The Council on Ethical and Judicial Affairs of the American Medical Association examines physicians’ professional ethical responsibility in the event that the security of patients’ electronic records is breached.

*The views expressed are the author's own. This article should not be construed as representing policies of the American Medical Association.

*Disclaimer: The views expressed are the author's and should not be ascribed to the American Medical Association.

Interdisciplinary hospital ethics committees have been the most common response to the mandates for ethical review procedures set forth by the Joint Commission for the Accreditation of Health Care Organizations, the American Hospital Association, and within institutions themselves. A 1989 national survey reported that 60% of hospitals had ethics committees. However, little is still known about the current state of these committees in hospitals, their composition, what functions are performed, or what issues are discussed.

Hospitals long ago shed their role as alms houses for the poor. What vestiges remain of the early American hospital are the tax-exempt, nonprofit hospital form and a general perception that hospitals, as charitable institutions, owe a duty to their communities. The appropriateness of the nonprofit hospital tax exemption has long been debated, and many theories have been advanced to justify the tax exemption of nonprofit hospitals. In a growing number of jurisdictions, however, state and local (...) authorities have gone beyond the theoretical debate and are challenging the tax exemption of their nonprofit hospitals. For various reasons, efforts are afoot to capture greater community benefit from nonprofit hospitals.At the heart of such challenges is the debate over the nature and extent of the duty charitable institutions owe to their communities. A demand is growing for nonprofit hospitals to earn their tax exemptions by benefiting their communities in concrete ways. Some have been stripped of their tax-exempt status by local authorities or pressured to make payments in lieu of taxes. A number of states have recently implemented initiatives in an attempt to make hospitals more accountable for their community benefits. Many hospitals are responding to this heightened scrutiny in a proactive way, by voluntarily documenting community benefits. A number of nonprofit hospitals and hospital associations are cooperating with—or even sponsoring—state legislation in this area. (shrink)

Hospitals long ago shed their role as alms houses for the poor. What vestiges remain of the early American hospital are the tax-exempt, nonprofit hospital form and a general perception that hospitals, as charitable institutions, owe a duty to their communities. The appropriateness of the nonprofit hospital tax exemption has long been debated, and many theories have been advanced to justify the tax exemption of nonprofit hospitals. In a growing number of jurisdictions, however, state and local (...) authorities have gone beyond the theoretical debate and are challenging the tax exemption of their nonprofit hospitals. For various reasons, efforts are afoot to capture greater community benefit from nonprofit hospitals.At the heart of such challenges is the debate over the nature and extent of the duty charitable institutions owe to their communities. A demand is growing for nonprofit hospitals to earn their tax exemptions by benefiting their communities in concrete ways. Some have been stripped of their tax-exempt status by local authorities or pressured to make payments in lieu of taxes. A number of states have recently implemented initiatives in an attempt to make hospitals more accountable for their community benefits. Many hospitals are responding to this heightened scrutiny in a proactive way, by voluntarily documenting community benefits. A number of nonprofit hospitals and hospital associations are cooperating with—or even sponsoring—state legislation in this area. (shrink)

We attempt to identify and evaluate the association between key characteristics of not-for-profit hospitals and market concentration, as measured by the Herfindahl–Hirschman Index, using data available from the American Hospital Association, the Centers for Medicare and Medicaid Services, and the Internal Revenue Service Form 990. Our goal is to provide decision support to policy makers on factors that contribute to market competitiveness, which has been linked to improvements in efficiency, costs, and access to health care. We (...) find that contributions are positively associated with market concentration. This could indicate that well-run NP hospitals are rewarded both financially as well as with increased market share. We also find that a higher percentage of Medicare patients is positively correlated with market concentration. This could be explained by the fact that Medicare reimbursement rates are generally lower than those paid by private insurers ; thus, hospitals might not necessarily choose to operate in areas with high Medicare populations. Further, median income is negatively associated with market concentration. One explanation for this effect could be the fact that a population with a higher median income is in a better position to pay for services, making them attractive to hospitals as a potential market. Finally, we find that the presence of managers with voting rights on the boards of directors has no significant impact. (shrink)

The Ancient Mariner’s killing of the albatross is described by Coleridge as a great act of “inhospitality.” The central virtue dealt with in The Odyssey is hospitality.Religious traditions and cultures throughout the world prize hospitality as a major virtue. Philosophy, for some reason, has proven the exception. Hospitalityis missing from just about any philosopher’s list of virtues. Few discussions of ethics pay attention to it. This essay explores why hospitality has been so prominent in literature but ignored in philosophy. What (...) Santayana called the “sedentary city mind,” typical of Modern thought, which replaced the medieval “pilgrim mind,”is seen as a key move leading philosophers to marginalize hospitality. The move to rehabilitate hospitality, I claim, can draw inspiration and sustenance from asurprising source: Jacques Derrida. (shrink)

The Ancient Mariner’s killing of the albatross is described by Coleridge as a great act of “inhospitality.” The central virtue dealt with in The Odyssey is hospitality.Religious traditions and cultures throughout the world prize hospitality as a major virtue. Philosophy, for some reason, has proven the exception. Hospitalityis missing from just about any philosopher’s list of virtues. Few discussions of ethics pay attention to it. This essay explores why hospitality has been so prominent in literature but ignored in philosophy. What (...) Santayana called the “sedentary city mind,” typical of Modern thought, which replaced the medieval “pilgrim mind,”is seen as a key move leading philosophers to marginalize hospitality. The move to rehabilitate hospitality, I claim, can draw inspiration and sustenance from asurprising source: Jacques Derrida. (shrink)

The annual volume of ethics consultations (ECs) has been a topic of interest in the bioethics literature, in part because of its presumed relationship to quality. To better understand factors associated with EC volume, we used multiple linear regression to model the number of case consultations performed in the last year based on a national survey. We found that hospital bed size, academic affiliation, and urban/rural location were all associated with EC volume, but were not the primary drivers. Instead, (...) these variables affected EC volume through three other variables, all of which relate to ethics staffing: the percentage of case consultations performed by a single individual; whether the survey respondent’s main role at the hospital contained the word “ethics”; and especially, the number of full-time ethics program staff. We conclude that EC is an example of supply-sensitive care, and further research is needed to determine the optimal level of EC activity. (shrink)

Background Few studies have been conducted to assess the quality of orientation practices for ethics advisory committees that conduct ethics consultation. This survey study focused on several Harvard teaching hospitals, exploring orientation quality and committee members’ self-evaluation in the American Society of Bioethics and Humanities ethics consultation competencies. Methods We conducted a survey study that involved 116 members and 16 chairs of ethics advisory committees, respectively. Predictor variables included professional demographics, duration on committees and level of training. Outcome variables (...) included familiarity with and preparedness in the ASBH competencies and satisfaction with orientations. We hypothesised that responses would be associated with both the aforementioned predictors and whether or not participants had encountered the ASBH competencies in training. Results A majority of respondents found their orientation curricula to be helpful, although a significant portion of respondents did not receive any orientation or were unsatisfied with their orientation. Familiarity with ASBH competencies was a statistically significant predictor of respondents’ self-evaluation in particular categories. Standard educational materials were reported as offered during orientation, such as readings and case studies ; different medium resources were less evidenced such as videos on ethics consultation. Conclusions Institutions should re-evaluate orientation practices for ethics committee members that perform ethics consultation. Integrating ASBH competencies and useful methods into a resourceful pedagogy will help improve both member satisfaction with orientation and preparation in consultation. (shrink)

Periodic and unexpected shortages of drugs, biologics, and even medical devices have become commonplace in the United States. When shortages occur, hospitals and clinics need to decide how to ration their available stock. When such situations arise, institutions can choose from several different allocation schemes, such as first-come, first-served, a lottery, or a more rational and calculated approach. While the first two approaches sound reasonable at first glance, there are a number of problems associated with them, including the inability to (...) make fine, individual patient-centered decisions. They also do not discriminate between what kinds of patients and what types of uses may be more deserving or reasonable than others. In this article I outline an ethically acceptable procedure for rationing drugs during a shortage in which demand outstrips supply. (shrink)

Professions have traditionally treated advocacy as a collective duty, best assigned to professional associations to perform. In North American nursing, advocacy for issues affecting identifiable patients is assigned instead to their nurses. We argue that nursing associations’ withdrawal from advocacy for patient care issues is detrimental to nurses and patients alike. Most nurses work in large institutions whose internal policies they cannot influence. When these create obstacles to good care, the inability of nurses to affect change can result in (...) avoidable distress for them and for their patients. We illustrate this point with a case study: the circumstances of the death of Michael Joseph LeBlanc, an inmate at Kingston Penitentiary Regional Hospital (Ontario). We conclude that patients and their nurses will suffer unnecessarily unless or until nursing associations cease to burden individual nurses with the responsibility for patient advocacy. (shrink)

Assessing the vast arena that continues to grow in pursuit of accountability in American hospitals, this paper raises the following question: Is this enterprise geared toward making hospitals better or toward making them only look better? ‘Accountability’ has become an umbrella concept to signal the need to demonstrate — to others — that performance is being measured and perfected. The author asserts that there is an imperfect fit between health‐care and the industrial model being used to measure quality of (...) care due to four problematic issues: the nature of contemporary patient care, the overstating and overselling of accountability proposals, inflated expectations placed upon ‘rationalization’, and insufficient attention afforded accident and error. The paper concludes with a plea for reconsideration of the tilt toward a business approach to health‐care, asking if, in our zeal to hold hospitals accountable, we are measuring what is important or simply making important what we can measure. (shrink)

This paper considers the maturation of the American Catholic tradition of social and economic thought in the seminal period between 1920 and 1940, particularly as encapsulated in the work of John A. Ryan. While different social ethical models emerged in the American Church during this time, the dominant school of thought was the liberal tradition associated with Ryan. This tradition, which Ryan described as "true economic liberalism," forged American political liberalism and papal critiques of secular modernity into (...) a new social ethical theory which became the capstone of prewar Catholic progressivism. True economic liberalism first manifested itself in critiques of the Supreme Court's description of "freedom" in Adkins v. Children's Hospital (1923). It took positive form during the 1920s in the widespread Catholic embrace of industrial democracy as a moral alternative to laissez-faire capitalism It was during the 1930s, however, when the Church confronted the economic crisis of the Great Depression, that true economic liberalism became a more totalizing system of social thought. It was also during the 1930s that this theory revealed the difficulties Catholic liberals have had in defining their relationship to a market economy and the state. On one hand, true economic liberalism provoked the creative maturation of Catholic thought and established the Church as a leading progressive critic of capitalism. At the same time, true economic liberalism circumscribed the possible depths of the Catholic moral critique. American Catholics liberals were so committed to constructing a social ethic that upheld "the priceless goods of liberty, opportunity, and democracy," that they accepted a reformed capitalism, guarded and chastened by religion, as the most desirable outcome for a modern economy. As John P. Carroll revealingly wrote, "The remedy, then, for the social evils. . . does not lie in the destruction of the present social system. The way to clean a house is not to dynamite it." By accommodating the Church's social ethic to the ideals of American democracy, liberal Catholics rejected radical reforms in favor of moderate legislative schemes which one writer described in Commonweal as "sniping at capitalism." It was for this reason that so many Catholics fawningly embraced the New Deal and, indeed, found in Franklin Roosevelt the supreme advocate for the principles set forth in Pius XI’s 1931 Quadragesimo Anno. (shrink)

This article provides a critical analysis of the evolution and impact of hospital-sponsored women's health centers. Using original data gathered from interviews, participant observation, and content analysis of documents and brochures, the authors describe the development of four models of hospital-sponsored women's health centers and illustrate three specific mechanisms of the co-optation process. They show how many elements of feminist health care were used for the purpose of marketing and revenue production rather than for empowering women and transforming (...) the delivery of care. Following Stratigaki's notion of negative countereffect, the authors show how the key feminist concepts of women-centered care and empowerment ended up contradicting their original meaning and purpose. Rather than being the subject of care, women became the object of treatment and revenue production. (shrink)

This book traces the further development and emergence of American philosophy, particularly Naturalism and Pragmatism, against the backdrop of still-dominant Hegelian philosophy, during the third decade of the 20th century, through the addresses and biographies of the presidents of its oldest and largest philosophical society. Of special interest is the previously unpublished presidential address of Henry Walgrave Stewart, second president of the Pacific Division of The American Philosophical Association. The work contains the biographies, photographs, and addresses of (...) 24 past presidents, and photographs and addresses of others. No other publication has collected the presidential addresses of this, the largest society of philosophers, during its third decade of existence, and in no other publication are the biographies and photographs of all of its presidents available. While some histories of this period in 20th century American philosophy have been written, and while some collections of articles by philosophers exist which include writings of some of these individuals, none has concentrated on a representation of the leadership of. (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and medicine, (...) truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

Ever since the U.S. Attorney General named health care fraud as the government's second highest priority after violent crime, the government has cracked down on health care fraud and abuse. Some of this crackdown has been needed. The General Accounting Office estimates that as much as 10 percent of all government expenditures on health care are being siphoned out of the system because of fraud or abuse.The extreme measures taken to curb health care abuse have raised eyebrows, however. The (...) class='Hi'>American Medical Association and the American Hospital Association both have been vocal in their disapproval, describing the current enforcement initiative as “absolutely out of control.” The associations even went so far as to file suit to enjoin the government's actions. (shrink)