An Ethics Casebook for Hospitals: Practical Approaches to Everyday Cases

An Ethics Casebook for Hospitals: Practical Approaches to Everyday Cases

An Ethics Casebook for Hospitals: Practical Approaches to Everyday Cases

An Ethics Casebook for Hospitals: Practical Approaches to Everyday Cases


This collection of thirty-one cases and commentaries addresses ethical problems commonly encountered by the average health care professional, not just those working on such hightech specialties as organ transplants or genetic engineering. It deals with familiar issues that are rarely considered in ethics casebooks, including such fundamental matters as informed consent, patient decision-making capacity, the role of the family, and end-of-life decisions. It also provides resources for basic but neglected ethical issues involving placement decisions for elderly or technologically dependent patients, rehabilitation care, confidentiality regarding AIDS, professional responsibility, and organizational and institutional ethics.

The authors describe in detail the perspectives of each party to the case, the kind of language that ethicists use to discuss the issues, and the outcome of the case. A short bibliography suggests useful articles for further reading or curriculum development.

Easily understood by readers with no prior training in ethics, this book offers guidance on everyday problems from across the broad continuum of care. It will be valuable for health-care professionals, hospital ethics committees, and for students preparing for careers in health-care professions.


This book is a collection of cases with commentary and bibliographic resources designed especially for educational efforts in hospitals. Most of the cases were submitted from hospitals not affiliated with an academic health science center. They reflect the day-to-day moral struggles within the walls of hospitals typically described as community hospitals. While most of the hospitals were labeled "community," they vary greatly. Some are rural, others suburban, and a number are situated in urban settings. Bed capacity ranges from 40 to 400; some were tertiary care facilities; some had mature ethics committees while others were struggling to develop an ethics mechanism. Nonetheless, one common element was that "research" was not a major emphasis nor was the teaching of residents usually a priority. As a result, the cases are not the esoteric high-tech dilemmas of the academic medical center but deal with fundamental problems that are pervasive in health-care delivery in the United States.

Instead of focusing on esoteric procedures such as organ transplantation, genetic engineering, or experimental protocols, this casebook deals with problems such as where to send a frail elderly patient who no longer seems able to care for herself but refuses to go to a nursing home, determining whether a patient has the mental capacity to make his own decisions regarding his treatment, what role the family should play in making a treatment decision when the choice made would greatly affect them, what a family should do when they suspect that their mother is not getting proper care, and what a hospital should do when it is getting "stuck" with too many unpaid bills. This kind of problem is the "stuff" of clinical ethics across most of the country, but only rarely does it provide the focus for ethics casebooks.

Given the recent changes in health-care delivery, it is no longer as useful to distinguish the lines between the community hospital and the academic medical center. During the years since the first few cases of the casebook were compiled, six of the contributing hospitals have either been purchased by or have formed a formal affiliation with a new integrated health-care system that has as its focus the academic teaching hospital. Thus, what was originally "outside the walls" of the academic health center is now inside or at least passes more fluidly between the institutions.

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