«PROFESSIONAL DEVELOPMENT AND RESOURCE SERIES *Formerly published as “Vital Bonds” by NHPCO, 2001 HOSPICE AND PALLIATIVE CARE PREAMBLE Considered ...»
GUIDELINES FOR HOSPICE AND PALLIATIVE CARE
CLINICAL AND ORGANIZATIONAL CONDUCT*
PROFESSIONAL DEVELOPMENT AND RESOURCE SERIES
*Formerly published as “Vital Bonds” by NHPCO, 2001
HOSPICE AND PALLIATIVE CARE PREAMBLE
Considered to be the model for quality, compassionate care for people facing a life- limiting illness or injury, hospice and palliative care services provide a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes. These services are delivered with sensitivity to the fact that, as hospice and palliative professionals, we have entered into people’s lives and affairs during a period of heightened need and potential vulnerability.
Through its work in supporting providers and professionals and offering education to the public, the National Hospice and Palliative Care Organization serves as an advocate for patients facing the end of life and their families. Through its standards, policies and procedures, NHPCO seeks to promote an ethical corporate culture among its members, involving both internal and external relationships.
NHPCO encourages all its members to provide services which are grounded in fundamental ethical principles of healthcare. These principles include Autonomy, Beneficence, Nonmaleficence, and Justice. In addition to these four, Conscientious Objection is a highly held principle, encouraging people to speak up when a situation or circumstance is contrary to their beliefs.
The National Hospice and Palliative Care Organization offers this Hospice and Palliative Care Code of Ethics as a guideline to hospice and palliative care programs and professionals to assist them in assuring that hospice and palliative care throughout the country is provided in accordance with the highest standards of ethical behavior.
Recognizing that situations do and will arise when ethical principles conflict, the National Hospice and Palliative Care Organization recommends that every hospice and palliative care program have a process and format in place to deal with situations arising from these conflicts.
Ethical Principles: Guidelines for Hospice and Palliative Care Clinical and Organizational Conduct
NHPCO ETHICAL PRINCIPLES:
GUIDELINES FOR HOSPICE AND PALLIATIVE CARE
CLINICAL AND ORGANIZATIONAL CONDUCT*
TABLE OF CONTENTSINTRODUCTION
HOW USE THESE PRINCIPLES GUIDELINES
TO AND NHPCO’S ETHICAL PRINCIPLES (Overvie
Care and Services
Conflicts of Interest
Development and Fundraising
Discontinuation of Care
Employee and Volunteer Relations
External Collegial Relationships
Information Management, Confidentiality and Privacy
Marketing and Referrals
GLOSSARY KEY TERMS
OF 2006 ETHICS COMMITTEE
NHPCO LEADERSHIP TEAM
*Formerly published as “Vital Bonds” by NHPCO, 2001
INTRODUCTIONThe National Hospice and Palliative Care Organization (NHPCO) advances the philosophy and practice of hospice and palliative care with the goal of profoundly enhancing quality of life for people dying in America and their loved ones. NHPCO serves as a voice and resource for its members and the field of hospice and palliative care.
NHPCO envisions a world where individuals and families facing serious illness, death, and grief will experience the best that humankind can offer. Our mission is to lead and mobilize social change for improved care at the end of life.
THOSE SEEKING TO IMPROVE THE QUALITY OF LIFE FOR PEOPLE NEARING THE END
OF LIFE MUST ASSUME THE RESPONSIBILITY OF GREAT TRUST. THIS RESPONSIBILITY
GOES BEYOND LEGAL OR BUSINESS OBLIGATIONS. IT IS A CRUCIAL RELATIONSHIP
THAT MUST BE WELL TENDED AND NOURISHED. IN FACT, THE PATIENT AND FAMILY
ARE, AND MUST BE, THE CENTER AROUND WHICH EVERY CONVERSATION,
DECISION, AND ACTION OF THE ORGANIZATION REVOLVES.
NHPCO believes it is crucial to establish ethical guidelines that will help assess our accountability to the individuals and the communities we serve. Though common sense is foundational, it is not sufficient in providing guidance to hospice and palliative care professionals as they navigate the complex and often confusing waters of the hospice and palliative care field.
An organization with clearly articulated ethical principles, and a thorough commitment to those principles, is better positioned to respond more effectively in times of crisis and change than one without such guidelines.
These guidelines build upon the previous policies and guidelines that NHPCO has developed (see Resources section in the Appendix). While these documents provide direction, the current business environment in healthcare and the world in general, has created the need for additional attention to ethical and transparent business, clinical, and organizational practices.
1 Ethical Principles: Guidelines for Hospice and Palliative Care Clinical and Organizational Conduct The rapidly changing healthcare environment and the ever-increasing pressures on healthcare providers often lead to a feeling of uncertainty regarding “the right thing to do.” Fundamental political shifts, emergence of managed care, increasing competition, consolidation, downsizing in the general healthcare arena, technological advances, potential workforce shortages, and an atmosphere of intense government, media, community, and citizen scrutiny have led to a situation in which new and difficult legal and ethical issues are regularly presenting hospice and palliative care leaders with difficult business and organizational decisions.
While the issues above play an important role in healthcare, hospice and palliative care organizations, many of the overwhelming ethical issues do not have a business or legal orientation, but are intimate, profoundly personal life and death situations involving relationships between end-of-life care professionals and those for whom they are providing care. These relationships and the manner in which they are handled are critical to gaining and keeping the trust of the patient, family and the public, which is the essential basis for the work of hospice and palliative care.
An increased awareness of individual and organizational ethics can build a culture that celebrates trust — a culture that is also compliant with laws and regulations. It also encourages a commitment to a sustained ethical environment that can be a direct force in heightening the excellence, efficiency, productivity, and morale of any healthcare organization.
In hospice and palliative care, our touchstone should extend beyond legalities and bioethics to provide enduring support — guiding us through constant business, organizational and regulatory changes, internal and external pressures, and the sensitive nature of our work.
NHPCO is committed to working with hospice and palliative care organizations to ensure these principles and guidelines are effectively understood and implemented in programs across the country. We believe they will help hospice and palliative care providers foster the highest possible ethical standards in serving the needs of their patients, their families and their communities.
There are a variety of ways in which these Principles and Guidelines can be used by the hospice and palliative care community. They can
provide guidance at two different — but intersecting — levels:
N at the organizational level — both internally and externally;
N at state and national levels.
At the same time, however, these principles and guidelines are intended to be a living and vibrant set of guidelines for each organization and should be viewed as a roadmap for ongoing assessment and implementation of necessary changes. They are designed to be adapted, customized, and modified according to the unique characteristics of each hospice and palliative care organization. Note that regardless of the organization’s proprietary status, tax status or religious orientation, Board members, employees and volunteers are not exempt from inducement issues or other ethical and compliance concerns that are described in this document.
Each topic includes a Principle, its Intent, Guidelines for following the Principle, and Examples of actions or situations related to the principle that have been designated as “Optimal” or “Not Recommended”.
NHPCO hopes that the information provided will assist in decisionmaking that cultivates and deepens the trust placed in hospice and palliative care organizations.
Given its nature, this document should not be viewed as establishing standards of conduct or practice generally applicable to hospice or palliative care organizations, and its contents are not intended to be used by others for legal, regulatory or enforcement purposes.
Guidance at the Organizational Level Internally These Principles and Guidelines have been designated as an educational tool for all the individuals who comprise the organization — leadership, staff, and volunteers.
They should be helpful in creating governing body and employee meetings and discussions concerning organizational ethics issues, more formal educational sessions, and policy formation and review. In addition, they can be used as a benchmark against which to gauge overall clinical and organizational ethics efforts.
The Principles and Guidelines will also help to develop an organizational structure and culture that meets both voluntary and mandatory standards promulgated by other institutions. Two increasingly common approaches are to develop a separate organizational ethics committee or to charge an existing ethics committee with organizational ethics issues.
The Principles and Guidelines are an excellent source of information for educating members of the community who come into contact with or can support the organization. They also offer a framework for relationships with other healthcare providers in the community — be they local, regional, statewide or as part of a network. Hospice and palliative care organizations have much to learn from one other, and a sharing of best practices, policies, successes — and even failures — in the clinical and organizational ethics area will help fulfill organizational missions in a more complete way.
Guidance at State and National Levels
The Principles and Guidelines provide a helpful means through which the overall hospice and palliative care industry can actively ensure organizational standards meet the high standards the public expects. They can be used by state and national hospice and palliative care organizations to facilitate their efforts and further the trust relationships with other entities.
These Principles and Guidelines also will aid hospice and palliative care organizations — at all levels — to maintain an industry and regulatory environment which strengthens the trust placed in them by their stakeholders and enable them to offer services to everyone who is in need of hospice and palliative care.
ETHICAL PRINCIPLESMembers of the National Hospice and Palliative Care Organization should subscribe to and practice the following principles.
Care and Services Provide patients and their families with the highest possible level of quality end-of-life care and services, while maintaining professional boundaries that respect their rights and privacy.
Discontinuation of Care Discontinue care only upon the voluntary consent of the patient, when the patients is no longer medically eligible, or when the organization cannot provide care without compromising the ethical or professional integrity, or the safety, of its employees.
Information Management, Confidentiality and Privacy Respect and protect confidential information.
B. Employees and Volunteers
EXTERNAL RELATIONSA. Hospice Market (other hospices, suppliers, payers) External Collegial Relationships Work cooperatively with other healthcare providers, suppliers and payers to provide compassionate and competent end-of-life care.
B. Donors Development and Fundraising Be open and transparent in soliciting and accepting financial and/or in-kind support.
C. General Public Access Promote universal availability of comprehensive hospice and palliative care services, in diverse healthcare settings and with specific emphasis on reaching traditionally underserved populations.
Marketing and Referrals Follow marketing and referral practices that promote compassionate, high-quality care for patients and their families.
Public Information Develop and disseminate accurate, honest and timely information about hospice, palliative care and other end-of-life issues to local, state and national communities.
D. Society Research Support the advancement of knowledge to improve the provision, quality, and outcomes of hospice and palliative care.
Note: Due to the overlapping nature of external and internal relations, and to enable easier use of this document the following “Principles and Guidelines” are listed alphabetically by topic.