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Hospital Ethics

  • Dennis F Thompson

Hospital ethics, familiar enough in practice but surprisingly neglected in the literature, deals with the ethical problems that arise distinctively or typically in hospitals. More precisely, it consists of the ethical principles that shouldgovern 1) the conduct of healthcare professionals and other staff in their capacities as members of the hospital as an institution, and 2) the conduct of the hospital itself as an institution. It is a species of institutional ethics, which focuses on the ethical problems created or significantly shaped by the institutional setting in which they occur.

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1. Jonsen, AR, et al. , Clinical Ethics. 2nd ed. New York: Macmillan, 1986.

2. Baldrige, P, Kauffman, S, Hopkins, C.Institution and documentation of universal precautions. Internal Memo to Department Heads, Massachusetts General Hospital, January 19, 1988.

3. Hilts, PJ.Many hospitals found to ignore rights of patients in AIDS testing. New York Times 1990 Feb. 17:1.

4. The latest, and one of the most serious, version of the charge that we are spending too much on healthcare is a humane essay by a liberal: Callahan, D.What Kind of Life: The Limits of Medical Progress. New York: Simon and Schuster, 1990.

5. For an early statement of rationale for this role division, see Fried, C. Rights and health care–beyond equity and efficiency. New England Journal of Medicine 1975;293:241–5.See also Brody, BA. The macro-allocation of health care resources. In: Saas, HM, Massey, RU, eds. Health Care Systems: Moral Conflicts in European and American Public Policy. Dordrect: Kluwer Academic Publishers, 1988:213–36.

6. The American system, unlike the more centralized British system, offers no assurance that resources not spent on one patient will be used on other more needy patients. See Daniels, N. Why saying no to patients in the United States is so hard: Cost containment, justice and provider autonomy.New England Journal of Medicine 1986;314:1381–3.

7. Stauss, MJ, LoGerto, JP, Yeltatzie, JA, et al. Rationing of intensive care unit services. Journal of the American Medical Association 1986;255:1143–6.

8. Faced with a reduction of ICU beds from 18 to 8 (because of a shortage of nurses), physicians informally rationed beds so that patients at greatest risk of myocardial infarction were more likely to be admitted. See Singer, DE, Carr, PL, Mulley, AG, et al. Rationing intensive care – physician responses to a resource shortage. New England Journal of Medicine 1983;309:1155–60.

9. Rosenthal, E. Crowding causes agonizing crisis in intensive care. New York Times 1989 Aug. 22:C11.

10. Engelhardt, HT, Rie, MA.Intensive care units, scarce resources, and conflicting principles of justice. Journal of the American Medical Association 1986;255:1159–64.

11. Taffet, G, Teasdaale, TA, Luchi, RJ.In-hospital cardiopulmonary resuscitation. Journal of the American Medical Association 1988;260:2069–72.

12. Younger, SJ.Do-not-resuscitate orders: no longer secret, but still a problem. Hastings Center Report 1987;17:24–33.

13. See note 12. Younger. 1987;25.

14. Flood, AB, Scott, WR.Hospital Structure and Performance. Baltimore:Johns, Hopkins, 1987;and Hollingsworth, JR.Controversy about American Hospitals: Funding Ownership and Performance. Washington, D.C. American Enterprise Institute, 1987.

15. Cohen, CB.Ethics committees: birth of a network. Hastings Center Report 1988; 18(1): 11.

16. Wikler, D.Institutional agendas and ethics committees. Hastings Center Report 1989; 19(5):2123.

17. Cohen, CB.Ethics committees: is case consultation in retreat? Hastings Center Report 1988:18(5): 2324.

18. Murray, T.Where are the ethics in ethics committees? Hastings Center Report 1988; 18(1): 1213.

19. Fost, N, Cranford RE. Hospital ethics committees: administrative aspects. Journal of the American Medical Association 1985;253:2687–92.

20. Siegler, M.Ethics committees: decisions by bureaucracy. Hastings Center Report 1986; 16(3):22.

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Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
  • URL: /core/journals/cambridge-quarterly-of-healthcare-ethics
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