In the 'civil law' approach or 'horizontal' approach patient rights are well defined rights actionable against specified parties that should be respected with no limitations as to the providers’ resources. The patient has a right of appeal to a Court or similar authority if they are not respected. If violation occurs, compensation and/or sanction can be imposed. One good model here is the Dutch law on medical treatment that has served as an example for other EU Member States .
In the ‘public law’ approach or ‘vertical’ approach the patient has no avenue for direct action against the healthcare provider.There are mainly obligations imposed on physicians and other healthcare providers often formulated as rights of patients, for instance in a legally binding code of medical deontology. In Nordic countries patient rights belong to this category.
The difference between the civil law and public law approach is mitigated by the recourse possibilities such as disciplinary procedures against medical professionals and complaint procedures against health care providers that exist in both systems. And in a public law or vertical system the civil law way may remain open for the patient in the case of malpractice. Also in a civil law approach additional protection to the patient may be offered in the so called vertical relation, using administrative legislation.
The existence of rights legislation according to the horizontal or the vertical approach does not exclude the possible application also of a policy document according to patient rights which are embedded in non-legally binding documents such as patient charters and non-binding codes of medical deontology. Moreover, the terminology used may mislead as to the nature of the rights of patients and the corresponding obligations of the physicians.