choose medicines or diagnostic tests from sources other than those recommended by their doctors or hospitals.

The draft charter, prepared by the National Human Rights Commission, has outlined various rights that patients are entitled to under existing legal provisions and proposed a three-tier mechanism to address patients' grievances.

The charter, released by the health ministry on Thursday for public comments up to 30 days, has recommended that grievances should be addressed by internal grievance redress units in clinical establishments, then district-level authorities and then state councils for clinical establishments.

The document outlines patients' rights to information about their illness, proposed diagnostic tests, possible complications as well as likely additional costs due to changes in the course of the illness. Patients also have the right to emergency medical care irrespective of their paying capacity.

Amid long-standing suspicions about kickbacks being exchanged in the healthcare sector, the charter also asserts the right of patients to choose medicines or diagnostic services from any registered pharmacy or diagnostic centre.

Patients sometimes find themselves nudged towards specific diagnostic service outlets.

The charter has said "it is the duty" of treating doctors or hospital managements to inform patients that "they are free to access prescribed medicines or investigations from a pharmacy of diagnostic centre of their choice". Patients' decision should not in any way adversely influence the care provided by doctors or hospitals.

The charter's rights are linked to existing legal provisions - such as the Consumer Protection Act, the Medical Council of India's code of ethics, the National Consumer Dispute Redressal Commission's rulings and a Supreme court judgment on emergency care - but will require states to implement them.

However, health activists point out that the Clinical Establishment Act - a broad legislation to regulate healthcare services and assure patients of certain rights - passed by Parliament in 2010 remains largely unimplemented in most states.

"Such a charter is a good gesture, but not a quick remedy - implementation and enforcement will be a challenge," said K.M. Gopakumar, a legal adviser and senior researcher with the Third World Network, an international non-profit research and advocacy organisation.

The NHRC expects the charter to serve as a "guidance document" for the Centre and states to formulate concrete mechanisms to protect the patients' rights and "operational mechanisms to make them enforceable by law".

"This is especially important and an urgent need at the present juncture because India does not have a dedicated regulator like other countries," the NHRC said. "Another objective is to generate widespread public awareness and educate citizens regarding what they should expect from their governments and healthcare providers."

Patients' rights advocates have welcomed the list of rights and legal provisions underlying those rights. "Patients could use this to understand how their rights have been violated," said Malini Aisola, a coordinator with the All India Drug Action Network, a non-government consortium of doctors and patients' rights advocates.