Correspondence
Correspondence Physicians' province Cleveland, Ohio To The Editors: My interest in the article entitled, "Diminishing Resources, Critical Choices," [March 8] turned to professional horror and...
...More recently, the same journal published a special report calling for medical ethics to be incorporated in the core of the medical school curriculum, and for the subject to be taught by both clinical specialists and ethicists, each complementing the other's knowledge...
...This power shift has happened as a result of the tremendous changes in financing health care, which has turned it into the nation's third largest industry, consuming 10.9 percent of the Gross National Product in 1984...
...I am hoping that administration can take a leadership role, as authorized by the legal governing agency, the boards of trustees, in assuring that the problems are formally addressed...
...Seiden's thesis...
...White has some questions as to what a health care ethicist is, and who, in fact, I am...
...Correspondence Physicians' province Cleveland, Ohio To The Editors: My interest in the article entitled, "Diminishing Resources, Critical Choices," [March 8] turned to professional horror and disbelief as I began to understand Ms...
...To the Editors: My thanks to Dr...
...For broad policy issues, the professional community must grapple with these questions with the larger community, through lay representatives on a hospital board, through the legislature, the courts, the clergy, and the whole range of organizations that represent the views of the larger society...
...Certainly, as The New England Journal of Medicine letter section pointed out recently, being a medical ethicist (and, apparently, this writer is a doctoral candidate for such a degree) raises the question as to what qualifications and background even these people have...
...DENA J. SEIDEN 17 May 1985: 319...
...Am I to believe that she truly feels that the responsibility for the moral and ethical decisions as far as patients are concerned should become the priority of hospital administrative staff...
...To have the audacity to want to rewrite and redesign the true responsibilities for patient care, in all of its dimensions, which historically, professionally, and even morally comprise a physician's relationship to and with a patient and family, really is mind boggling...
...allocating clinical resources...
...Health care ethicists are trained to work within that definition on matters relating to (a) the health of individuals and (b) the policies of the institutions that mediate health...
...Luke's-Roosevelt Hospital Center in New York City, as well as assistant administrator at Bel-levue Hospital and City Hospital Center at Elmhurst in Queens...
...First, I am not advocating that hospital administrators be allowed greater power over critical decisions affecting the patients within their institutions...
...Robert J. WHITE, m.d...
...All have major roles to play in forming moral standards in health care...
...I spend considerable amounts of my waking hours working on effective ways to bring the ethical issues inherent in modern day health care to the attention of the professional and larger community, and I would welcome correspondence from Dr...
...This is the appropriate province of the practicing physician...
...White for allowing me to clarify further some of the themes of my article...
...I could never advocate that ethical decision-making become the sole responsibility of any professional health group — administrator, physician, nurse, trustee, etc...
...As I see it, the responsibilities of health care administrators, like this woman with or without her "ethical degree,'' are to provide the resources, the agencies, and the know-how to guarantee the housing, equipment, and pharmacology to treat each and every American at an appropriate level of medical care...
...White mentions was in response to an article (Oct...
...The correspondence in The New England Journal of Medicine which Dr...
...The overall view I would advocate for relations between the public and the health professions is along the lines of a contractual model, urged by Robert Veatch in his book, A Theory of Medical Ethics...
...White on the subject...
...The moral and ethical dilemma that seems to be facing contemporary medicine is not new, in spite of the advances in biotechnology...
...11, 1984) by health ethicist, Dr...
...Health professionals cannot mandate their views, however altruistic, upon their patients...
...The central concern of my article is that this shift in power is not accompanied by a shift in the training and direction of health-care administrators, that would enable them to deal more fully with the ethical side of the budgetary/ policy decisions they are currently making, e.g...
...I have been studying for three years at Union Theological Seminary, concentrating in ethics, with adjunct work at the Columbia School of Public Health, and I plan to specialize in the ethics of health care administration, which I now teach at the Columbia School of Public Health...
...I also worked as an assistant director at the United Hospital Fund...
...However, the main reason I would never advocate that any health professional group control decision-making is my rather firm belief that all decisions in these matters must be made with the patient, and if appropriate, with the patient's family, for individual cases...
...I am merely noting the fact that this has already happened, as Paul Starr pointed out in his book, The Social Transformation of American Medicine...
...Ruth Purtillo, attempting to put limits on what can reasonably be expected from this new profession, and what are some necessary safeguards...
...The article argued that' 'every physician should have access to ethical consultations for his or her more difficult cases," so that ethical and (Continued on page 319) Commonweal: 292 Correspondence (Continued from page 292) philosophical concepts can be used with precision (January 24, 1985...
...Director of Neurosurgery Metropolitan General Hospital The author replies New York, N.Y...
...As to the former, I define ethics as the formal use of both reason and compassion to deal with conflicting and/or supplementing sets of values, with the goal of reaching a morally acceptable solution...
...As for myself, I have been assistant vice-president of St...
...My hope is to encourage dialogue within this newly empowered group, to allow the formulation of ethical parameters, and to change the training of administrators so that they may understand the impact their "business" decisions have on patients' lives and deaths and on physicians' ability to practice...
...Given this national dollar commitment, inevitably power has come to those who control the dollars (administrators) and those who wish them to control more tightly (the government and the insurers...
Vol. 112 • May 1985 • No. 10
