From ethics to palliative care: a community hospital experience.

One of the most vulnerable and voiceless groups of patients within American hospitals and institutions today are those who are dying. Health care institutions struggle with the challenge of providing excellent palliative and end-of-life care to patients while providing curative therapies at the same time. This article describes the efforts and accomplishments of the ethics committee of a community hospital system to provide for the palliative and end-of-life needs of its patients.

Catholic health care's community-benefit role.

"While contemporary Catholic health care and other not-for-profit health care institutions excel in quality, innovation and technology, they remain community-benefit organizations, founded and sustained because of community need," Sister Carol Keehan, a Daughter of Charity who chairs the board of trustees of the Catholic Health Association of the United States, said in May 26 testimony in Washington before the House Ways and Means Committee, which conducted a hearing on the tax-exempt hospital sector. Keehan chairs the board of Sacred Heart Health System in Pensacola, Fla. She spoke the day after Sen. Chuck Grassley, R-Iowa, announced that the Senate Finance Committee, which he chairs, had asked 10 nonprofit hospitals or health systems to account for their charitable activities in light of their tax-exempt status. Rep. Bill Thomas, R-Calif., chairman of the Ways and Means Committee, said at the House hearing that "the standards for tax exemption are not just an academic debate." In reviewing the broad ways Catholic hospitals benefit local communities, Keehan stressed that the services of Catholic hospitals are not provided "to justify continued tax exemption" but because serving communities in this way is integral to their identity and mission. Keehan's text follows.

The benefits of serving on a hospital ethics committee: a faculty perspective.

Community hospitals ethics committees rarely have formal support from persons within the academic community. The author discusses a liaison between a suburban hospital system and a nearby university school of nursing that garners positive educational, service, and programmatic benefits, related to ethics, for both. The lessons learned and insights gained by a faculty member serving on the ethics committee are examined.

Cooperation or co-optation?: Assessing the methodological benefits and barriers involved in conducting qualitative research through medical institutional settings.

In this article, the authors highlight some benefits of and barriers to doing qualitative research in association with hospital-based services. They first describe an ongoing qualitative research project that involves interviewing women about their post-sexual assault medicolegal experiences in hospital-situated sexual assault centers across a large Canadian province. Their methodological journey led them to engage program coordinators at these centers to assist with locating participants and qualified interviewers, and with negotiating the demands of their respective research ethics boards. They outline the ways in which their project was shaped, positively and negatively, by working with them in medical institutions. They conclude by recommending that hospitals and hospital ethics boards counteract tendencies toward paternalism by recognizing the value of feminist qualitative research contributions to the activities of their own sexual assault centers and to the recovery of sexually assaulted women. Such recognition might be productively engaged by adopting an ethics-in-process approach.

Providing life-saving health care to undocumented children: controversies and ethical issues.

Pediatricians and hospitals with special pediatric expertise are facing the dilemma of rationing care to uninsured, undocumented children, especially for expensive life-saving care such as transplants, chemotherapy, and dialysis. This article reviews a relevant case history and provides a review and discussion of the ethical and policy issues associated with this problem.

Toward a typology of confidentiality breaches in health care communication: an ethic of care analysis of provider practices and patient perceptions.

Confidentiality should be a fundamental right of patients in a health care setting. However, health care providers who take an oath to uphold confidentiality often neglect this basic patient right. Breaching confidential health information is a serious ethical problem and a communication issue that, historically, has received limited empirical, theoretical, or practical attention. The goals of this project were to frame this issue from an ethic of care perspective, define the concept of a confidentiality breach, identify the types of confidentiality breaches being communicated in health care organizations, and understand how patients perceive these breaches. Based on interviews with 51 patients and observations of health care providers, a definition and typology of confidentiality breaches emerged. Theoretical and practical implications also became evident.