Hospital Ethics Committees: one of many centers of responsibility.

Ethical reality is coextensive with human dignity. Therefore, one essential way to understand ethics is as the systematic effort to discern the imperatives of human dignity. Seeing ethics in this way highlights the fact that health care institutions have many centers of ethical responsibility (CERs) - the Chief Executive Officer, Board of Trustees, senior management team, etc. The Ethics Committee is only one such CER and not the most important one. These other CERs will benefit from identifying: (1) the fact that they are consistently dealing with ethical reality and making ethical decisions; (2) some critical elements of good ethical decision-making: (i) having the appropriate community; (ii) making the guiding value priorities explicit and specific; (iii) gaining skill in using the needed intellectual tools; and (iv) fashioning appropriate process and structure for discernment.

Governing boards as facilities' principal ethics committees.

Ethics is the systematic analysis of our (individual and organizational) behavior's impact on the dignity of persons. It is the disciplined approach to choosing the better alternative for respecting dignity. Any group that primarily deals with issues that have a deep and broad impact on the dignity of persons should be recognized as an ethics committee. In organizations such as hospitals, the chief among these groups is the board of trustees because governance responsibility concerns the most far-reaching and fundamental questions of the organization's life and its impact on its employees, patients, and community. Adequate ethical reflection requires four key elements: participation of the community of concern, that community which represents all the major aspects of the problem at hand; a consensus on fundamental value priorities; shared critical methodology and conceptual tools; and appropriate process and structures. The principal focus here is on the consensus of value priorities. An agreement on general values such as justice, charity, and compassion can be assumed to exist, but dealing with specifics reveals considerable diversity and even conflict. Therefore a group charged with governance responsibilities must build a consensus on the meaning of key values in terms of making specific decisions and then further specify these values in probing questions, key indicators, criteria, and auditing methods.

Facility's employment practices reflect affirmative action commitment.

The U.S. bishops' statements on racism over the last 40 years have addressed the structural as well as the personal aspects of racial discrimination. They have noted its persistence, described it as a moral and religious problem, and called for aggressive action among Catholics to combat it. "Meaningful equality" for blacks, however, remains a distant dream, the U.S. Supreme Court noted in a recent case involving institutional discrimination, because of the basically disadvantaged position into which blacks are born. As statistics on health, education, work, and standard of living illustrate, the socioeconomic opportunities available to blacks are markedly lower than those available to white Americans. Despite these odds, efforts to improve blacks' chances of contributing to society--through affirmative action programs--have achieved striking results in industry. Hospitals, as major workplaces, likewise should focus greater attention on developing and extending minority employment and advancement programs. Catholic health care facilities especially should evaluate their commitments to affirmative action. Increased efforts to eliminate discrimination in all aspects of a hospital's relationships with the business community as well as with its own employees will cause them to be recognized as symbols of justice not only in the workplace but also in society.

Incidence and extent of venous sequelae with intravenous diazepam utilizing a standardized conscious sedation technique.

Twenty-four periodontal patients volunteered for a study designed to investigate the incidence of venous sequelae with Injectable Valium administered by a standardized conscious sedation technique. Sedative doses were injected into veins on the dorsum of the hand utilizing a continuous infusion drip of 5% dextrose in water. Postoperative evaluation extended over 12 weeks. Ultrasonic tests for thrombosis were performed with a Doppler Flowmeter. Independent variables considered included age, vein size, volume of drug, volume of intravenous solution, pain upon injection and initial venous flow velocity. Sixteen subjects (66.67%) experienced some form of venous sequelae. Thirteen sequelae advanced to thrombophlebitis. Those subjects who demonstrated no complications had significantly higher initial venous flow than those with complications. Those subjects with resolution of complications demonstrated a significantly greater initial venous flow than those without resolution of complications. Clinical variables of pain on injection, vein diameter, dose of diazepam and volume of infusion solution did not significantly differ across groups. However, those subjects with no complications were significantly older than those with complications. It is recommended that the larger veins of the forearm and antecubital fossa, with greater mean velocities of venous flow, be preferred for intravenous diazepam administration to attempt to decrease the nature and incidence of thrombophlebitis.