Ethical codes and the health professions: looking at the ACHCA code.

Codes play an important role in both the development of professions as well as provide ethical guidance for their members. They should be recognized as an aggregate "best" effort to define the moral expectations and boundaries of professional behavior and practice. In addition, they cannot and should not be viewed as a means of policing professional standards given their lack of formal legal backing. Finally, they should be amended as needed. With respect to the ACHCA Code, while not attempting to be overly specific and allowing for reasonable professional interpretation, it is well designed and addresses most of the major attributes found in such formal statements. Coupled with parallel documents addressing "standards of practice" and a more detailed listing of "patients rights," long-term care professionals should be prepared to meet most of the difficult professional challenges facing them.

Euthanasia and long-term care: values of the long-term care professional.

Nursing home administrators and other long-term care professionals appear positively predisposed toward respecting the autonomy of residents in decisions involving euthanasia and assisted-suicide.

Ethical and legal issues confronting college health.

More than 11 million students currently attend institutions of higher education in the United States. While this segment of the population traditionally constitutes a young, healthy cohort, experience demonstrates that college and university health services play a critical role in assuring student health maintenance, completion of school, consumer health education, and the development of sound health practices and behaviors. In examining institutional policies and protocols governing the support and the delivery of student health services, several critical ethical issues emerge from both a macro and micro orientation. As university and college resources become more scarce and budget decreases increase, institutions are reestablishing priorities. Oftentimes, the question of continued support of campus based health services is raised. Suggestions range from discontinuing their operation, to dramatic decreases in their services, to requiring them to become fully self-sufficient (i.e., through mandatory prepayments or fee-for-services mechanisms and elimination of general fund support). At a macro level, such discussions raise issues associated with social justice and whether the universities and colleges should serve in a loco parentis (paternalistic) role. This essay more specifically addresses several micro issues that directly impinge on the delivery of health services to millions of college and university students.

Computers, medical records, and the right to privacy.

Recent advances in computer technology permit the accumulation, analysis, and storage of an unlimited quantity of medical record information, thereby seriously compounding existing controversies surrounding patient confidentiality and privacy. This article surveys both benefits and problems arising from this increased availability of medical records. It examines legal and ethical dilemmas arising from the conflict between the usefulness of patients, in particular their right to privacy. The article suggests guidelines for insuring fair and balanced health information policies.