Intimacy in Hospital Care: Where Sterility Ends and Dignity Begins. A Proposal of Standards for Long-Term and Palliative Care

Abstract

Background:Intimacy, privacy, and patient sexuality remain frequently marginalized topics in hospital practice. Although the World Health Organization defines sexual health as an integral component of overall well-being, in the clinical reality of follow-up and palliative care these needs often encounter barriers related to institutional routines and an emphasis on environmental “sterility.” From a quality management perspective, this represents an area with an increased presence of latent risks, which may manifest as ethical dilemmas, patient complaints, or reputational harm to healthcare providers.Aim:The aim of this study is to propose an implementable framework of standards that reconciles requirements for care safety with the protection of patient dignity and intimacy in inpatient healthcare settings.Methods:A narrative review of the literature and relevant professional recommendations was conducted, complemented by an analysis of the Czech legal framework. The proposed standards were structured according to A. Donabedian’s quality model (structure–process–outcome) and supplemented with auditable indicators.Results:The analysis confirmed that barriers to the protection of intimacy are more often systemic in nature (e.g., physical environment, unclear responsibilities) rather than the result of individual professional failure. The paper presents a set of eight process-based standards addressing areas ranging from governance and environmental design (“privacy by design”)to specific approaches to assessing consent in patients with cognitive impairment.Conclusion:Intimacy in hospital care should not be regarded as an optional extra, but as an integral component of care quality and safety. The implementation of clear and structured processes not only protects patient dignity but also provides essential legal and ethical support for healthcare professionals.