The White House is requesting that Health and Human Services (HHS) Secretary Kathleen Sebelius initiate rulemaking to lift restrictions on unrelated visitors to act as surrogate decision-makers and to visit hospitalized patients. The memo, issued Thursday, said the ruling would affect hospitals that participate in Medicare or Medicaid.
"It means that doctors and nurses do not always have the best information about patients' medications and medical histories, and that friends and certain family members are unable to serve as intermediaries to help communicate patients' needs," the memo said.
One of the groups that would be impacted by the request are "gay and lesbian Americans who are often barred from the bedsides of the partners with whom they may have spent decades of their lives unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated."
But other individuals would be impacted as well, including widows or widowers with no children who are "denied the support and comfort of a good friend," and members of religious orders are "sometimes unable to choose someone other than an immediate family member to visit them and make medical decisions on their behalf."
The White House noted that individual states have begun to change the law. North Carolina, for instance, recently amended its Patients' Bill of Rights to give each patient "the right to designate visitors who shall receive the same visitation privileges as the patient's immediate family members, regardless of whether the visitors are legally related to the patient." Delaware, Nebraska, and Minnesota also have passed similar laws.
The rulemaking should make it clear that designated visitors—including individuals designated by legally valid advance directives (such as durable powers of attorney and healthcare proxies)—should "enjoy visitation privileges that are no more restrictive" than those that immediate family members enjoy.
The rulemaking also should take into account the need for hospitals to "restrict visitation in medically appropriate circumstances, as well as the clinical decisions that medical professionals make about a patient's care or treatment," the memo said.
In response to Obama's executive order, the American Hospital Association said, "Hospitals' first responsibility is to our patients and their care. We recognize how important family support is to a patient's well-being and we work hard to involve patients and their loved ones in their care. That's why hospitals encourage patients to fill out advance directives and make their wishes known.
"The executive order states that changes will take place through the federal rule-making process, including guidance on how hospitals can best comply with new regulations. We will look forward to details of the new regulations as well as direction on coordinating with states laws.
"Hospitals' top priority is caring for patients and we will continue to engage patients as active members of the care team," AHA said.
Christine Burch, executive director of the National Association of Public Hospitals and Health Systems, said she was "heartened" by Obama's order.
"I think the fact that you can have by your bedside the person who knows you the best and knows what you want is a significant step in providing good care. Overall, it's heartening. It's a good step," she said.