Rule changes on hospital visitation

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Last week, President Obama ordered federal health officials to draft new rules requiring that hospitals which receive Medicare and Medicaid payments grant all patients the right to designate who can visit them and who can make critical care decisions.

The rules changes will also require that most hospitals recognize the visitation rights of gay couples.

The changes were motivated in part by the case of a woman from Washington state who collapsed while on vacation in Miami three years ago. Her partner was denied the right to be by the bedside and make medical decisions, despite showing proof that she was her partner’s designated health care proxy.

“Every day, all across America, patients are denied the kindness and caring of a loved one at their sides,” Mr. Obama said in his memorandum announcing the rule changes. “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.”

The memorandum also states that visitation privileges can not be denied, “on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability.”

Art Caplan, professor of bioethics at the University of Pennsylvania says the president’s edict is enormously important.

“When you don’t have that kind of legally recognized authority, many hospitals have been unwilling to grant standing to direct care to anyone who is outside the blood relatives or outside the marriage relationship. This solves that problem and also cuts back on the variability.”

Under the new rules, people are required to make a designation if they intend to appoint someone other than a spouse or family member to make health care decisions for them. This can be done through something called a surrogate or durable power of attorney.

“A surrogate decision maker is simply appointing someone to do decision making to you. It’s a simple step, an easy step. You need to tell the person that you’ve designated them … write it down, get it notarized, update it every couple of years.”

And make sure those who need to know — the decision maker, primary doctor, family and friends — have a copy of the document.

Also keep in mind that it will take some time for the rule changes to be implemented at hospitals, says Caplan.

“Just issuing a directive from Washington doesn’t mean that every hospital will know about it, understand how to implement it … I wouldn’t look for a change tomorrow morning. I think it’s going to take a least many months, if not a year or two, to really sweep through the system.”

While critics of the edict call it another big government overreach by President Obama, Caplan says it’s nothing of the sort.

“At the end of the day, this is consistent in fact, not with big government meddling, but with big government opening the door to let families, individuals who care for one another to work out their decisions in private.”

Read President Obama’s memorandum here.

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