HIPAA – Empowering the Patient

Recently the enactment of the new HIPAA* regulations with regard to privacy have added an extra and troubling burden to the delivery of spiritual care. Those compelled to implement the privacy laws struggle to reconcile the conflicting obligations of providing patients with access to spiritual care while simultaneously protecting their right to confidentiality.

There are numerous places where the concerns about HIPAA have been carefully explained and the various “rules” and “players” defined. The negative ramifications of HIPAA are frequently documented, not just by those involved in the effort to deliver spiritual care, (who seem to have taken a heavy hit by the changes brought about by HIPAA) but by many others impacted by the cumbersome changes. There are still misinterpretations of HIPAA being applied in healthcare facilities that impinge on the rights of patients, clergy, and chaplains, and those still need to be addressed. This short essay should not be seen as an effort to negate those concerns, but rather to offer another perspective.

The intention for HIPAA has been to insure privacy for each person rendered vulnerable to unwarranted exposure by either well-meaning or unscrupulous practices involving patient information. Implementation of these protective changes has shaken up the way things “had always been done” with and for patients. The results have been somewhat disorienting, but change is almost always disorienting. If that inherent discomfort were removed from the equation, HIPAA – as it relates to spiritual care services – is actually all about empowering, not just protecting patients. The new rules return to patients the right to take charge in a way and at a time when there is very little autonomy allotted them! What “had always been done” involved clergy having the freedom to visit patients without patients having the opportunity to gracefully decline. There were many scenarios in which the pastor/patient visit in the hospital proved awkward and disquieting for patients, but since the rules of the hospital and the rules of pastoral propriety favored visitation, patients had little choice.

In the hospital setting, patients are accustomed to sacrificing their right to making small choices once they’re admitted. Other than what to have for breakfast and the right to leave without being treated, patients have few opportunities to exercise autonomy or control (and sometimes even breakfast is prescribed). Consequently, the lack of autonomy with regard to a pastoral visit was consistent with the rest of the hospitalization. Spiritual care was provided during clergy visits, so both clergy and hospital had fulfilled their obligations, but at what cost? The new changes may result in the loss of unsolicited, but possibly salutary pastoral contact, but the reward is that HIPAA returns some modicum of autonomy to the patient during their care.

If HIPAA were fully understood, supported and implemented, pastoral visits would still occur – but as a result of the patient’s request and at a time of his or her choosing. Rather than pastors, priests, and rabbis routinely initiating visits to very sick patients – patients who may or may not be comfortable while under-dressed, over-medicated, or following embarrassing surgeries – clergy can now respond to the parishioners' defined needs and at a time when they might really be open to the spiritual content of the visit.

It seems to me that patients’ being empowered to say when and whether to be visited by their clergy has a distinctly positive, even spiritual value – a reminder that despite whatever physical vulnerability brought them into the hospital, they are still able to exercise functional free will and moral agency. Empowerment strengthens overall outcomes and the conscious involvement patients take in their own healing processes. It may be a stretch to attach such lofty results to HIPAA’s convoluted legalistic rhetoric, but each time I distill it down I’m left with the same basic answer – HIPAA’s shift in control from the hospital and the pastor to the patient has the potential to be a good thing!

* The U.S. Health Insurance and Portability Act (HIPAA) which took effect in April 2003 established privacy standards that provide patients with access to their medical records and more control over how their personal health information is used and disclosed. For more information visit http://www.os.dhhs.gov/news/facts/privacy.html

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