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National Ethics Teleconferences - Call Summaries
National Ethics Teleconferences (NET calls) provide education on selected topics in health care ethics and offer an opportunity for practitioners and others throughout VHA to discuss an important health care ethics issue. Summaries of recent NET calls are listed below. Summaries of earlier calls can be found on the Archives page.
To view a list of NET call summaries organized by ethics domain and topic click here.
Ethical Considerations for Resource Allocation in Health Care (May 27, 2009) [Word] (Audio not available)
The Interplay Between Patient Advocacy and Health Care Ethics (March 25, 2009) [Word] (Audio not available)
Ethical Considerations in the Report of a Work Group on Post Traumatic Stress Disorder (PTSD) and Vulnerable Populations in Research (February 25, 2009) [Word]
Moral Distress: How Can Ethics Consultants Respond? (November 25, 2008) [Word]
Special 75th Diamond Edition. NET Calls - Yesterday, Today, and Tomorrow (October 29, 2008) [Word]
Ethical Considerations in the use of Home Oxygen for Patients and/or Third Parties Who Smoke (July 30, 2008) [Word]
Ethics and the Discharge Process: What to Consider When a Patient Prefers a Plan that the Team Believes is Unsafe (May 28, 2008) [Word]
National Ethics Committee Report: Advance Directives for Mental Health: An Ethical Analysis of State Laws & Implications for VHA Policy (March 26, 2008) [Word]
Disclosure of Adverse Events to Patients: Ethical and Policy Requirements (February 26, 2008) [Word]
Strategies for Increasing Influenza Vaccination Rates in Health Care Workers: Ethical Considerations (January 30, 2008) [Word]
National MRSA (Methicillin-Resistant Staphylococcus Aureus) Initiative: Ethical Considerations in Implementation (October 2007) [Word]
National Ethics Committee Report - Impaired Driving in Older Adults: Ethical Challenges for Health Care Professionals (September 2007) [Word]
State-Authorized Portable Orders: Out of Hospital DNR Orders and Orders for Life-Sustaining Treatment (July 2007) [Word]
National Ethics Committee Report: Ethical Aspects of the Relationship between Clinicians & Surrogate Decision Makers (April 2007) [Word]
Advance Care Planning and Management of Advance Directives (March 2007) [Word]
IntegratedEthics Initiative: Ready to Launch (January 2007) [Word]
Informed Consent Practices: Lessons Learned from Implementing iMedConsent (November 2006) [Word]
Adverse Events and the Management of DNR Orders: Ethical Considerations (September 2006) [Word]
National Ethics Committee Report: The Ethics of Palliative Sedation as a Therapy of Last Resort (July 2006) [Word]
Influenza Pandemic Preparedness Planning: Ethics Concerns (June 2006) [Word]
Patients' Requests to Have Their Health Records Amended (May 2006) [Word]
Ethical Considerations of Cardiac Pacemakers and Implantable Defibrillators for End-of-Life Care (April 2006) [Word]
The Ethical Challenges of Coordinating Mental Health Care Between VHA and DoD (March 2006) [Word]
National Ethics Committee Report: Compensation to Health Care Professionals from the Pharmaceutical Industry (February 2006) [Word]
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Executive Summary and other resources
Title: Ethical Considerations in the Report of a Work Group on Post Traumatic Stress Disorder (PTSD) and Vulnerable Populations in Research
Link to NET Summary: Ethical Considerations in the Report of a Work Group on Post Traumatic Stress Disorder (PTSD) and Vulnerable Populations in Research (February 25, 2009) [Word]
Date: February 25, 2009
Domain: Ethical Practices in Research
Topic: Other -- Research Involving Patients with Post Traumatic Stress Disorder (PTSD)
Summary of Call:
The Secretary of the Department of Veterans Affairs (VA) charged the Work Group on PTSD and Vulnerable Populations to examine the tension between the need to study veterans with PTSD to help improve their condition and the need to protect veterans with PTSD from further risk, given their potential vulnerability as research participants.
Specifically, the Secretary of Veterans Affairs charged the Work Group to provide consensus recommendations to the Under Secretary for Health (USH) for the following questions:
1. Is it ever ethically permissible for VHA to support the conduct of research on veterans with PTSD?
2. Are veterans with a diagnosis of PTSD considered “vulnerable” for the purpose of applying guidelines for the protection of human subjects in research?
3. Should veterans with a diagnosis of PTSD be afforded special consideration and/or extra protections under VHA guidance to protect human subjects in research?
Take-home Points:
The Work Group reached the following primary conclusions:
1. It is not only ethically permissible for VHA to support the conduct of research involving veterans with PTSD, but VHA has an ethical obligation to do so.
2. As a group, veterans with PTSD are not categorically vulnerable and, therefore, do not require special protections in the form of new regulations, policy, or guidance.
3. Veterans with a diagnosis of PTSD should be afforded special consideration consistent with current regulation and policy if and when an IRB determines that these veterans have impaired decision-making capacity, an increased susceptibility to undue influence or coercion, or an increased susceptibility to the risks associated with a particular research study.
Faculty:
Kenneth Berkowitz, MD, FCCP*
Sherrie Hans, PhD*
Douglas Olsen, RN, PhD*
Joel Kupersmith, MD, Chief Research and Development Officer, Office of Research and Development
Charles Marmar, MD, Sierra, Director for PTSD Activities, Sierra Nevada Mental Illness Research, Education & Clinical Center
*National Center for Ethics in Health Care
Links to closely related Ethics Center and VHA materials:
Links to the PTSD Work Group Report: http://www.ethics.va.gov/docs/net/PTSD_Work_Group-Vulnerable_Populations-Research_20081001.PDF
Department of Veterans Affairs, Veterans Health Administration. VHA Directive 1058, Responsibilities of the Office of Research Oversight; 2008.
Department of Veterans Affairs, Veterans Health Administration. VHA Handbook 1200.05, Requirements for the Protection of Human Subjects in Research; 2008. This Veterans Health Administration (VHA) Handbook prescribes procedures for the protection of human subjects in Department of Veterans Affairs (VA) research.
References:*
Institute of Medicine. Treatment of posttraumatic stress disorder: An assessment of the evidence. Washington, DC: The National Academies Press; 2008. Concludes that well-designed research is needed to answer the key questions regarding the efficacy of treatment modalities in veterans.
Kipnis, K. Vulnerability in Research Subjects: A Bioethical Taxonomy. Ethical and Policy Issues in Research Involving Human Research Participants. Bethesda, MD: National Bioethics Advisory Commission; 2001. Describes a taxonomy of seven ways in which a person can be vulnerable. Last accessed on September 9, 2008 at: http://onlineethics.org/reseth/nbac/hkipnis.html
National Bioethics Advisory Commission. Research Involving Persons with Mental Disorders That May Affect Decisionmaking Capacity vol.1. Bethesda, MD: National Bioethics Advisory Commission; 1998. Considers how ethically acceptable research can be conducted with human subjects who suffer from mental disorders that may affect their decisionmaking capacity; whether, in this context, additional protections are needed; and, if so, what they should be and how they should be implemented. Last accessed on September 9, 2008, at http://bioethics.georgetown.edu/nbac/capacity/TOC.htm
Penslar RL. Protecting Human Research Subjects: Institutional Review Board Guidebook. Washington, DC: National Institutes of Health; 1993. Describes a wide range of individuals (e.g., elderly, severely ill, homosexual or bisexual, women, or minorities) who are considered potentially “vulnerable.” Uses the term “vulnerable” in a broad sense to include individuals, who while not categorically vulnerable, may be more susceptible to coercion or undue influence than other individuals in the context of a particular research study.
*Complete references may be accessed in the links provided above for the PTSD Work Group Report.
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Executive Summary and other resources
Title: Moral Distress: How Can Ethics Consultants Respond?
Link to NET Summary: Moral Distress: How Can Ethics Consultants Respond? (November 25, 2008) [Word]
Date: November 25, 2008
Domain: Ethical Practices in the Everyday Workplace
Topic: Ethical Climate
Summary of Call:
“Moral distress” has been described as painful feelings that result when a health care provider believes that he or she knows what the right thing to do is, but is prevented from doing the right thing. Internal barriers, such as the lack of power or understanding, and external barriers, such as a lack of time or administrative support, may prevent a provider from doing what he or she believes is the right thing.
Moral distress exacts a heavy toll, imposing psychological burdens on providers and threatening job satisfaction and retention. Moral distress can also affect patient care indirectly by affecting care providers.
This call describes several ethics scenarios that illustrate moral distress; looks at common features and ethical considerations that underlie moral distress; and outlines strategies that ethics consultants can use to address moral distress, including using the CASES approach to ethics consultation.
Take-home Points:
Several common features underlie moral distress: e.g., the decision being considered may involve life and death; questions of capacity may be involved; and there may have been a failure to negotiate and agree on goals of care, resulting in an uncertain or inconsistent care plan.
Several ethical considerations also underlie moral distress: e.g., a provider may feel that his/her values are compromised when asked to provide care that he/she believes is high burden and low benefit, or when the provider is asked to discharge a capable patient to an environment that the patient chooses, but the provider feels is unsafe.
By following the steps in the CASES approach, ethics consultants within VHA may address moral distress by providing: a forum for discussion and consistent practices for all parties involved in a distressing situation, a level playing field for all parties to the situation, and a “moral space” within which to discuss underlying ethical considerations.
Faculty:
Kenneth Berkowitz, MD, FCCP*
Barbara Chanko, RN, MBA*
Cynthia Gunnarson, RNC, MSN, Magnet Coordinator, North Chicago VAMC
Maureen Lavin, JD, MA student in Bioethics, University of Pennsylvania
*National Center for Ethics in Health Care
Links to closely related Ethics Center and VHA materials:“Ethics Consultation: Responding to Ethics Questions in Health Care.” This primer describes the ethics consultation function of IntegratedEthics, including a detailed description of CASES, a step-by-step approach to ethics consultation.
“Preventive Ethics: Addressing Ethics Quality Gaps on a Systems Level.” This primer describes the preventive ethics function of IntegratedEthics, including a detailed description of ISSUES, a step by step approach to addressing ethics issues on a systems level.
“Ethical Leadership: Fostering an Ethical Environment and Culture.” This primer describes the ethical leadership function of IntegratedEthics, including a detailed description of the four “compass” points of ethical leadership.
References:
Arras GJ. Doctors, Drugs, and Driving – Tort Liability for Patient-Caused Accidents. NEJM 2008: 521-525. Discusses recent court cases that limit the legal liability and help to clarify ethical responsibility of clinicians. If the physician does everything he or she can to ensure that a patient understands the potential risks of a given course of action, then the patient assumes ethical responsibility for his or her own choice(s).
Jameton A. Dilemmas of moral distress: moral responsibility and nursing practice. AWHONNS Clin Issues Perinat Womens Health Nurs. 1993;4(4):542-51. Nursing Practice: The Ethical Issues. Prentice-Hall Series in the Philosophy of Medicine. NJ: Prentice-Hall, 1984. Introduces the notion of “moral distress” within the nursing literature and distinguishes between moral distress, moral uncertainty and moral dilemmas.
Smith M, Paradis C. Professionals’ Moral Distress: A Neglected Dimension in Ethics Consultation. 2008 Annual Meeting of the American Society of Bioethics and Humanities. Provides examples of de-identified clinical scenarios in which clinicians reported moral distress; discusses common features and ethical considerations that underlie moral distress; and offers general strategies for addressing moral distress.
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Executive Summary and other resources
Title: Special 75th Diamond Edition: N ational Ethics Teleconferences (NET Calls) Yesterday, Today, and Tomorrow
Link to NET Summary: Special 75th Diamond Edition. NET Calls - Yesterday, Today, and Tomorrow (October 29, 2008) [Word]
Date: October 29, 2008
Domain: This NET call cuts across several ethics domains and topics.
Topic: This NET call cuts across several ethics domains and topics.
Summary of Call:
This call is the 75th in the National Ethics Teleconference (NET) Call series. The NET Call series has addressed a wide range of ethics concerns over the last 8 years, focusing on such topics as discharge to an environment that the team feels is unsafe; DNR orders; pandemic influenza preparedness; and IntegratedEthics structure and processes.
Using examples of past calls, this 75th call looks back and forward to illustrate the goals and scope of the NET Call series and to illustrate how the series tracks the evolution of ethics thinking within VA. Participation in the NET Call series helps those in the field be ahead of and part of the ethics curve within VA.
Take-home Points:
The main intent of the NET Calls series is to provide practical, useful, and relevant information on ethical issues that arise within VHA, and a forum to discuss them. Individual NET calls are responsive to ethics concerns that arise and are addressed in real time. The calls have not shied away from discussing controversial topics and allow participants to contribute to the evolution of ethics thinking within VHA.
The process of developing each NET call is dynamic and interactive, and involves collaboration with relevant VACO program office staff, outside content experts, and ethics resources from the field.
The NET Call series provides an opportunity for the Ethics Center to educate field staff about newly revised policies or those in revision and to answer questions from the field about implementation.
Faculty:
Ellen Fox, MD*
Kenneth Berkowitz, MD, FCCP*
Barbara Chanko, RN, MBA*
Susan Owen, PhD*
* National Center for Ethics in Health Care
Link to closely related Ethics Center and VHA materials:DNR FAQs
VHA Handbook 1004.1, “Informed Consent for Clinical Treatments and Procedures"
VHA Handbook 1004.2, “Advance Care Planning and the Management of Advance Directives”
VHA Handbook 1004.04, “State-Authorized Portable Orders”
VHA Directive 2006-021, “Reducing the Fire Hazard of Smoking When Oxygen Treatment is Expected”
References:
None
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Executive Summary and other resources
Title: Ethical Considerations in the Use of Home Oxygen for Patients and/or Third Parties Who Smoke
Link to NET Summary: Ethical Considerations in the use of Home Oxygen for Patients and/or Third Parties Who Smoke (July 30, 2008) [Word]
Date: July 30, 2008
Domain: Professionalism in Patient Care
Topic: Difficult Patients
Summary of Call:
This presentation describes the ethical challenges presented by patients who receive home oxygen therapy and continue to smoke. Practical guidance is offered about how to balance professional obligations to treat, patient’s rights, and safety interests of patients and others. Specific measures stated in the VA directive 2006-021” Reducing the Fire Hazard of Smoking When Oxygen Treatment is Expected” are reviewed.
Concrete recommendations regarding education, smoking cessation, and smoking restrictions are considered.
Take-home Points:
Long term oxygen therapy is the standard of care for treatment of hypoxemic patients with COPD and certain other patients. It improves survival and quality of life.
Risks associated with home oxygen use are small, but real.
Anxiety about risks may prompt caregivers to consider discontinuing treatment, although this is rarely justifiable and may contribute to requests for ethics consultation.
Education of patients, families, care providers, and contractors is essential to maximize smoking cessation, minimize safety risks, and respond in an open and consistent way to patients who continue to smoke.
VHA Directive 2006-021 outlines steps that should be taken to consult about high-risk patients who continue to smoke despite education and warnings.
Faculty:
Kenneth Berkowitz, MD, FCCP*
Barbara Chanko, RN, MBA*
Susan Owen, PhD*
* National Center for Ethics in Health Care
Link to closely related Ethics Center and VHA materials:
VHA Directive 2006-021, “Reducing the Fire Hazards of Smoking When Oxygen Treatment is Expected”
2004 report from the VA National Center for Patient Safety, “Selected Root Cause Analyses Topic: Fires and Oxygen Therapy”
References:
Clinical Practice Guidelines on Management of Tobacco Use and Dependence
Surgeon General's Report on Treating Tobacco Use
Edelman DA, Malekyo-Jacobs S, White MK, Lucas CE, Ledgerwood AM. Smoking and home oxygen therapy; a preventable public health hazard. Journal of Burn Care & Research 2007; 29: 119-122.
This study determined the number of patients admitted to the authors burn center from January 2004 through December 2005, also calculating patient demographics, outcomes, total charges, costs and reimbursement to the hospital. The authors found that counseling patients about the dangers of home oxygen use may not be effective, but emphasize that counseling regarding smoking cessation should happen at every physician visit if the patient smokes, regardless of whether the patient is on home oxygen.
Lacasse Y, LaForge J, Maltais F. Got a match? Home oxygen use in current smokers. Thorax 2006; 61:374-375.
In this editorial the authors discuss the controversy related to home oxygen therapy prescribed for smokers. They suggest three things to be considered when prescribing this therapy: first, the risks and benefits must be weighed; second, there must be a clear indication for its prescription; third, re-evaluation should be required when there is an acute exacerbation of COPD.
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Executive Summary and other resources
Title: The Interplay between Patient Advocacy and Health Care Ethics
Link to NET Summary: The Interplay Between Patient Advocacy and Health Care Ethics (March 25, 2009) [Word] (Audio not available)
Date: March 25, 2009
Domain: IntegratedEthics Program
Topic: Other – IntegratedEthics structure and processes
Summary of Call:
This call provides an overview of patient advocacy, the skills required of the patient advocate, and the role of the patient advocate within VHA.
The call also illustrates the connection between patient advocacy and health care ethics, focusing in particular on how patient advocacy contributes to and is supported by the IntegratedEthics initiative in VHA. Specifically, the call compares and contrasts the role of the patient advocate and the role of the ethics consultant in ethics consultation and describes the connection between the goals of patient advocacy and the goals of preventive ethics.
Take-home Points:
At VHA patients and families must have access to someone who will hear their concerns or complaints and respond to them in a timely manner. Patient advocates assume this role. Drawing on such skills as interviewing, careful listening, and mediation, the patient advocate acts on behalf of a patient, giving the patient a voice in situations where he or she might otherwise go unheard.
The professional skills of patient advocates and ethics consultants overlap and diverge. Both patient advocates and ethics consultants have process and interpersonal skills that enable them to communicate respect and empathy to involved parties and to facilitate consensus. However, ethics consultants also have additional ethics knowledge and skills that will enable them to clarify and analyze ethics questions brought to the local Ethics Consultation Service.
A patient advocate may participate in the Ethics Consultation Service, either in his or her professional role as a representative of a particular patient, or as a member of the Ethics Consultation Service itself. If the patient advocate is a member of the Ethics Consultation Service, he or she will not be advocating for a particular patient, but rather will share the goal of ethics consultation, which is to improve ethics quality in health care by facilitating the resolution of ethical concerns.
In addition to serving as members of the Ethics Consultation Service, patient advocates are also ideally suited to serve as members of the local Preventive Ethics Team, since they have been very involved at the systems and quality improvement level within VHA.
Faculty:
Kenneth Berkowitz, MD, FCCP*
Joan Van Riper, MS, RN, Director, National Veteran Service and Advocacy Program
Stephanie Krieg, MA Program in Health Advocacy, Sarah Lawrence College
*National Center for Ethics in Health Care
Links to closely related Ethics Center and VHA materials:
VHA Handbook 1003.4, VHA Patient Advocacy Program
This VHA Handbook provides guidance for establishing Patient Advocacy programs at VHA facilities and guidance to VHA staff in resolution of patient complaints and concerns. The Handbook outlines the requirements for utilization of patient complaints to facilitate system changes.
Patient Advocate Guidebook, September 2006
This Guidebook describes different roles that the patient advocate within VHA may be called upon to play: e.g., champions of patient’s rights; patient satisfaction managers; change facilitators and problem solvers; and public relations liaisons that represent the VHA both inside and outside the organization.
IntegratedEthics: Improving Ethics Quality in Health Care
This 13-page IntegratedEthics monograph provides an overview of the background and fundamental concepts and structures of IntegratedEthics.
References:
American Nurses Association. “Code of Ethics for Nurses with Interpretive Statement.” Washington, DC. 2005. Retrieved on August 12, 2008 from: http://nursingworld.org/ethics/code/protected_nwcoe813.htm#prov3
Describes how nurses might find themselves in a position where they fulfill the patient advocacy role: e.g., by striving to protect the health, safety and rights of the patient.
Bateman, Neil. Advocacy Skills for Health and Social Care Professionals, London: Jessica Kingsley Publishers. 2000 Chapters 2-6, pp. 45-113. Discusses some of the competencies needed to be an effective advocate, including being able to listen to the patient and advocate accurately on his or her behalf.
National Patient Safety Foundation
“The Role of the Patient Advocate: A Consumer Fact Sheet.” 2003
http://www.npsf.org/download/PatientAdvocate.pdf
Describes a patient advocate as someone who looks out for the best interests of the patient and helps the patient navigate a health care system which can often be confusing.
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Executive Summary and other resources
Title: Ethical Considerations for Resource Allocation in Health Care
Link to NET Summary: Ethical Considerations for Resource Allocation in Health Care (May 27, 2009) [Word] (Audio not available)
Date: May 27, 2009
Domain: Ethical Practices in Resource Allocation
Topic(s): Systems level (macroallocation) and Individual level (microallocation)
Summary of Call:
This call reviews the ethical underpinnings of resource allocation and identifies specific factors for ethics consultants and others to consider as they begin to develop frameworks for considering ethics concerns within the domain of ethical practices in resource allocation.
Within IntegratedEthics, the domain of ethical practices in resource allocation is defined as how well the facility demonstrates fairness in allocating resources across programs, services, and patients. At the systems level, macroallocation refers to how well the facility demonstrates fairness in allocating resources across programs and services. At the individual level, microallocation refers to how well the facility demonstrates fairness in allocating resources to individual patients and or staff.
The call describes concrete examples in which ethical conflict might arise at the intersection of macro- and microallocation, e.g., when decision-makers are faced with decisions regarding the welfare of individual patients, but within a context where the welfare of the group or population of patients is also important.
Finally, the call describes how the three functions of IntegratedEthics have tools and resources designed to improve processes needed for setting priorities and allocating resources.
Take-home Points:
The ethics literature discusses three general areas in which uncertainty or conflict about values may contribute to ethical conflict in health care resource allocation decisions: different definitions of the term “justice”; differing stakeholder goals; and lack of agreement on what constitutes basic health care services.
Justice understood as fairness or impartiality requires that we treat equals equally; in order to justify, from an ethical perspective, treating people differently, we must be able to identify morally relevant ways in which one person is different from another.
Distributive justice determines who should get what based on criteria deemed to be relevant (such as need, age, ability to pay, service-connection). Procedural justice evaluates fairness by examining the quality of the decision-making process (e.g., does it involve relevant stakeholders, has it weighed benefits and harms, is it transparent). Many times, when allocating limited resources in health care, distributive criteria conflict with one another and provide no formula about how to set priorities. That requires us to put the most weight on ensuring that the process for decision-making meets the standards for procedural justice and that decisions reached are explained in a respectful way to affected parties.
The Ethical Leadership Primer recommends that the process of practicing ethical decision making be: informed; participatory; values-based; beneficial; systems-focused; and reasonable. When faced with an ethical conflict or uncertainty about the values involved in a resource allocation decision, a leadership group should ask the following questions:
- What types of information does the group need to make an informed decision?
- Who should be involved in the decision?
- What values are at stake in the decision?
- What are the short and long term consequences of the decisions that are being considered?
- What, if any, underlying systems issues are causing or contribute to the ethical concern?
- How would the decision made look to an outsider?
Generally, VHA as a system has strong systemic practices and policies in place to protect and balance the interests of all parties in a fair process when making allocation decisions. What is not so well established is how competing interests are balanced for specific decisions. When ethics consultants and others within VHA confront ethical concerns about resource allocation, sound ethical processes and ethical analysis of specific circumstances through ethics consultation should help.
Faculty:
Kenneth Berkowitz, MD, FCCP*
Barbara Chanko, RN, MBA*
Ben Walton, PA-C, MMS, Detailee from West Palm Beach VAMC
*National Center for Ethics in Health Care
Links to closely related Ethics Center and VHA materials:
Ethical Leadership: Fostering an Ethical Environment & Culture. This primer describes the ethical leadership function of IntegratedEthics, including a detailed description of the four “compass” points of ethical leadership.
Pre-decisional Draft Guidance: “Meeting the Challenge of Pandemic Influenza: Ethical Guidance for VHA Leaders and Clinicians.” Among a number of resources that the National Center for Ethics has available as part of its Pandemic Influenza Ethics Initiative. The goal of the Initiative is to provide resources to support VHA leaders, clinicians, and staff for meeting the ethical challenges of hospital-based pandemic influenza planning and response.
IntegratedEthics: Improving Ethics Quality in Health Care. This 13-page IntegratedEthics monograph provides an overview of the background and fundamental concepts and structures of IntegratedEthics.
References:
Foglia MB, Pearlman RA, Bottrell MM, Altemose JA, Fox. "Ethical Challenges Within Veterans Administration Healthcare Facilities: Perspectives of Managers, Clinicians, Patients, and Ethics Committee Chairpersons.” Amer Journ of Bioethics. 2009 April; 9(4): 28-36. Characterizes ethical challenges in Veterans Administration (VA) facilities from the perspectives of managers, clinicians, patients, and ethics consultants. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges.
Foglia MB, Pearlman RA, Bottrell MM, Altemose JA, Fox. “Priority setting and the ethics of resource allocation within VA healthcare facilities: results of a survey." Organ Ethics. 2008 Fall-Winter; 4(2):83-96. Foglia MB, Pearlman RA, Bottrell MM, Altemose JA, Fox E. Identifies factors that influence How well a healthcare facility ensures fairness in the way it allocates its resources across programs and services. In this study, clinicians and managers alike identified the need for improvement in healthcare ethics practices related to resource allocation.
Jiwani B, Nathoo AN. “Tough Choices: The Ethics of Allocating Health Resources - Ethics and Resource Allocation: A Primer for Policy Makers.” Provincial Health Ethics Network, Alberta, Canada. 2002. Includes a discussion of the tests that decision-makers may use to help determine whether they have ensure fairness in designing an ethically justifiable policy for the allocation of resources.
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