The Ethical Foundations of Accompanying Patients: The Need for Institutionalization.

The partnership approach is part of a broader shift in healthcare that seeks to empower patients in their own care. Accompanying patients (APs) extend the concept of peer support. They are experienced patients who engage directly and individually with new patients, enhancing the partnership model. However, the ethical foundations of this role and the ethical tensions arising from its integration are underexplored. To identify the key skills and values required by APs and the ethical tensions they experience, we conducted a qualitative study based on in-depth interviews with nineteen APs between January and May 2021 in Québec, Canada. Interviews explored motivations, skills, values, and experiences in healthcare institutions. Thematic analysis was complemented by Tannahill's public health ethics framework to interpret the ethical tensions identified. The core values identified for this role were empathy, respect, and altruism. All participants agreed that experiential knowledge was paramount. APs identified independence from healthcare institutions as the key to connecting and developing a trusting relationship with patients. However, they also expressed a need to be part of the healthcare system to ensure the sustainability of their role. Our results show an ethical tension between the philosophical core of APs and their needs to pursue their functions. We conclude that independence and authenticity as an AP is not necessarily incompatible with institutionalization, professionalization, and remuneration. These can be achieved if AP programmes are aligned with the philosophy of patient partnership, structured with flexible criteria, and remain self-regulated.