Because of increasing pressure on healthcare, hospitals are developing new ways of organising care. One example is training informal carers to perform medical actions normally performed by professionals. Think of changing an infusion pump or injecting a muscle. Martin Buijsen, Professor of Health Law at Erasmus School of Law, appeared in a De Telegraaf article on the subject. “You would like medical acts to all be performed by professionals but there just aren't enough of them anymore.”
Buijsen emphasises that the practice of informal carers performing medical acts is not new. "Currently, informal carers already perform medical acts. Think of the informal carer who helps a not always willing partner with diabetes administer insulin subcutaneously. That informal carer can also make a miscalculation and administer more units than necessary. That too can be dangerous", Buijsen says. He explains that informal carers who take on such tasks should be properly educated and trained to minimise these risks.
Buijsen believes the legal implications are limited, as long as work is done according to guidelines based on the best available scientific evidence. "Civil and disciplinary liability for professional healthcare providers and institutions are minor when it is done using evidence-based guidelines", explains the professor and he therefore advocates the development of good professional standards that oversee the education and training of informal carers.
Weighing up the pros and cons
Asked whether the government should develop policies to support this practice, Buijsen responded cautiously. "These are initiatives that emerge ‘from the field’. The motives behind these initiatives also vary widely. Sometimes it is related to technology that the patient or their informal carer performs actions at home independently. Sometimes it is born of necessity that this happens because, for example, home care simply does not have the professional manpower." According to Buijsen, for now the government needs to limit itself to monitoring to prevent informal carers from providing suboptimal care where professional care would be better.
Buijsen points to two important ethical considerations in shifting medical actions to informal carers: efficiency and patient-centred care. "After all, there are medical acts that informal carers could perform just as well as professional carers with some education and training. And informal carers cost nothing. The second is the pursuit of what is called ‘patient-centred care." After all, patients prefer to receive care at home rather than in an institution. This is often possible while maintaining quality. And then informal care also enters the picture", says Buijsen.
Voluntary and protected?
Training informal carers to perform medical procedures can only be on a voluntary basis, Buijsen stresses. "The motives for not cooperating can be very different but whatever they are, ultimately refusals can only be respected. Care providers then have to provide an alternative." But according to Buijsen, it is not said that you will then get district nursing. "For more and more acts, you no longer get an indication for care at home", he says. "And then the government has no duty of care." At this, Buijsen points out that the law cannot prescribe rules for dealing with these refusals; this is a matter of professional standards.
Specific laws or regulations protecting informal carers when they perform medical procedures do not currently exist. However, Buijsen sees no need for additional legislation. "Protection must - as always in care - come from good professional standards. If these could be developed in consultation with patient associations and interest groups of informal carers and volunteers, this should suffice", he concludes.
- Professor