s and public health care systems, with essential feedback on the quality of services. Justified complaints are an opportunity not only to apologize for mistakes and provide compensation if appropriate, but also to help avoid similar problems from arising in the future. Proper handling of a complaint, with a fair procedure, provides an opportunity to explain what has been done and can often satisfy the complainant.

Rights of access to medical care

As regards rights of access to medical care, the first point to note is that the general right not to be discriminated against applies in the field of medical care. Non-discrimination does not require any particular level of service, but forbids unjustified variations. In the European legal order, the substantive right to medical care is a social right, which requires government to ensure, directly or indirectly, the availability of adequate provision.

The right can be found in the European Social Charter (Article 13) and the United Nations’ International Covenant on Economic, Social and Cultural Rights (Article 12), but is set out most clearly in the Charter of Fundamental Rights.

The first sentence of Article 35 of the Charter states: that “everyone has the right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices.”

How government is to secure this right to citizens, and the general level of service to be provided, are matters of debate.

In this connection, I would like to draw your attention briefly to the case-law of the European Court of Justice concerning the conditions under which patients may claim re-imbursement in their own Member State for treatment obtained in another Member State. Although the legal basis of this case law is the freedom to provide services, it also has great significance for rights of access to health care in the European Union.

Autonomy rights

The third category of rights, and those which I propose to devote most attention to, are what I call autonomy rights.

To talk about autonomy in the context of medical care may seem at best a polite fiction. The paradigm of the patient is a person who is suffering from an illness, or dysfunction, and who needs treatment in order to become well.

The process of treatment is in many cases almost the opposite of what we normally understand by autonomy. Think, for example, of an anaesthetized patient undergoing an operation.

Furthermore, there are many different conceptions of autonomy. Some of them have even been used to justify coercion, as Isaiah Berlin, the great Oxford political philosopher who recently passed away, pointed out in his famous 1969 essay on liberty.

To explain what I mean by autonomy and why the autonomy rights are fundamental to the idea of patients’ rights, we need to examine the doctor-patient relationship.

In doing so, we shall draw on two well-known pieces of published work. The first is by Professor Edward SHORTER, holder of the Hannah Chair in the History of Medicine at the University of Toronto, on the history of the doctor-patient relationship. The second is by Linda and Ezekiel EMANUEL (respectively now Professor of Medicine and Director of the Buehler Center on Aging at Northwestern's Feinberg School of Medicine and Chair of the Department of Clinical Bioethics at the National Institutes of Health, Bethesda, Md), presenting four ideal-typical models of that relationship.

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