Ethics committees are continually challenged by matters of identity. Does its membership reflect a fair representation of health care disciplines? Does the committee have the institution's or the patient's best interests at heart? Just when ethics committees seem to be getting a handle on these matters, the political environment is changing, with more hospitals becoming involved in managed care systems. So the question persists, but at a different level. The following articles summarize various ideas being proposed as solutions.
{"title":"Articles address issues of integrated systems, authority, and payment.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Ethics committees are continually challenged by matters of identity. Does its membership reflect a fair representation of health care disciplines? Does the committee have the institution's or the patient's best interests at heart? Just when ethics committees seem to be getting a handle on these matters, the political environment is changing, with more hospitals becoming involved in managed care systems. So the question persists, but at a different level. The following articles summarize various ideas being proposed as solutions.</p>","PeriodicalId":79630,"journal":{"name":"Hospital ethics","volume":"10 5","pages":"10-2"},"PeriodicalIF":0.0,"publicationDate":"1994-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21007870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Decisions program looks to regionalization.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79630,"journal":{"name":"Hospital ethics","volume":"10 5","pages":"12-3"},"PeriodicalIF":0.0,"publicationDate":"1994-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21055445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Defining the specific ethical issues anticipated under integrated health care delivery systems is difficult for several reasons: (1) We don't know with certainty what structures, processes, and rules will be in place, and (2) the lines of authority and accountability are still unsettled. Despite these unknowns, everyone seems fairly certain that managed care processes within a structure of managed competition will be permanent and prominent fixtures in the reformed environment of health care. The following articles summarize three recent articles on life under managed care. The first two reflect the concerns of physician-ethicists, and the third makes an effort to think of ethical obligations at the organizational level.
{"title":"Ethical questions under managed care begin to surface in the literature.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Defining the specific ethical issues anticipated under integrated health care delivery systems is difficult for several reasons: (1) We don't know with certainty what structures, processes, and rules will be in place, and (2) the lines of authority and accountability are still unsettled. Despite these unknowns, everyone seems fairly certain that managed care processes within a structure of managed competition will be permanent and prominent fixtures in the reformed environment of health care. The following articles summarize three recent articles on life under managed care. The first two reflect the concerns of physician-ethicists, and the third makes an effort to think of ethical obligations at the organizational level.</p>","PeriodicalId":79630,"journal":{"name":"Hospital ethics","volume":"10 5","pages":"7-9"},"PeriodicalIF":0.0,"publicationDate":"1994-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21007582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A problem area certain to become a tough nut to crack in years to come is the extension of patient rights and autonomy to a more stringent level within the informed consent process in situations covering education, research, and epidemiology. Recent events and reports indicate at least an acknowledgment of some specific issues that need attention, as the following articles show.
{"title":"Consent evades consensus.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A problem area certain to become a tough nut to crack in years to come is the extension of patient rights and autonomy to a more stringent level within the informed consent process in situations covering education, research, and epidemiology. Recent events and reports indicate at least an acknowledgment of some specific issues that need attention, as the following articles show.</p>","PeriodicalId":79630,"journal":{"name":"Hospital ethics","volume":"10 5","pages":"5-6"},"PeriodicalIF":0.0,"publicationDate":"1994-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21007864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Patient refusal of food and water--a way out of the aid-in-dying debate?","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79630,"journal":{"name":"Hospital ethics","volume":"10 5","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"1994-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21007861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Applying the principles of decision making to end-of-life situations has been discussed at length in the medical ethics literature, but published accounts of actual experiences encountered when life-sustaining interventions are withdrawn have been limited. Once the decision is made to withdraw treatment and the goal of care shifts from cure to palliation, attention must be given to the clinical and ethical processes involved in extricating patients from their high-tech dependencies. The following articles summarize the work of several groups that are trying to define what ought to be done on behalf of these patients.
{"title":"Care of the dying. Studies look for humane ways of withdrawing treatment.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Applying the principles of decision making to end-of-life situations has been discussed at length in the medical ethics literature, but published accounts of actual experiences encountered when life-sustaining interventions are withdrawn have been limited. Once the decision is made to withdraw treatment and the goal of care shifts from cure to palliation, attention must be given to the clinical and ethical processes involved in extricating patients from their high-tech dependencies. The following articles summarize the work of several groups that are trying to define what ought to be done on behalf of these patients.</p>","PeriodicalId":79630,"journal":{"name":"Hospital ethics","volume":"10 4","pages":"10-1"},"PeriodicalIF":0.0,"publicationDate":"1994-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21006771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevorkian's acquittal of violating Michigan's assisted-suicide ban and a federal court's ruling that Washington state's ban on assisted suicide is unconstitutional say more about the inability of the judicial process to provide clear guidance through ethical quagmires than they do about ethical issues at hand, as the following articles explain.
{"title":"Physician-assisted suicide. Legal rulings skirt around ethics of aid-in-dying.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Kevorkian's acquittal of violating Michigan's assisted-suicide ban and a federal court's ruling that Washington state's ban on assisted suicide is unconstitutional say more about the inability of the judicial process to provide clear guidance through ethical quagmires than they do about ethical issues at hand, as the following articles explain.</p>","PeriodicalId":79630,"journal":{"name":"Hospital ethics","volume":"10 4","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"1994-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21006769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Discussions of values reappear in health reform debate.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79630,"journal":{"name":"Hospital ethics","volume":"10 4","pages":"14-5"},"PeriodicalIF":0.0,"publicationDate":"1994-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21006543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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