PHILADELPHIA, March 20, 2023 – The American College of Physicians (ACP) today published a paper offering ethical guidance on policies for family visitation in hospitals and long-term care facilities, recommending that policies should be guided by, evidence, and a strong presumption in favor of preserving opportunities for caregiver support/visitation, including during public health emergencies. “Ethical Guidance on Family Caregiving, Support, and Visitation in Hospitals and Residential Health Care Facilities, Including During Public Health Emergencies: An American College of Physicians Position Paper” was published in The Journal of General Internal Medicine.
The paper was developed by ACP’s Ethics, Professionalism and Human Rights Committee in response to the concern that many institutions continue to restrict or prohibit caregivers at the bedside, raising questions of whether restrictive visitation policies were/are supported by ethical principles and best-available medical evidence.
Early in the COVID-19 pandemic – when faced with uncertainty about the virus and its transmission, rapid spread of a novel pathogen, high death tolls, and health care systems stretched to their limits – hospitals and other facilities implemented severe visitor restrictions to protect public health. Yet restrictive visitor policies did not evolve in keeping with emerging medical knowledge, increased PPE supplies, vaccination availability, and evidence demonstrating the harms of such policies.
Additionally, patients with disabilities, communication challenges, and cognitive or psychiatric impairments are particularly vulnerable without caregiver presence. The unintended harms of visitor restrictions include social isolation and loneliness, impaired or delayed medical decision making and dying alone. Families and caregivers were also found to experience poor bereavement and healthcare workers similarly suffered emotional distress in accompanying patients through the dying process.
“Loved ones and families of patients are not mere ‘visitors’,” said Ryan D. Mire, MD, MACP, President, ACP. “They provide emotional support, assist in the daily activities of patients, and meet important psychosocial needs. Most patients benefit from the care they receive from their families and those who rely on family caregivers are harmed the most by visitor restrictions.
“There must be an ethical approach to patients, families, and loved ones who are vital to their care,” Mire added.
In the paper, ACP recommends the following:
- Ethical principles and scientific evidence should guide development of health care facility visitation policies. Policymakers and administrators must consult with relevant stakeholders, including physicians and other health care team members, as part of this process before implementing policy.
- Visitation policies and those who implement them must recognize the value of loved ones/family caregivers to patients and include them as sources of continuity of care and supporters of patient autonomy.
- During public health emergencies, visitation policies must evolve in keeping with continuous reassessment of risks and benefits as new evidence emerges.
- Physicians have a responsibility to advocate for patients and family caregivers. Visitation policies must respect and safeguard the dignity, rights, relationships, and values of all patients, with special regard for the vulnerable and marginalized. Policies should be clearly communicated to patients and families in understandable language and include readily accessible appeals procedures.
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About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 160,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Instagram, and Facebook.
ACP Media Contact: Andrew Hachadorian, (215) 351-2514, AHachadorian@acponline.org