and France (in 2002) and Cyprus (in 2005).

At the international level, prominent examples of documents about patients’ rights include:

• The Declaration on the promotion of patients' rights in Europe of March 1994. This resulted from an initiative of the World Health Organization Regional Office for Europe;
• The Ljubljana Charter on Reforming Health Care of 1996 (also a W.H.O. initiative);
• The Council of Europe’s 1997 Convention on Human Rights and Biomedicine. Despite its name, this Convention also deals with patients rights in general; and
• The “European Charter of Patients’ Rights”, drafted under the auspices of an Italian-based NGO called the Active Citizenship Network.

Varieties of rights

In contemporary legal and political debate, the language of rights is increasingly used to assert and to recognize the legitimacy of a wide variety of claims and interests. Look, for example, at a modern document such as the Charter of Fundamental Rights of the European Union. The Charter was proclaimed at the Nice summit of the European Council in December 2000 and forms Part II of the Constitution Treaty for Europe. It constitutes the European equivalent of a Bill of Rights. In the Charter, we find not only individual rights, but also statements of principle that could imply group or collective rights, such as prohibitions on making the human body and its parts a source of financial gain, and on reproductive cloning. These prohibitions are included in Article 3 of the Charter on the “right to the integrity of the person”.

That is not because I consider these questions as unimportant, but because the issues are different from those involved in individual rights.

The introduction to the 1995 version of the French Charter for hospital patients expresses well the approach that I am adopting: “[a] hospital patient is not just someone who is sick. He is first and foremost a person with rights and duties”. I should add: that goes for all patients, not just those in hospital.

3 Categories of individual rights

In my view, the individual patient’s rights fall into three categories:

• Rights to redress, including compensation;
• Rights of access to medical care; and
• Autonomy rights.

These three categories of rights are best understood as the concretization of certain fundamental human rights.

I will briefly discuss the first two categories before focusing on the autonomy rights and the doctor-patient relationship.

Rights to redress

The most fundamental right to redress is the right to bring proceedings in a court of law. This is a traditional civil right associated with the principle of the rule of law. It can be found in Article 6 of the European Convention on Human Rights and Article 47 of the Charter of Fundamental Rights.
In the medical context, the right to go to court provides the most fundamental guarantee of the autonomy rights that I shall discuss later. It may also be an appropriate way to enforce certain rights of access to medical care.

The right to compensation if medical care falls below an acceptable standard also comes under this heading. I will not discuss this complex question in detail, but only to point out that there are basically two legal pathways to the provision of compensation, each of which has its own particular costs and benefits.

The first is litigation. As already mentioned, this is the traditional and fundamental pathway to justice. As the example of the United States illustrates, however, lawsuits about medical negligence can become big business, not always to the benefit of patients.

The second pathway is a compensation scheme, which may be based on no-fault liability. Such a scheme may be offered to patients as an alternative to court proceedings. From my perspective as an Ombudsman, I will add that rights to redress are not just about damages or compensation. Complaints provide complex organizations, such as hospital

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