THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release April 15, 2010
April 15, 2010
MEMORANDUM FOR THE SECRETARY OF HEALTH AND HUMAN SERVICES
SUBJECT: Respecting the Rights of Hospital Patients to
Receive Visitors and to Designate Surrogate
Decision Makers for Medical Emergencies
There are few moments in our lives that call for greater
compassion and companionship than when a loved one is admitted
to the hospital. In these hours of need and moments of pain and
anxiety, all of us would hope to have a hand to hold, a shoulder
on which to lean -- a loved one to be there for us, as we would
be there for them.
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.
For all of these Americans, the failure to have their wishes
respected concerning who may visit them or make medical
decisions on their behalf has real consequences. 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. It means that a stressful
and at times terrifying experience for patients is senselessly
compounded by indignity and unfairness. And it means that all
too often, people are made to suffer or even to pass away alone,
denied the comfort of companionship in their final moments while
a loved one is left worrying and pacing down the hall.
Many States have taken steps to try to put an end to these
problems. North Carolina 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" -- a right that applies in every
hospital in the State. Delaware, Nebraska, and Minnesota have
adopted similar laws.
My Administration can expand on these important steps to ensure
that patients can receive compassionate care and equal treatment
during their hospital stays. By this memorandum, I request that
you take the following steps:
1. Initiate appropriate rulemaking, pursuant to your
authority under 42 U.S.C. 1395x and other relevant provisions
of law, to ensure that hospitals that participate in Medicare
or Medicaid respect the rights of patients to designate
visitors. 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.
2. Ensure that all hospitals participating in Medicare or
Medicaid are in full compliance with regulations, codified at
42 CFR 482.13 and 42 CFR 489.102(a), promulgated to guarantee
that all patients' advance directives, such as durable powers
of attorney and health care proxies, are respected, and that
patients' representatives otherwise have the right to make
informed decisions regarding patients' care. Additionally,
I request that you issue new guidelines, pursuant to your
authority under 42 U.S.C. 1395cc and other relevant provisions
of law, and provide technical assistance on how hospitals
participating in Medicare or Medicaid can best comply with the
regulations and take any additional appropriate measures to
fully enforce the regulations.
3. Provide additional recommendations to me, within
180 days of the date of this memorandum, on actions the
Department of Health and Human Services can take to address
hospital visitation, medical decisionmaking, or other health
care issues that affect LGBT patients and their families.
This memorandum is not intended to, and does not, create any
right or benefit, substantive or procedural, enforceable at
law or in equity by any party against the United States, its
departments, agencies, or entities, its officers, employees,
or agents, or any other person.
You are hereby authorized and directed to publish this
memorandum in the Federal Register.
BARACK OBAMA
