[Federal Register Volume 75, Number 75 (Tuesday, April 20, 2010)]
[Presidential Documents]
[Pages 20511-20512]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-9211]


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  Federal Register / Vol. 75, No. 75 / Tuesday, April 20, 2010 / 
Presidential Documents  

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 Title 3--
 The President

[[Page 20511]]

                Memorandum of April 15, 2010

                
Respecting the Rights of Hospital Patients to 
                Receive Visitors and to Designate Surrogate Decision 
                Makers for Medical Emergencies

                Memorandum for the Secretary of Health and Human 
                Services

                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

[[Page 20512]]

                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.
                
                
                    (Presidential Sig.)

                THE WHITE HOUSE,

                    WASHINGTON, April 15, 2010

[FR Doc. 2010-9211
Filed 4-19-10; 8:45 am]
Billing code 4110-60-P