The Second Rule of Hospitals

The first rule of hospitals is to try to stay out of them. Unfortunately, that rule must sometimes be broken. So let me suggest a second rule: no one should be alone in a hospital.

Hospitals can work miracles, saving lives and improving quality of life. But they can still be dangerous and (ironically) inhospitable places. Patients need someone by their side not just to provide comfort, but often to monitor their care and act as their advocate.

A natural corollary is that patients should be free to choose as their companions and advocates whomever they most trust in those roles.

I thus find it astounding that, at least until last night, hospitals could refuse to honor advance directives in which a patient had specified who they wanted to have visitation rights and the power to make decisions on their behalf. As President Obama wrote in a memo to HHS Secretary Sebelius:

Yet every day, all across America, patients are denied the kindnesses and caring of a loved one at their sides — whether in a sudden medical emergency or a prolonged hospital stay. Often, a widow or widower with no children is denied the support and comfort of a good friend. 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.

Also uniquely affected 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.

The President’s executive order forbids this conduct for any hospitals that receive Medicare or Medicaid money:

It should be made clear that designated visitors, including individuals designated by legally valid advance directives (such as durable powers of attorney and health care proxies), should enjoy visitation privileges that are no more restrictive than those that immediate family members enjoy.

You should also provide that participating hospitals may not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. The rulemaking 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.

Sounds right to me.

7 thoughts on “The Second Rule of Hospitals”

  1. Yes, but unfortunately, it still remains to be seen how long this will take to implement, and even longer to get the affected hospitals to actually abide by it. We will see a lot of “private” hospitals begin to refuse Medicare and Medicaid patients just so they can continue their discriminatory policies, simply because president Obama’s memo includes sexual orientation and gender identity/expression in it. This is a long overdue policy, but without having anything in force to prevent hospitals from remaining discriminatory, we will see even fewer hospitals that will accept patients who are on Medicare and Medicaid due to being associated with the Religious Reich and especially the radical elements of the Religious Reich.

  2. This is a positive change – if it has teeth. Unfortunately, hospitals are no place to go it alone. Just from personal experience alone I’ve seen how essential it is to have an advocate. In the best of circumstances, that means having someone to serve as a central point of information, since in our current system communication between multiple doctors with each other and the nursing staff is either hampered or crippled. In the worst of circumstances, I’ve seen this situation endanger a family member’s life. Until medical teams develop new and effective methods for accurately tracking information and communicating, they are obligated to provide alternatives. Far too many preventable mistakes occur in hospitals. If they won’t take steps to create the institutional change to prevent them, they have no business obstructing patients who wish to protect themselves.

  3. Mr. Walter, if a privately-owned hospital chooses not to accept Medicare or Medicaid patients (and thereby voluntarily deprives itself of federally-subsidized payments for same), because this ruling is offensive to its governing religious or moral principles, what do you care? You have the same right not to patronize that hospital, as that hospital has not to accept federally-subsidized patients.

    Further, although my personal preference, like yours, is that individuals be left alone to appoint whomever they wish to direct their medical care as necessary, your use of emotionally charged language such as Religious Reich, serves only to undermine your overall statement.

  4. When someone is trying to get it into our law that the only form of religious freedom is theirs, then I see that as the same as Nazism. If you disagree, that is your prerogative. My opinions stand, and when you think about it, it takes a reich to be able to hide crimes committed against children for over a century the way a certain group who joined with the Mormons to pass discriminatroy legislation that should never have gotten on the ballots because it is so shamefully unconstitutional, and was only passed through using fear, lies, and intimidation. All of these are signs of a REich.

  5. Also, why are theyallowed to use emotionally charged rhetoric and language, but those of us who are the ones ultimately harmed by their language not alowed to use it?

  6. Huh?

    Most hospitals liberalized visiting policies 20 years ago, just about anyone can walk in, unless 1) the patient does not want them their or 2) it is ICU, CCU or the like.

    (On occasion the family will have issues with the significant other, but that is hardly the fault of the hospital.)

    As far as advanced directives, this is largely controlled by state law. In the states with which I am familiar, a person can appoint just about any sane adult as a health power-of-attorney (disclaimer – I am not familiar with all state laws).

    The real problem comes about when a single adult (of any orientation) is unable to make their own decisions and there are no health POA or other directives. Usually the only default is parents, if they are still alive and able.

    All persons, and especially single adults, should have some sort of advanced directive valid in the state of residence.

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