Ethics and Trusteeship for Health Care: Hospital Board Service in Turbulent Times The slides presented here are drawn from a research project conducted by The Hastings Center and The New York Academy of Medicine Project Staff Bruce Jennings MA, Project Co-Director (The Hastings Center)
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The slides presented here are drawn from a research project conducted by
The Hastings Center
The New York Academy of Medicine
For further information contact
The Hastings Center
Garrison, New York 10524
Parallel virtues, which apply to moral agents
Derive from the basic human and social ends served by a role
Principles state general moral duties
Complex roles usually encompass more than one principle
Principles may conflict
Principles provide guidance, not absolute answersThe Uses of Ethical Principles
Principles are not static of a role
Principles need to be applied to specific circumstances
Principles may conflict in given circumstances
Moral values and ends are plural, so principles may point in more than one direction
Principles require interpretationApplying Ethical Principles
Trustees should use their authority and best efforts justly to promote the integrity and fulfillment of the mission of the not-for-profit organization, and to keep that mission alive by interpreting its meaning over time in light of changing circumstances.
Trustees should ensure that high quality health care is provided to patients in an effective and ethically appropriate manner.
Trustees should govern hospital policy and deploy hospital resources in ways that enhance health and quality of life in the broader community that the hospital serves.
Trustees should sustain and enhance the integrity of the hospital as an institution, as an effective organization for the delivery of high quality health care services, and as a moral community of caregiving.
Bradford H. Gray, Ph.D.
Linda Weiss, Ph.D.
The New York Academy of Medicine
“Trustees have a fiduciary responsibility to make sure resources given to the hospital are used properly. We represent the community in assuming this responsibility.” (Trustee, urban hospital)
“We hold the hospital in trust for the community”
(Chair, community hospital)
“We have a responsibility to the community to maintain the hospital so that it can effectively meet the needs of the community. If the hospital isn’t strong, then it’s not doing its job for the community.” (Chair, urban hospital)
“Trustees are to support and uphold the mission of the institution. To make sure we are following what the mission is and doing it in a way that is financially responsible.” (CEO, teaching hospital)
“…to ensure that the mission is carried out in a compassionate manner. (Trustee, teaching hospital)
“…to develop and ratify the mission for the institution and to oversee the fulfillment of the mission” (CEO, community hospital)
Trustees should “ensure that the hospital provides ethical and appropriate services” (Chair, urban hospital)
Trustees should “make sure the hospital is fiscally and socially responsible…” (Trustee, major teaching hospital)
“Well of course, ultimately [we’re] responsible for everything that happens at the institution. As a practical matter, the [trustee’s] primary responsibility is to ensure that to the best of his ability – his or her ability – that the systems and procedures are in place to ensure that the care delivered is of the highest quality and that it is delivered in a financially responsible manner. And much flows from that” (Chair, teaching hospital)
“[The board’s job] is to select the CEO and monitor his performance, to ratify his decisions, change his mind, or replace him. If too much is done by trustees regarding running the organization, it brings mediocrity.” (Trustee, urban teaching hospital)
“We’re not running the hospital. We’re setting the board policy under which people that we chose are running the hospital. If we get unhappy with the way the hospital is run, then we get a new CEO.” (Chair, teaching hospital)
The Question We Asked:
“Of the issues your board has considered in recent years, are there any you think of as ethical issues?”
Most common response?
“It looks like we will be doing a full asset merger with [two other hospitals]. Mission compatibility is our primary concern; we exist to serve a very needy population. (CEO, urban community hospital)
“Ethics are implicitly discussed in terms of our commitment to the community and how to maintain it. Questions include who is going to own the hospital and how to protect community control of the institution. (CEO, urban community hospital)
“Ethical issues? I think of them primarily as survival issues. But maybe ethical is “what is our responsibility to the community?” That was certainly our decision to go ahead with the [deal to help another hospital].” (Chair, urban community hospital)
“The merger with a Catholic hospital presented a number of ethical issues. The agreement calls for us not to be governed by the ethical and religious directives of the Catholic Church. But there was a lot of discussion about how the community would respond to a relationship with a Catholic facility and whether there would be any indirect influence to do things that we would not normally do or restrict things that we would not normally restrict. And what it will mean for us in the long run and the short run.” (CEO, non-urban community hospital)
“Probably every issue we face has an ethical aspect. If we weren’t cognizant of the fact that we represent the community and the delivery of health care needs that it expects and requires, then our ethical responsibility would require it…If we make decisions improperly or without proper information in effect we’ve hurt these people in terms of access, quality, and comfort ability of receiving care, and then ethically have not begun to do our responsibility as trustees of health.” (Trustee, Non-urban community hospital)
“I think every issue we deal with is an ethical issue. If you’re adopting a budget, that’s and ethical issue. How much money do you allocate to the emergency room? How much money is available for unreimbursed care? How do you take care of the uninsured? When do you decide you’re going to let some people go, those are ethical decisions. I think it’s hard to separate out ethics from any decision facing a board today in any hospital. We’re literally dealing with the most fundamental ethical issues that we have. Care for the sick and needy. I don’t know how you can get more fundamental than that. There are other ethical issues that have to be addressed. Do you treat people differently because they can pay? Do you treat people differently because they’re on Medicaid as opposed to private insurance? I can tell you from the very beginning, [this hospital] has always been committed to one level of care” (Trustee, urban community hospital)