Relationships explored for patients, caregivers

Association issues paper to explore ethics

The American College of Physicians (ACP) has issued a position paper to guide ethical relationships among patients, physicians, and caregivers.

The Journal of General Internal Medicine has published "Family caregivers, patients, and physicians: Ethical guidance to optimize relationships."1 The text and an online appendix of resources to help physicians manage relationships with patients and caregivers are available at The article is listed under "Individual position papers."

The paper defines caregivers as relatives, partners, friends, and neighbors of patients who assist with activities of daily living and complex health care needs. It outlines four primary principles for physicians, who might face ethical challenges collaborating with patients and caregivers while preserving the primacy of the patient-physician relationship:

• Respect for the patient's dignity, rights, and values should guide all patient-physician-caregiver interactions.

• Effective communication and physician accessibility are fundamental to supporting the patient and family caregiver.

• The physician should recognize the value of family caregivers as a source of continuity regarding the patient's medical and psychosocial history and facilitate the intellectual and emotional transition to the end stage of serious chronic illness.

• When the caregiver is a health care professional, the physician should draw appropriate boundaries to ensure that the caregiver is not expected to function in a professional capacity in relation to the patient and that the caregiver receives appropriate support, referrals, and services.

Although hospice and palliative care address the impact of illness on patients and families, the authors wrote, historically the patient-physician relationship has focused on the patient's rights and interests with less attention to the patient's experience within the context of family and social relationships, according to the authors. "Contemporary bioethics with its emphasis on patient autonomy and confidentiality has supported this model but is beginning to recognize the need for a family-centered approach," the authors add.


1. Mitnick S, Leffler C, and Hood VL, for the American College of Physicians Ethics and Human Rights Committee. Family caregivers, patients, and physicians: Ethical guidance to optimize relationships. J Gen Intern Med 2010. Doi 10.1007/s11606-009-1206-3.